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Most people have received vitamin prescriptions from a physician at least once, while some health influencers on platforms like Instagram suggest taking numerous bottles of nutritional supplements. However, is this always necessary when there are alternative approaches, such as adjusting one’s diet, that can help prevent health problems?
What exactly are vitamins, and why should we care about them?
- Vitamin A
- Vitamin B1
- Vitamin B2
- Vitamin B3
- Vitamin B5
- Vitamin B6
- Vitamin B7
- Vitamin B9
- Vitamin B12
- Vitamin C
- Vitamin D
- Vitamin E
- Vitamin K
Vitamins, essential for our well-being and growth, are a group of organic compounds, and there are thirteen of them that your body needs. These vitamins play a crucial role in supporting enzymes, which are proteins that speed up chemical reactions in your body. Some vitamins, like Vitamin B6, can even take charge of these chemical reactions on their own.
Without vitamins, your body can’t operate at its best. It requires just the right amount of these nutrients to keep all its reactions running smoothly. When vitamins are lacking, chemical processes slow down or come to a halt. For example, if a child doesn’t get enough vitamin A, their vision can deteriorate, and they risk going blind because the production of a visual pigment called rhodopsin gets disrupted.
However, it’s important to note that taking excessive dietary supplements can lead to too much of a good thing and result in unwanted side effects. For instance, an excess of vitamin A can become toxic when it accumulates in the liver.
Vitamins are classified into two main types: fat-soluble (vitamin A, D, E, and K) and water-soluble (vitamin B and vitamin C). The fat-soluble ones are stored in the liver and fatty tissues and aren’t easily destroyed by cooking. On the other hand, the water-soluble vitamins are more delicate and can be destroyed by cooking or exposure to bright light.
Vitamins can be taken in the form of pills or capsules, but they primarily address deficiencies related to specific vitamins. They aren’t effective in treating diseases that aren’t related to a lack of a particular vitamin.
Your vitamin needs can vary depending on your gender, age, and health condition. The daily vitamin intake recommendations differ from country to country and are based on nutritional factors and regional differences. The World Health Organization (WHO) guidelines serve as the foundation for these recommendations.
Vitamins are measured using three units: milligrams (mg), micrograms (mcg), and international units (IU) for some vitamins. Medical professionals use international units to standardize prescriptions. The IU value of a vitamin depends on its activity in the body, and each vitamin has its own unique value. For instance, Vitamin D is equivalent to 0.025 mcg, while Vitamin C is represented as 50 mcg.
Vitamin A
Vitamin A is a fat-soluble vitamin that comes in two varieties: beta-carotene and retinol. Beta-carotene is a type of vitamin A precursor naturally occurring in plant-based foods, which your body can convert into the active form. In contrast, retinol is a form of vitamin A found in animal products and supplements, readily available for immediate use.
What are some Vitamin A-rich foods?
Diets can benefit from various sources of Vitamin A, such as egg yolks, milk, liver, cheese, and butter. Additionally, you can get your Vitamin A fix from fruits and vegetables containing beta-carotene, like spinach, carrots, zucchini, corn, mangoes, and papaya.
How much Vitamin A should you aim for daily?
When it comes to beta-carotene, the recommended daily intake is 5 mg, with no specific guidelines for children. It’s worth noting that 1 microgram of Vitamin A is approximately equal to 6 micrograms of beta-carotene. For adults, the recommended daily dose is 900 micrograms of Vitamin A.
What happens if you don’t get enough Vitamin A?
Vitamin A plays a crucial role in the production of rhodopsin, a vital protein for vision. Inadequate Vitamin A intake can lead to vision issues, ranging from chronic eye dryness (xerophthalmia) to difficulty seeing in low light conditions (night blindness). In severe cases, like those who have faced lifelong malnutrition, a deficiency in retinol can even result in complete blindness.
Moreover, children with a deficiency in Vitamin A can encounter issues like slowed bone growth and weakened immune systems, which make them more vulnerable to illnesses.
It’s worth noting that severe Vitamin A deficiency is generally not a concern in developed countries. This deficiency is primarily observed in regions with limited resources, such as Pakistan, Bangladesh, and Sri Lanka. Furthermore, individuals with conditions like celiac disease, cystic fibrosis, and certain rare diseases may also face difficulties in absorbing vitamin A.
What are the signs of Vitamin A overdose?
In urban areas, excess rather than deficiency of vitamin A is often the problem. Vitamin A toxicity can manifest as acute, chronic, or teratogenic (causing birth defects in pregnant women) poisoning.
Acute vitamin A poisoning: This occurs when an individual takes a single dose of 660,000 IU of vitamin A. Symptoms can include nausea, vomiting, dizziness, and blurred vision.
Chronic vitamin A poisoning: Chronic poisoning arises from ingesting more than ten times the daily recommended amount of retinol (30,000 IU) for over a month, which can result from both supplements and a diet rich in vitamin A. Symptoms may include impaired coordination, hair loss, elevated blood lipids, bone and muscle pain, vision problems, liver complications, and more.
