Folate, iron and vitamin B6
There are two vitamins that are important in connection with vitamin B12: folate and vitamin B6. First of all, because both vitamins work closely with vitamin B12, but also because a deficiency of either or both often occurs in addition to a vitamin B12 deficiency. 24% of our members reported having had a folate deficiency. In addition, these three vitamins together ensure the normalization of homocysteine. A high level of homocysteine is a risk factor for cardiovascular disease.
Besides these two vitamins, iron is also an important factor and many people with PA are also iron deficient (up to 40%). Anaemia is often caused by an iron deficiency, but can also be caused by a deficiency of vitamin B12, B6 and/or folate. That is why it is advisable to test for all four when anaemia is diagnosed. In disorders of the stomach and/or intestines, like auto-immune gastritis, a deficiency of several vitamins and/or minerals may occur and should be monitored.
Folate
There is a close relationship between folate and vitamin B12. In addition to vitamin B12, the body also needs folate (vitamin B9 (or B11)) for the growth and maintenance of the body, the health of the nervous system and the production of white and red blood cells. Together with vitamin B12, folate is involved in the formation of purine and pyrimidine, components of RNA and DNA. In addition, it is also involved in conversions of some amino acids, such as the conversion of homocysteine in to methionine. A deficiency of folate can cause anaemia, intestinal disorders, fatigue, depression and birth defects. Not enough folate can also lead to high homocysteine levels which may result in a higher risk of cardiovascular disease. There is no storage in the body, so a deficiency can quickly develop.
Possible causes of a folate deficiency include: not enough folate in the diet, certain liver diseases, disruption of absorption due to stocha/intestinal disease, pregnancy, breastfeeding, alcoholism, kidney dialysis and as a result of certain medications.
The effect of vitamin B12 is closely intertwined with that of folate, but these two vitamins are not interchangeable. Administering large amounts of folic acid can restart both vitamin B12 and folate-dependent reactions in the body, but this is only temporary. When anaemia caused by a vitamin B12 deficiency (temporarily) disappears after the administration of folic acid, the premature conclusion is sometimes drawn that there was (only) a folic acid deficiency. Administration of folic acid for a vitamin B12 deficiency does show an improvement in the blood values (Hb and MCV), and can therefore mask a vitamin B12 deficiency. Neurological symptoms resulting from a vitamin B12 deficiency can be exacerbated by the administration of folic acid, resulting in nerve damage that can become permanent. That is why folic acid should only be given if a vitamin B12 deficiency has been ruled out or is already being treated. In order not to take any risk, it is advisable to always make sure enough vitamin B12 is available when taking folic acid.
In plasma, folate is mainly present as 5-methylterahydrofolate (5-methyl THFA). Once in the cells, it is converted into THFA, the active form. Vitamin B12 is required for this conversion, and in the absence of this, folate is “trapped” as 5-methyl THFA, an inactive form, meaning that not enough DNA can be synthesized. Anaemia and neurological/psychiatric symptoms, among other problems, can occur due to the lack of THFA.
Iron
The mineral iron plays an important role in metabolic processes in the blood and body cells. Iron is an important component of haemoglobin, a component of red blood cells. Red blood cells transport oxygen from the lungs to the tissues and iron is indispensable for that transport. There are different types of iron: haeme iron and non-haeme iron. Symptoms of an iron deficiency include dizziness, fatigue, pale skin, difficulty breathing on exertion, headache, palpitations, loss of appetite and tingling in hands and feet. A clear iron deficiency will lead to anaemia.
An iron deficiency can be caused by blood loss. For example, after an operation or childbirth, after a period of prolonged or heavy menstruation, or when you lose small amounts of blood (unnoticed) for a longer period of time, for example in your stomach or intestines. Such ‘creeping’ blood loss can occur when using certain painkillers (acetylsalicylic acid, ibuprofen, naproxen, diclofenac) or in stomach/intestinal diseases. An iron deficiency can also occur due to an increased usage of iron in the body (in a growing child or in a pregnant woman), a serious shortage of iron in the diet (in some elderly people or strict vegetarians) or due to reduced absorption of iron idue to a disease of the stomach or intestines, like auto-immune gastritis.
Vitamin B6
Vitamin B6 plays an important role in the metabolism. It is especially necessary for the breakdown and construction of amino acids, the building blocks that make up proteins. It also regulates the functioning of certain hormones in the body and is indispensable in the immune system, growth, blood production and the nervous system. Vitamin B6, together with vitamin B12 and folate, is necessary for normalizing homocysteine levels.
An iron deficiency can be caused by blood loss. For example, after an operation or childbirth, after a period of prolonged or heavy menstruation, or when you lose small amounts of blood (unnoticed) for a longer period of time, for example in your stomach or intestines. Such ‘creeping’ blood loss can occur when using certain painkillers (acetylsalicylic acid, ibuprofen, naproxen, diclofenac) or in stomach/intestinal diseases. An iron deficiency can also occur due to an increased usage of iron in the body (in a growing child or in a pregnant woman), a serious shortage of iron in the diet (in some elderly people or strict vegetarians) or due to reduced absorption of iron idue to a disease of the stomach or intestines, like auto-immune gastritis.
The symptoms of vitamin B6 deficiency include nervous system disorders, anaemia, loss of appetite, diarrhea, depression, skin problems, confusion, reduced resistance and glossitis.
High doses of vitamin B6 can lead to neurological complaints such as tingling. In addition, light sensitivity or a deterioration of memory and thinking processes may occur. Avoid prolonged high intake of more than 25 mg per day, unless under medical supervision.