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VITAMIN B12/FOLIC ACID DEFICIENCY
These two vitamin deficiencies will be discussed together because they often coexist and have similar symptoms. Vitamin B12 is found in meat (especially liver). It combines with a substance in the stomach and is then absorbed in the small bowel where it enters the bloodstream. It is vital for healthy blood, and it is important in the nervous system. Some elderly people fail to produce the substance in the stomach which vitamin B12 needs in order to get absorbed. Also there are many people who have had part of the stomach removed (usually because of ulcers) and they too may fail to get any B12 in. (The other name for this condition is pernicious anaemia, because of its slow and debilitating onset.) Folic acid is another vitamin found especially in fresh vegetables. It too is needed for blood making and a healthy nervous system. Lack of this vitamin is usually due to a poor diet. Poor diets are probably 20 per cent ignorance and 80 per cent poverty.
The two conditions present in the same way. There are usually complaints of tiredness and lethargy. If the nervous system is affected there may be complaints of abnormal sensation in the arms and especially the legs with unsteadiness and a feeling that one is walking on cotton wool. Walking may become difficult and a gradual onset of confusion may develop. The person looks pale and is usually anaemic. They often have a pale lemon tinge to the colour of their skin. A neurological examination will often reveal many abnormalities and a blood test shows abnormally big red blood cells. All these symptoms lead the doctor to consider the diagnosis and send off more specific tests. Vitamin B12 can be measured in the blood, but as there are numerous causes, often more sophisticated tests have to be done as well. The folic acid content of red blood cells is the best blood test and this is routinely performed.
Unfortunately, vitamin 12 cannot be given by mouth as it is destroyed in the stomach. Therefore, when the diagnosis is made the treatment is by injection of B12. These are usually given every three months. The injections have to be continued for life. Folic acid deficiency is easily treated by either improving the diet generally or by giving folic acid in tablet form daily.
The longer the conditions have been present the less likely all the neurological complications will be reversed. The anaemia seems to improve well, but if established chronic confusion is present there are few reported cases of the mental state going back completely to normal.
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