Long-term excessive intake of vitamin A, even in doses exceeding 1500 IU per day, can lead to brittle bones, particularly in elderly individuals, especially older women who are at a higher risk of osteoporosis. Those who regularly consume liver-based meals should exercise caution when considering vitamin A supplements.
Teratogenic vitamin A poisoning: Teratogenic poisoning often occurs during the first trimester of pregnancy and can lead to miscarriages or the birth of babies with heart defects or other abnormalities with doses as low as 10,000 IU. Vitamin A should only be taken during pregnancy if prescribed by a medical professional.
Notably, consuming substantial amounts of beta-carotene is generally not a cause for concern, as the body effectively regulates retinol synthesis and will not convert processed food into vitamin A unless it is needed. People who consume a diet rich in carotene-containing plant foods may develop slightly yellowish skin due to beta-carotene accumulation, which has a bright orange color. This is usually harmless but may appear unusual.
Which Health Conditions Require Vitamin A Supplements?
Doctors frequently prescribe Vitamin A supplements for specific cases, including premature infants and individuals with cystic fibrosis. In these situations, the prescribed doses often exceed the recommended daily intake. Moreover, certain forms of Vitamin A supplements may be recommended for addressing skin issues like psoriasis or hyperpigmentation. However, the exact dosages are determined on an individual basis by the physician.
It’s important to note that healthy adults, pregnant and breastfeeding women, as well as infants and children who maintain a balanced diet typically do not require additional Vitamin A supplementation. In such cases, taking supplements does not offer any added health benefits.
Is a Vitamin A Test Necessary?
Typically, a doctor can assess Vitamin A deficiency or excess through clinical observation and discussions with the patient. This is because a blood test for Vitamin A may not always accurately indicate its deficiency or excess. When there’s an excess of retinol, the body stores it in the liver, and in cases of deficiency, Vitamin A is sourced from the liver. In either scenario, the blood level of Vitamin A remains within normal ranges.
A Vitamin A blood test is typically only ordered by a physician when you have been prescribed additional Vitamin A supplementation. These tests serve to monitor the levels of retinol in your bloodstream and to prevent any potential risk of poisoning.
Reference Range
| Concentration in μmol / L | Age |
|---|---|
| 0.7-1.5 | 1-6 |
| 0.91-1.71 | 7-12 |
| 0.91-2.51 | 13-19 |
| 1.05-2.09 | >19 |
Safe Vitamin A Supplementation
Consulting with a physician before taking Vitamin A supplements is crucial. Generally, taking Vitamin A alongside Vitamin C is considered safe. In the past, it was recommended to take Vitamins A, C, and E together for preventing cardiovascular and certain types of cancer, but this advice has been removed from clinical guidelines due to a lack of scientific evidence.
Regarding Incompatible Combinations with Vitamin A
Although there is limited information on incompatible combinations with Vitamin A from reliable international sources, some studies in mice have suggested that Vitamin E may interfere with the absorption of Vitamin A, and conversely, Vitamin A can affect the absorption of Vitamin K. Additionally, there are 19 drugs known to interact with Vitamin A, so it is vital to discuss your Vitamin A consumption with a healthcare professional to ensure its safety and efficacy.
Vitamin B1 (Thiamine)
Vitamin B1, commonly known as thiamine, is one of eight water-soluble vitamins that play a crucial role in supporting various enzyme functions, particularly those involved in processing food for energy within the body.
Thiamine serves two essential purposes: firstly, it aids in converting carbohydrates into energy, and secondly, it plays a vital role in transmitting nerve impulses.
You can find significant amounts of thiamine in foods like yeast, legumes, pork, and whole-grain cereals. It’s worth noting that thiamine is present in the outer layer of grains, such as rice, but is typically lost during the milling process. Unfortunately, cooking and preservation methods can also lead to thiamine degradation, resulting in its absence in items like whole-grain bread and pork stew.
Recommended Daily Thiamine Intake
For adults, the recommended daily intake of thiamine is 1.5 mg (equivalent to 500 IU), while children require a range of 0.3-1.5 mg (100-500 IU) to meet their nutritional needs.
Thiamine Deficiency
A deficiency in vitamin B1, also known as thiamine, is commonly observed in individuals, both adults and children, from disadvantaged backgrounds who predominantly consume refined grains and milled rice. Additionally, thiamine deficiency can affect individuals with genetic disorders and chronic alcoholism, as these conditions can impede thiamine absorption.
Thiamine deficiency may also occur in people with obesity, those receiving parenteral nutrition, and individuals with severe type 1 and 2 diabetes. High levels of blood sugar can lead to increased thiamine excretion in urine. This deficiency can result in a condition known as “beriberi,” characterized by severe weakness and the potential for peripheral nerve damage, which can lead to a loss of mobility and, in severe cases, complete paralysis. Other symptoms may include heart problems, swelling, confusion, and nystagmus, particularly in alcoholics. If left untreated, beriberi can lead to brain damage and, in some cases, even death.
Excessive Thiamine
It’s important to note that excess thiamine doesn’t accumulate in the body and is excreted through urine, which makes thiamine toxicity unlikely.
