Overview

Vitamin deficiency anemia is a lack of healthy red blood cells caused when you have lower than normal amounts of certain vitamins. Vitamins linked to vitamin deficiency anemia include folate, vitamin B-12 and vitamin C.

Vitamin deficiency anemia can occur if you don't eat enough foods containing folate, vitamin B-12 or vitamin C, or it can occur if your body has trouble absorbing or processing these vitamins.

It's important to have your doctor diagnose and treat your anemia. Vitamin deficiency anemia can usually be corrected with vitamin supplements and changes to your diet.

Symptoms

Signs and symptoms of vitamin deficiency anemia include:

  • Fatigue
  • Shortness of breath
  • Dizziness
  • Pale or yellowish skin
  • Irregular heartbeats
  • Weight loss
  • Numbness or tingling in your hands and feet
  • Muscle weakness
  • Personality changes
  • Unsteady movements
  • Mental confusion or forgetfulness

Vitamin deficiency usually develops slowly over several months to years. Vitamin deficiency signs and symptoms may be subtle at first, but they increase as the deficiency worsens.

Causes

Vitamin deficiency anemia develops when your body has a shortage of the vitamins needed to produce enough healthy red blood cells. Red blood cells carry oxygen from your lungs throughout your body.

If your diet is lacking in certain vitamins, vitamin deficiency anemia can develop. Or vitamin deficiency anemia may develop because your body can't properly absorb the nutrients from the foods you eat.

Causes of vitamin deficiency anemias include:

Folate deficiency anemia

Folate, also known as vitamin B-9, is a nutrient found mainly in fruits and leafy green vegetables. A diet consistently lacking in these foods can lead to a deficiency.

Deficiency can also result if your body is unable to absorb folate from food. Most nutrients from food are absorbed in your small intestine. You might have difficulty absorbing folate or folic acid, the synthetic form of folate that's added to foods and supplements, if:

  • You have a disease of the small intestine, such as celiac disease
  • You've had a large part of the small intestine surgically removed or bypassed
  • You drink excessive amounts of alcohol
  • You take certain prescription drugs, such as some anti-seizure medications

Pregnant women and women who are breast-feeding have an increased demand for folate, as do people undergoing dialysis for kidney disease. Failure to meet this increased demand can result in a deficiency.

Vitamin B-12 deficiency anemia

Vitamin B-12 deficiency can result from a diet lacking in vitamin B-12, which is found mainly in meat, eggs and milk.

However, the most common cause of vitamin B-12 deficiency anemia is a lack of a substance called intrinsic factor, which can be caused when your immune system mistakenly attacks the stomach cells that produce this substance. This type of anemia is called pernicious anemia.

Intrinsic factor is a protein secreted by the stomach that joins vitamin B-12 in the stomach and moves it through the small intestine to be absorbed by your bloodstream. Without intrinsic factor, vitamin B-12 can't be absorbed and leaves your body as waste.

People with endocrine-related autoimmune disorders, such as diabetes or thyroid disease, may have an increased risk of developing pernicious anemia.

Vitamin B-12 deficiency anemia can also occur if your small intestine can't absorb vitamin B-12 for reasons other than a lack of intrinsic factor. This may happen if:

  • You've had surgery to your stomach or small intestine, such as gastric bypass surgery
  • You have abnormal bacterial growth in your small intestine
  • You have an intestinal disease, such as Crohn's disease or celiac disease, that interferes with absorption of the vitamin
  • You've ingested a tapeworm from eating contaminated fish. The tapeworm saps nutrients from your body.

Vitamin C deficiency anemia

Vitamin C deficiency can develop if you don't get enough vitamin C from the foods you eat. Vitamin C deficiency is also possible if something impairs your ability to absorb vitamin C from food. For instance, smoking impairs your body's ability to absorb vitamin C.

Certain chronic illnesses, such as cancer or chronic kidney disease, also increase your risk of vitamin C deficiency anemia by affecting the absorption of vitamin C.

