Overview
Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate.
This can happen if you don't eat enough foods containing vitamin B-12 and folate, or if your body has trouble absorbing or processing these vitamins.
Without these nutrients, the body produces red blood cells that are too large and don't work properly. This reduces their ability to carry oxygen.
Symptoms can include fatigue, shortness of breath and dizziness. Vitamin supplements, taken by pill or injection, can correct the deficiencies.
Symptoms
Vitamin deficiency anemia usually develops slowly over several months to years. Signs and symptoms may be subtle at first but usually increase as the deficiency worsens. These may include:
- Fatigue
- Shortness of breath
- Dizziness
- Pale or yellowish skin
- Irregular heartbeats
- Weight loss
- Numbness or tingling in the hands and feet
- Muscle weakness
- Personality changes
- Unsteady movements
- Mental confusion or forgetfulness
Request an appointment
From Mayo Clinic to your inbox
Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.
To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.
Causes
Vitamin deficiency anemia can occur if you don't eat enough foods containing vitamin B-12 and folate, or if your body has trouble absorbing or processing these vitamins.
Vitamin B-12 deficiencies
Low levels of vitamin B-12 can be caused by:
- Diet. Vitamin B-12 is mainly found in meat, eggs and milk, so people who don't eat these types of foods may need to take B-12 supplements. Some foods have been fortified with B-12, including some breakfast cereals and some nutritional yeast products.
- Pernicious anemia. This condition occurs when the body's immune system attacks cells in the stomach that produce a substance called intrinsic factor. Without this substance, B-12 can't be absorbed in the intestines.
- Gastric surgeries. If portions of your stomach or intestines have been surgically removed, that can reduce the amount of intrinsic factor produced and the amount of space available for vitamin B-12 to be absorbed.
- Intestinal problems. Crohn's disease and celiac disease can interfere with absorption of vitamin B-12, as can tapeworms that may be ingested from eating contaminated fish.
Folate deficiencies
Also known as vitamin B-9, folate is a nutrient found mainly in dark green leafy vegetables and liver. A folate deficiency can occur when people don't eat foods containing folate or their bodies are unable to absorb folate from food.
Absorption problems may be caused by:
- Intestinal diseases such as celiac disease
- Surgical removal or bypass of a large part of the intestines
- Excessive alcohol consumption
- Prescription drugs, such as some anti-seizure medications
Pregnant women and women who are breastfeeding have an increased demand for folate, as do people undergoing dialysis for kidney disease.
A lack of folate can cause birth defects during pregnancy. However, folate deficiency is less common now in countries that routinely add folate to food products such as breads, cereals and pasta.
Risk factors
Things that may increase your risk of vitamin deficiency anemia include:
- Certain autoimmune diseases, including Crohn's disease, celiac disease and type 1 diabetes.
- Surgery to remove part of your stomach or intestine.
- Older age.
- Chronic alcohol use.
Complications
Being deficient in vitamin B-12 or folate increases your risk of many health problems, including:
- Pregnancy complications. A developing fetus that doesn't get enough folate from its mother can develop birth defects of the brain and spinal cord.
- Nervous system disorders. Untreated, vitamin B-12 deficiency can lead to neurological problems, such as persistent tingling in the 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.
- Gastric cancer. Pernicious anemia increases the risk of stomach or intestinal cancers.
Prevention
You can prevent some forms of vitamin deficiency anemia by choosing a healthy diet that includes a variety of foods.
Foods rich in vitamin B-12 include:
- Beef, liver, chicken and fish
- Eggs
- Fortified foods, such as breakfast cereals
- Milk, cheese and yogurt
Foods rich in folate include:
- Broccoli, spinach, asparagus and lima beans
- Oranges, lemons, bananas, strawberries and melons
- Enriched grain products, such as bread, cereal, pasta and rice
- Liver, kidneys, yeast, mushrooms and peanuts
Most adults need these daily dietary amounts of the following vitamins:
- Vitamin B-12 — 2.4 micrograms (mcg)
- Folate or folic acid — 400 microgram (mcg)
Pregnant and breastfeeding women may require more of each vitamin.
Most people get enough vitamins from the foods they eat. But if your diet is restricted or you've had gastric bypass surgery, you may wish to take a multivitamin.