When Thiamine is Prescribed
Large doses of Vitamin B1 are prescribed for treating beriberi, managing chronic alcoholism, and addressing certain hereditary diseases.
Lab Tests for Thiamine
Thiamine treatment is generally considered safe and is often prescribed without the need for lab tests. Improvement in a patient’s symptoms usually confirms the diagnosis, and blood level testing for thiamine is not routinely performed.
Combining Thiamine With Other Vitamins
Authoritative sources do not widely provide information on combining Vitamin B1 with other vitamins. This is likely because people can typically obtain sufficient Vitamin B1 from their diet without requiring supplements.
Vitamin B2 (Riboflavin)
Riboflavin is a member of the flavin group, essential for vital chemical processes within our body’s cells, including red blood cells. In simpler terms, riboflavin plays a crucial role in enabling us to breathe and properly digest proteins and carbohydrates. It also contributes to the health of mucous membranes, like the ones in our mouth.
Where to get riboflavin
You can find riboflavin in everyday foods like milk, eggs, meat, fish, liver, cheese, leafy greens, yeast, and legumes.
Recommended Daily Intake
For adults, it’s recommended to have a daily intake of 1.8 mg (equivalent to 720 IU), while children’s requirements vary between 0.4 to 1.8 mg (160-720 IU).
Lack of Riboflavin
A deficiency in riboflavin often occurs in individuals who are deficient in other B-vitamins. Identifying symptoms specifically related to riboflavin deficiency can be challenging. This condition is called ariboflavinosis and its symptoms include pale skin, a sore throat, painful cracks at the corners of the mouth and on the lips, a purple tongue, and itchy red patches on the eyelids, ears, nose, and genital area. If left untreated, it may lead to anemia, resulting in a reduced number of red blood cells or hemoglobin levels, which in turn leads to insufficient oxygen supply to the body’s organs.
Excessive Riboflavin
The good news is that excess riboflavin is easily excreted through urine, making it unlikely to cause any adverse side effects.
Treatment for Health-Related Riboflavin Issues
In cases where individuals are malnourished, have conditions like anorexia nervosa, difficulty absorbing the vitamin due to factors such as celiac disease, short bowel syndrome, cancer, or rare metabolic disorders like Brown’s syndrome, riboflavin injections may be prescribed. Additionally, people who avoid dairy products or are on antiretroviral drugs for HIV may benefit from additional riboflavin. The specific dosage and form of the vitamin should be determined by a healthcare professional.
Supplements for Healthy Individuals
Generally, healthy people do not require vitamin B2 supplements. However, based on British clinical findings, adolescents and young women who do not obtain sufficient riboflavin from their diet may find it beneficial to take a small daily dose of 1-2 mg (equivalent to 400-800 IU).
Diagnostic Testing
Riboflavin deficiency is typically diagnosed based on clinical symptoms. In some instances, a test measuring the activity of the enzyme glutathione reductase in red blood cells may be ordered to confirm the diagnosis. An enzyme activity result exceeding 1.4 is an indicator of riboflavin deficiency.
Vitamin B3 (Niacin)
Niacin serves a crucial role in the processing of carbohydrates, fatty acids, and proteins in our bodies. It is present in various foods, including liver, meat, whole grains, and legumes. Interestingly, individuals who consume more than 100 grams of protein daily can produce niacin in their bodies by utilizing the amino acid tryptophan found in the foods they eat.
Recommended Daily Niacin Intake
When determining niacin intake, we consider not just the caloric value but also the “niacin equivalent” (NE). One NE is equivalent to 1 milligram of niacin or 60 milligrams of tryptophan. Given that different foods contain varying amounts of this amino acid, specialized tables are necessary for accurate calculations.
For adults, the recommended daily niacin intake is 20 milligrams (or 20 NE niacin, which is equivalent to 1200 NE tryptophan). Children, on the other hand, should consume 5-20 milligrams (or 5-20 NE niacin, equivalent to 300-1200 NE tryptophan).
Signs of Niacin Deficiency
A severe deficiency of niacin results in a condition known as pellagra, derived from the Italian term meaning “rough skin.” Pellagra causes the skin to become excessively sensitive to ultraviolet light, potentially leading to pigmented dermatitis with itchy, bright red patches on the face or neck. Additionally, individuals suffering from pellagra may experience diarrhea and neurological issues. Left untreated, pellagra can progress to dementia and, in severe cases, lead to fatality. Fortunately, pellagra is extremely rare among individuals with a balanced diet.
Vitamin B3 (Niacin) Overdose
Excessive intake of Vitamin B3 (Niacin) can lead to uncomfortable side effects, such as hot flashes, as well as nausea, vomiting, itching, and hives. When taken in high doses, especially exceeding 3000 milligrams per day, it can result in muscle issues, liver complications, and an elevated level of uric acid in the blood. This is a crucial consideration for individuals with gout, who should only use Vitamin B3 under the close supervision of a medical professional.