Risk factors

A number of factors can affect your body's vitamin stores. In general, your risk of vitamin deficiency is increased if:

  • Your diet contains little to no natural vitamin food sources, such as meat, dairy, fruits and vegetables. Vegetarians who don't eat dairy products and vegans, who don't eat any foods from animals, may fall into this category.

    Consistently overcooking your food also can cause vitamin deficiency.

  • You're pregnant, and you aren't taking a multivitamin. Folic acid supplements are especially important during pregnancy.
  • You have intestinal problems or other medical conditions that interfere with absorption of vitamins. Abnormal bacterial growth in your stomach or surgery to your intestines or stomach can interfere with the absorption of vitamin B-12.
  • You abuse alcohol. Alcohol interferes with the absorption of folate and vitamin C, as well as other vitamins.
  • You take certain prescription medications that can block absorption of vitamins. Anti-seizure drugs can block the absorption of folate. Antacids and some drugs used to treat type 2 diabetes may interfere with B-12 absorption.

Complications

Being deficient in vitamins increases your risk of many health problems, including:

Pregnancy complications

Pregnant women with folate deficiency may be more likely to experience complications, such as premature birth. A developing fetus that doesn't get enough folate from its mother can develop birth defects of the brain and spinal cord.

If you're thinking of becoming pregnant, ask your doctor whether you should consider taking folic acid supplements so that your body's stores of folate will be enough to support your baby.

Nervous system disorders

While vitamin B-12 is important for the production of red blood cells, it's also important for a healthy nervous system.

Untreated, vitamin B-12 deficiency can lead to neurological problems, such as persistent tingling in your hands and feet or problems with balance. It can lead to mental confusion and forgetfulness because vitamin B-12 is necessary for healthy brain function.

Without treatment for vitamin B-12 deficiency, neurological complications can become permanent. Vitamin B-12 deficiency can cause these and other health problems before it leads to anemia.

Scurvy

Vitamin C deficiency can lead to scurvy. Signs and symptoms of this rare disease include bleeding under the skin and around the gums.

Prevention

Choose a healthy diet

You can prevent some forms of vitamin deficiency anemias by choosing a healthy diet that includes a variety of foods.

Foods rich in folate include:

  • Dark green leafy vegetables
  • Nuts
  • Enriched grain products, such as bread, cereal, pasta and rice
  • Fruits and fruit juices

Foods rich in vitamin B-12 include:

  • Eggs
  • Fortified foods, such as breakfast cereals
  • Milk, cheese and yogurt
  • Meat and shellfish

Foods rich in vitamin C include:

  • Broccoli
  • Citrus fruits and juices
  • Strawberries
  • Green peppers
  • Tomatoes

Most adults need these daily dietary amounts of the following vitamins:

  • Vitamin B-12 — 2.4 micrograms (mcg)
  • Folate or folic acid — 400 mcg
  • Vitamin C — 75 to 90 milligrams

Pregnant and breast-feeding women may require more of each vitamin.

Consider a multivitamin

If you're concerned about getting enough vitamins from the food you eat, ask your doctor whether a multivitamin may be right for you. Most people get enough vitamins from the foods they eat. But if your diet is restricted, you may wish to take a multivitamin.

Don't smoke

Smoking interferes with the absorption of nutrients, such as vitamin C, so it can raise your risk of a vitamin deficiency.

If you smoke, quit. If you don't smoke, don't start. If you've tried to quit on your own and haven't been successful, talk with your doctor about strategies to help you quit.

Drink alcohol in moderation, if at all

Alcohol can contribute to vitamin deficiency anemia. If you choose to drink alcohol, do so in moderation. For healthy adults, moderate drinking is generally considered to be:

  • Two drinks a day for men age 65 and younger
  • One drink a day for men older than age 65
  • One drink a day for women of any age

A drink is 12 ounces (355 milliliters) of beer, 5 ounces (148 milliliters) of wine or 1.5 ounces (44 milliliters) of 80-proof distilled spirits.

Dec. 10, 2019
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