Certain individuals, like those grappling with alcoholism, anorexia nervosa, small intestine disorders, or complications from weight loss surgery, may struggle to absorb Niacin. In some cases, genetic conditions can also prevent the conversion of Tryptophan into Niacin. In these scenarios, a doctor may prescribe Vitamin B3 supplements, with the dosage determined on a case-by-case basis.
While Niacin has shown promise in lowering “bad” cholesterol levels in the blood, its use as a treatment for atherosclerosis has been largely abandoned due to concerns about its effectiveness and side effects.
Generally, individuals who are healthy and well-nourished do not require additional vitamin B3. Routine tests for niacin levels are seldom necessary. However, if there is a need to assess niacin levels, a urine test can be employed to detect its breakdown products. There is no specific standard for niacin levels. The most reliable way to obtain niacin is through food, which is considered the safest approach. Foods contain relatively modest amounts of the vitamin, so even those who consume substantial quantities of protein-rich foods like meat, liver, or legumes are unlikely to exceed normal levels of vitamin B3.
Vitamin B5 (Pantothenic acid)
Vitamin B5 plays a crucial role in the proper functioning of around 4% of all enzymes in the human body. Most of these enzymes are involved in energy production, while some contribute to the production of hormones and hemoglobin.
Sources
You can get your dose of Vitamin B5 from a variety of foods, such as chicken, beef, egg yolks, potatoes, tomatoes, broccoli, and whole grains. However, it’s important to note that cooking can reduce the vitamin’s content by 20-80%. The longer and hotter the cooking process, the less pantothenic acid remains in your meal. Additionally, it’s worth mentioning that our gut bacteria can also produce this vitamin.
Recommended Daily Intake: For adults, a daily intake of 5 mg is recommended, while children should aim for 1.0-5 mg. Unlike some vitamins, there is no standardized measurement for Vitamin B5 in IU (International Units).
Deficiency of Pantothenic Acid: A deficiency of Vitamin B5 is rare because it’s present in many common foods. It typically only occurs during severe food shortages or famines. In cases of deficiency, individuals might experience symptoms like extreme fatigue and a burning sensation in their feet, which can lead to neurological problems.
Excess Pantothenic Acid: The body effectively eliminates excess pantothenic acid through urine, preventing it from accumulating to harmful levels.
Disease Prevention with Vitamin B5: Maintaining a balanced and nutritious diet is the best way to prevent hunger and related nutrient deficiencies. Supplements or injections of Vitamin B5 are not usually recommended for those dealing with malnutrition.
Diagnostic Tests: Testing for Vitamin B5 is not a common practice. In some instances, people recovering from severe malnutrition in a clinical setting might be tested for excessive pantothenic acid through urine analysis. If the urine contains less than 1 mg of pantothenic acid, it suggests that the individual is not consuming enough food.
Blood Measurement: There is no specific blood test available to measure Vitamin B5 levels, which is why there are no established standard levels for it in the bloodstream.
Vitamin B6
Vitamin B6 is a crucial nutrient that plays a vital role in the proper functioning of various enzymes, including those that regulate cell division. A deficiency in this vitamin can impact the body’s ability to generate new red blood cells and immune cells.
Where to Find Vitamin B6
Vitamin B6 comes in three different forms – pyridoxine, pyridoxamine, and pyridoxal. You can find pyridoxine and pyridoxamine mainly in fresh vegetables and nuts, while pyridoxal is abundant in meat. However, it’s worth noting that cooking and long-term storage of these foods can lead to the loss of 10-50% of the vitamin’s potency.
Recommended Daily Intake: For adults, the recommended daily intake of vitamin B6 is 2 mg, while children should consume between 0.4 to 2 mg. It’s important to note that IU (International Units) are not used to measure vitamin B6.
Potential Consequences of Vitamin B6 Deficiency: A deficiency in vitamin B6 is relatively rare, as it’s present in many common foods. However, it can occur in severe cases of protein malnutrition or if a person relies heavily on processed foods instead of fresh vegetables and meat.
Common Causes of Vitamin B6 Deficiency: Vitamin B6 deficiency can be triggered by various factors, including impaired absorption of food in the intestines, loss of the vitamin during hemodialysis, severe alcoholism, and hereditary disorders related to pyridoxine metabolism. Certain medications like anticonvulsants, antibiotics, and pain relievers can also lead to a deficiency.
Recognizing the Signs of Vitamin B6 Deficiency: Symptoms of a vitamin B6 deficiency may include scalp dandruff, a flaky red rash on the body, numbness in the arms and legs, and tingling sensations. In severe cases, individuals may experience a red and sore tongue, cracks in the corners of the mouth, and potentially develop anemia or suffer from convulsions.
Potential Risks of Excessive Vitamin B6: Accumulating too much vitamin B6 can occur if high-dose supplements, typically around 250 mg per day, are consumed over several months or years. Excess intake can result in symptoms similar to a deficiency, such as skin rashes, irritation, dizziness, nausea, and limb tingling.
When and How to Use Vitamin B6 Supplements: Vitamin B6 supplements are primarily prescribed for individuals taking medications that deplete the body’s supply of pyridoxine compounds. The appropriate dosage is determined by a physician. For others, healthcare professionals often recommend adjusting their diet by incorporating more vegetables, fruits, and home-cooked meat products.
Diagnostic Information: While a blood test for pyridoxine is available, it is usually not necessary for most individuals. Diagnosis is typically based on observable symptoms. The reference range for men is 27-75 nmol/l, and for women, it’s 26-93 nmol/l. Vitamin B6 supplements should be taken with food, and there is no need for additional intake for individuals without specific medical conditions.
Vitamin B7 (Biotin)
Function: Biotin, also known as Vitamin B7, plays a vital yet mysterious role in our body’s functions. What we do know is that it assists enzymes involved in the production of glucose and fatty acids.
Food Sources: You can find biotin in a variety of foods, with liver, egg yolk, soy products, and yeast being particularly rich sources.
Recommended Daily Intake: For adults, a daily dose of 50 micrograms (mcg) of Vitamin B7 is advised, while children should aim for 10-50 mcg. We don’t typically measure biotin in International Units (IU).
Shortages and Their Effects: Biotin deficiencies are quite rare and are often linked to consuming raw eggs regularly, as the egg whites contain avidin, which interferes with biotin absorption. People on parenteral nutrition and those lacking certain essential enzymes like biotinidase may also experience biotin shortages. Symptoms of deficiency may include skin issues around the eyes, nose, and mouth, conjunctivitis, weight loss, nausea, muscle pain, hair loss, and various neurological symptoms, from hallucinations to drowsiness.
Excess and Its Consequences: The good news is that Vitamin B7 is not harmful in excess. Any surplus is excreted in the urine.
Prescription: Vitamin B7 supplements are typically recommended for individuals who lack the necessary enzymes for biotin metabolism. Some cosmetic companies claim that biotin supplements enhance skin, nail, and hair health, but there’s no solid scientific evidence supporting these claims.
Lab Tests: Blood tests to measure biotin levels are seldom necessary and are usually conducted to confirm a biotin deficiency due to enzyme-related issues.
Healthy Blood Levels: The normal blood range for biotin levels in both men and women typically falls around 1500 picomoles per liter (pmol/L).
Vitamin B9 (Folic acid)
Function: Vitamin B9, also known as folic acid, plays a pivotal role in supporting cell division and protein synthesis. It’s particularly crucial for women who are planning to become pregnant because it’s essential for the formation of the neural tube during the first month of pregnancy. This tube eventually gives rise to the brain and spinal cord.
Sources: You can find folate compounds in a variety of foods such as spinach, fruits, legumes, peas, nuts, liver, eggs, and milk. Notably, animal products have a higher absorption rate of vitamin B9 compared to plant-based sources. It’s also important to note that prolonged cooking can lead to a breakdown of folate, so foods that are boiled, stewed, or canned tend to have lower vitamin B9 levels compared to their raw counterparts.
Recommended Intake: For adults, a daily intake of 400 micrograms (mcg) is advised, while children should aim for 50-400 mcg. International Units (IU) are not typically used to measure vitamin B9.
Shortages and Their Effects: In generally healthy adults with a balanced diet, vitamin B9 deficiency is rare. However, it can be more common in individuals who have alcoholism, anorexia, celiac disease, or certain hereditary conditions that impact folate digestion. Medications like metformin, which hinder vitamin B9 absorption, can also lead to a deficiency.
Vitamin B9 deficiency often overlaps with a deficiency in vitamin B12, making it challenging to distinguish between them. A shortage of either B12 or B9 can result in symptoms reminiscent of beriberi disease.
For those lacking these vitamins, red blood cells can be rapidly destroyed, potentially causing anemia over time. In severe cases of vitamin B9 deficiency, the skin may take on a yellowish hue due to the liver’s inability to process increased pigment levels in the bloodstream.
Anemia is the primary symptom of vitamin B9 deficiency, whereas a deficiency in vitamin B12 can also lead to neurological issues, including sensitivity problems, pain, tingling in the hands and feet, and difficulties with balance when walking.
Pregnant and lactating women, individuals with hemolytic anemia and dermatitis, and patients undergoing hemodialysis may also experience a deficiency in folic acid, which can negatively impact fetal development and worsen underlying health conditions, even if symptoms are not immediately evident.
Folic acid is generally non-toxic, and there have been no reported cases of poisoning even with high doses. Individuals with chronic hemolytic anemia and dermatitis may be prescribed a folic acid supplement, often up to 1 milligram (mg) per day. Women preparing for pregnancy are advised to consume a diet rich in meat, fresh vegetables, and fruits while taking a daily 400 mcg folic acid supplement for at least 12 weeks before conception. In certain situations, a doctor may recommend even higher doses of folate, up to 4 mg, if a woman has previously had children with congenital nervous system disorders. Starting vitamin B9 supplementation 1-3 months prior to planned pregnancy is essential, as the body can only store 5-10 mg of the vitamin, which may be sufficient for maternal needs but not necessarily for the developing child.
The neural tube, a critical structure that takes shape between days 21 and 28 of pregnancy, can sometimes fail to close properly when there’s a deficiency of vitamin B9. This incomplete closure can lead to gaps in the spinal cord, potentially resulting in malformations. That’s why it’s advisable for pregnant women to ensure they’re getting enough vitamin B9 even when they’re in the pre-conception stage. Often, women may not yet be aware of their pregnancy during this period. While not taking folic acid during pregnancy doesn’t necessarily lead to a high risk of congenital disorders, especially if the mother has a diet rich in fresh vegetables, it’s a precaution worth taking. In Europe, the occurrence of neural tube defects in newborns is typically low, with fewer than 10 cases per 10,000 births. It’s important to note that folic acid supplements don’t offer significant benefits to individuals with a well-balanced diet, and they don’t provide protection against heart disease, stroke, or cancer.
Diagnosis: To uncover the root cause of anemia, healthcare professionals often order blood tests to assess levels of vitamins B9 and B12. It’s worth noting, however, that testing for serum vitamin B9 is not recommended for pregnant women. This is because it doesn’t provide an accurate reflection of the body’s folate levels and can’t predict potential issues with nervous system development. The established reference range for vitamin B9 levels in the blood is 7 nanomoles per liter (nmol/L) or higher. If these levels fall below this range, a deficiency in vitamin B9 may be suspected as the cause of anemia.
It’s crucial to ensure that vitamin B12 levels are sufficient before considering folic acid supplementation. A deficiency in vitamin B12 can lead to persistent nervous system problems, even if the anemia is treated. That’s why healthcare providers often prescribe both vitamins B9 and B12 in combination to address these concerns.
Vitamin B12 (Cobalamin)
Vitamin B12 plays a vital role in our bodies by assisting in the formation of DNA and RNA, aiding enzymes in converting food into energy, improving the absorption of folic acid, and supporting cell division, especially in blood cells like red blood cells, white blood cells, and platelets. You can find the main sources of Vitamin B12 in animal products, such as seafood, meat, liver, dairy products, cheese, and eggs. Interestingly, seaweed is the only plant-based food that contains a small amount of Vitamin B12.
For adults, the recommended daily intake of Vitamin B12 is 3 micrograms (mcg), while children should get between 0.3 to 3.0 mcg daily. Unlike some other vitamins, we measure Vitamin B12 in micrograms rather than International Units (IU).
Vitamin B12 deficiency is unusual in healthy adults with a balanced diet. However, around 11% of elderly individuals and 3% of hospital patients may experience low levels of Vitamin B12 in their blood, leading to symptoms like weakness and fatigue.
Severe Vitamin B12 deficiency is more common in strict vegans who don’t use supplements, individuals with significant intestinal issues (like Crohn’s disease, celiac disease, or complications from bariatric surgery), those with autoimmune conditions (such as vitiligo), and people with rare genetic disorders. Some medications, like metformin, can interfere with the absorption of both Vitamin B9 and Vitamin B12.
Vitamin B12 deficiency develops slowly, and it’s the only water-soluble vitamin that our bodies can store for 5-10 years even if we stop eating foods rich in Vitamin B12. Children and newborns rarely suffer from this deficiency, but infants of vegan mothers who don’t take Vitamin B12 supplements could be at risk.
A Vitamin B12 deficiency can lead to a condition called B12-deficient anemia, which presents differently in children and adults. In children, it can be challenging to diagnose because the symptoms, such as slow weight gain, delayed development, irritability, and muscle weakness, can mimic other issues. In adults, symptoms are usually more pronounced and may include muscle weakness, tingling or numbness in the limbs, an unsteady walk, irritability, forgetfulness, and, at times, inflammation of the tongue (glossitis).
Severe anemia can cause symptoms like yellowing of the skin, dizziness, and shortness of breath. It’s crucial to address a Vitamin B12 deficiency early to prevent further complications.
Vitamin B12 is generally considered safe and non-toxic, but excessive intake can lead to its accumulation in the body. Therefore, it’s not advisable to consume high doses of Vitamin B12.
Vitamin B12-deficiency anemia is a common condition often associated with digestive problems related to Vitamin B12 absorption. Doctors may prescribe Vitamin B12 supplements if a deficiency is suspected. For mild deficiencies, daily doses of 1000-2000 mcg of Vitamin B12 are typically recommended. In cases of confirmed anemia, doctors may prescribe Vitamin B12 injections 1-4 times a week, with the dose and duration determined by the healthcare provider.
To diagnose Vitamin B12 deficiency, doctors may order a blood test for patients suspected of having B12-deficiency anemia. The process starts with a complete blood count test to estimate the number and size of red blood cells and check for anemia. Additionally, blood tests for both Vitamin B9 and B12 may be conducted to further clarify the nature of the deficiency.
The reference range for Vitamin B12 is above 221 pmol/l. If your level falls within the borderline range of 148-221 pmol/l, a retest may be needed. A Vitamin B12 level below 148 pmol/L is considered a confirmed deficiency.
Vitamin B12 can be taken alongside Vitamin B9, but it’s important to note that Vitamin C might reduce the concentration of Vitamin B12 in the blood. As a result, it’s best not to take Vitamin C and Vitamin B12 together.
Vitamin C (Ascorbic acid)
Vitamin C is a crucial water-soluble nutrient that plays a vital role in various enzyme functions within the body.
Function: Vitamin C is involved in the operation of enzymes responsible for creating other vitamins, producing collagen (a protein that helps connect our body tissues), making noradrenaline, and reducing inflammation in the body through prostaglandins.
Sources: You can find vitamin C in foods like citrus fruits, tomatoes, Brussels sprouts, cauliflower, broccoli, strawberries, cabbage, and spinach. It’s worth noting that cooking, prolonged storage, and exposure to light can reduce the amount of vitamin C in these foods.
Recommended Daily Intake: For adults, it’s recommended to get 90 mg (equivalent to 1800 IU) of vitamin C daily, while children should aim for 30-90 mg (600-1800 IU).
Deficiency: Nowadays, vitamin C deficiency is rare due to the availability of affordable fruits and vegetables year-round. In the past, sailors and polar explorers experienced a severe lack of ascorbic acid, leading to a condition known as scurvy because their diets lacked fresh produce.
Scurvy impairs collagen synthesis, resulting in skin bruises that can turn into ulcers, bleeding gums, tooth loss, weakness, joint pain, and swelling. Prolonged vitamin C deficiency can even be fatal.
Today, scurvy symptoms can still be found in chronic alcoholics, severely fatigued individuals, and in conditions that cause excessive iron buildup, such as sickle cell anemia and bone marrow transplantation. Excess iron can also deplete ascorbic acid in the body, leading to scurvy. To prevent scurvy, the concentration of ascorbic acid in the blood should be above 11 mmol/L.
Overdose: Overdosing on vitamin C is uncommon because excess is typically excreted from the body. However, taking extremely high doses of supplements (more than 2000 mg per day) for several days can lead to nausea and diarrhea. High doses of vitamin C can also increase the risk of kidney stones and potentially cause life-threatening arrhythmias in patients with sickle cell disease.
Prescription: Doctors usually prescribe vitamin C supplements to treat scurvy, with different recommended doses for adults and children. Children may take 100 mg three times a day for a week, and then once a day until they fully recover. Depending on the severity of the condition, adults may need to take 300-1000 mg of vitamin C daily for a month. It’s important to note that vitamin C supplements are not beneficial for healthy individuals, and there’s no evidence to suggest that taking extra ascorbic acid can prevent cardiovascular disease, colds, or cancer.
Normal range for the average person: 34-91 μmol/L.
Avoidance: It’s not advisable to consume vitamin C and vitamin B12 together, as vitamin C can reduce the concentration of vitamin B12 in the blood.
Vitamin D (Calciferol)
Vitamin D is a fat-soluble vitamin that plays a crucial role in our health. A portion of it comes from our diet, while our skin naturally produces some when exposed to sunlight.
Function: Vitamin D is essential for regulating calcium levels in our bodies. Calcium is vital for bone strength, muscle function, nerve signals, and the release of various hormones, making vitamin D a key player in maintaining overall health.
Sources: You can find vitamin D in fatty fish like salmon, herring, sardines, and mackerel, as well as in red meat, liver, and egg yolks.
The recommended daily intake of vitamin D varies with age. Adults and children are advised to get 10 micrograms (or 400 international units, IU) of vitamin D daily, while those over 60 years old should aim for 15 micrograms (or 600 IU).
Most of our vitamin D is produced in the skin when it’s exposed to sunlight. However, during the winter, especially in regions with limited sunshine, it can be challenging to get enough vitamin D, particularly for seniors and those with limited mobility. To ensure an adequate intake of vitamin D in such areas, it’s recommended to spend 5-15 minutes outdoors with your arms and legs exposed two to three times a week.
Certain groups are more at risk of vitamin D deficiency, including the elderly, individuals with digestive disorders, cystic fibrosis, renal failure, or certain hereditary conditions, as well as those taking medications that interfere with calcium absorption, like glucocorticoids.
Long-term vitamin D deficiency can lead to reduced bone density in adults, potentially causing brittle bones, and in children, it can result in a condition known as rickets, where the bones soften and may bend. Thankfully, cases of rickets related to malnutrition are rare in developed countries thanks to proper nutrition.
Serious vitamin D deficiencies are uncommon in individuals with a balanced diet who spend time outdoors. Still, mild deficiencies can occur without causing significant health issues. These subclinical deficiencies, affecting nearly half of the global population, according to some reports, can lead to osteoporosis in old age if left untreated.
It’s important to be aware of the possibility of vitamin D overdose. High doses, exceeding 60,000 IU per day, can lead to toxicity, accumulating in the liver and fat cells. This excess vitamin D can increase the level of free calcium in the blood, resulting in symptoms like muscle weakness, vomiting, and confusion. Long-term consumption of high doses of vitamin D can also cause muscle and bone pain and the formation of kidney stones.
A healthy vitamin D level is considered to be over 75 nanomoles per liter (nmol/L). It’s advisable not to combine vitamin D with other fat-soluble vitamins like vitamin A, E, and K, as research in mice suggests they may compete for absorption. It’s best to take vitamin D separately from other fat-soluble vitamins.
Vitamin K
Vitamin K is a key player in maintaining proper blood clotting and promoting healthy bones. It’s a fat-soluble vitamin, which means it dissolves in fat and is stored in your body for future use. You can find it in various foods like spinach, broccoli, vegetable oils, and cereals. Interestingly, some of the vitamin K your body needs is also produced by the helpful bacteria living in your intestines.
For grown-ups, the recommended daily intake of vitamin K is around 120 micrograms, while children typically require 30 to 120 micrograms. Unlike other vitamins, vitamin K isn’t typically measured in International Units (IU).
Fortunately, vitamin K deficiency isn’t a common issue among healthy adults. But in situations of prolonged starvation or conditions that affect fat absorption, like celiac disease or short bowel syndrome, people might not get enough vitamin K from their diets alone. Moreover, extended use of antibiotics can potentially deplete vitamin K because they also eliminate the beneficial gut bacteria that help produce it.
If you’re low on vitamin K, it can hinder your blood clotting ability, leading to symptoms such as easy bruising, prolonged bleeding from cuts, and bleeding in your mouth and nose.
Now, about vitamin K overdoses, these are exceptionally rare, and you’re unlikely to encounter them. They usually occur in newborns who are given formula containing excessive vitamin K, leading to the rapid destruction of red blood cells and a condition known as hemolytic anemia, which causes a yellowish skin color.
Vitamin K supplements are occasionally recommended by doctors, mainly for individuals with blood clotting disorders or diagnosed deficiencies. The dosage will be determined by your healthcare provider. Newborns are often given a vitamin K injection right after birth to prevent hemorrhagic disease.
When it comes to testing for vitamin K levels, it’s not a routine practice, but it may be done if there are specific health concerns like anemia. Instead of directly measuring vitamin K levels, healthcare professionals typically assess it indirectly by examining the concentration of blood clotting factors. A vitamin K deficiency will often result in a reduction of these factors by more than 50%. The reference range typically falls between 0.13 and 1.88 nanograms per milliliter.
One more thing to keep in mind: high doses of vitamins E and A can interfere with vitamin K absorption, so it’s best to take them separately to ensure you get the full benefit of each nutrient.
Vitamin E (Tocopherol)
Vitamin E is a fat-soluble vitamin that plays a crucial role in safeguarding cell membranes from harm. It acts as a shield against free radicals, which are highly reactive oxygen molecules that can damage the fatty acids in cell membranes. This protective action helps extend the lifespan of all the cells in your body.
Vitamin E also has a role in preventing blood platelets from sticking together. This action is believed to safeguard blood vessels from clot formation and restrain excessive cell division.
You can find vitamin E in various foods, including vegetable oil, meat, eggs, and leafy greens.
Vitamin E Requirements: Adults should aim for around 15 mg of vitamin E daily, while children typically require 3-15 mg. When it comes to supplements, the measurement units (IU) can vary. For instance, an adult dose of d-alpha-tocopherol is roughly 23 IU, whereas dl-alpha-tocopherol is approximately 16 IU.
Deficiency: Vitamin E deficiency is a rare occurrence in individuals with a well-balanced diet and overall good health. However, individuals adhering to a strict vegan diet may face challenges in obtaining enough vitamin E due to the presence of “tocopherols” in plant-based foods, which can hinder absorption. Deficiency is more likely in individuals with conditions such as pancreatic diseases, liver diseases, hereditary disorders, or those who’ve undergone intestinal surgery, as these conditions can hinder the absorption of fats and fat-soluble vitamins. Vitamin E deficiency can result in various symptoms, including reduced sensitivity in the limbs, muscle weakness, muscle wasting, and destruction of blood cells. Some individuals with a deficiency may not experience any noticeable symptoms.
Vitamin E Toxicity: Consuming excessive amounts of Vitamin E can lead to adverse health effects. The recommended daily upper limit is 272 mg or 400 IU, and surpassing this limit can disrupt blood clotting, increase the risk of strokes related to bleeding, and potentially lead to higher mortality rates.
Vitamin E Supplements: There’s no compelling evidence to suggest that Vitamin E supplements provide significant health benefits for adults and children. Therefore, it’s advisable to avoid doses exceeding 400 IU. In certain specific cases, such as severe pancreatic insufficiency or cholestatic liver disease, a doctor may prescribe Vitamin E, with the dosage determined by a healthcare professional.
Testing Vitamin E Levels: When patients are receiving high doses of Vitamin E, healthcare providers may conduct tests to monitor their levels. The normal range for Vitamin E levels in the blood typically falls between 14.3-18.5 micromole/L.
Vitamin E Interactions: Studies in mice have indicated that Vitamin E can interfere with the absorption of fat-soluble vitamins A and K. Therefore, it’s recommended not to combine Vitamin E with these vitamins. For generally healthy individuals, it’s best to obtain Vitamin E from dietary sources. In cases where a prescription is necessary, it should be taken as directed by a healthcare provider.
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