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- Written byDr. Ingrida Leonaviciute, MD
- Last updated onDecember 28, 2021
Fact checked:This artictle is based on scientific evidence.
- by Dr. Ingrida Leonaviciute, MD.
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What are the main functions of Vitamins B9 (folate, folic acid) und B12 (cobalamin)?
We will analyse Vitamins B12 and B9 together because they are both responsible for healthy red blood cells (also called erythrocytes). Lack of these vitamins results in large red blood cells that cannot properly attach and carry oxygen to the tissues. This is called anemia.Another important function of Vitamin B12 is healthy peripheral nerves. Vitamin B9 does not perform this function.Another very common cause of anemia is iron deficiency, which is especially common in young menstruating women (because of the loss of iron during bleeding). Lack of iron produces too small red blood cells that also cannot attach and carry oxygen properly. Red blood cells must not be too small or too large to perform their function properly.
What are the main sources of Vitamins B9 (folate, folic acid) und B12 (cobalamin)?
- Vitamin B9: legumes, leafy vegetables, fruits, nuts.
- Vitamin B12: mostly in animal products (seafood, fish, meat, cheese, except honey), dried and fermented plant foods (nori).
- Intestinal bacteria also synthesize small amounts of Vitamins B9 and B12.
How long are Vitamins B9 (folate, folic acid) und B12 (cobalamin) stored in the liver?
- Vitamins B9 and B12 are the only water-soluble vitamins stored in our liver. All other water-soluble vitamins are excreted in the urine.
- Vitamin B9: 3-4 months.
- Vitamin B12: 3-4 years.
Daily recommended doses of Vitamin B9 (folate, folic acid)
- The dose depends on age, pregnancy, and breastfeeding.
- Doses written in micrograms (mcg) of dietary folate equivalents (DFEs):
- 1 mcg DFE = 1 mcg food folate
- 1 mcg DFE = 0.6 mcg folic acid from fortified foods or dietary supplements consumed with foods
- 1 mcg DFE = 0.5 mcg folic acid from dietary supplements taken on an empty stomach
- The table provides daily recommendations for folate from food und its upper limits from fortified food or supplements.
Daily recommended doses of Vitamin B12 (cobalamin)
- The dose depends on age, pregnancy, and breastfeeding.
- Doses written in micrograms (mcg).
- from dietary supplements taken on an empty stomach
- The table provides daily recommendations for Vitamin B12. There are no data about its upper limits.
How Vitamin B9 (folate, folic acid) interacts with medications?
- Antiepileptic medications, such as phenytoin, carbamazepine, and valproate, are used to treat epilepsy psychiatric diseaseas, and other medical conditions. They can reduce serum folate levels. It is also important that Vitamin B9 can reduce the blood level of antiepileptic drugs. In this case, an epileptic seizure may occur. Therefore, always tell your doctor about the supplements you are taking.
- Methotrexate, used to treat cancer and autoimmune diseases like rheumatoid arthritis or psoriasis, and Vitamin B9 work against each other. Thus, not only blood folate levels but also the effects of methotrexate may be reduced.
- Sulfasalazine is used to treat ulcerative colitis. This medication reduces the absorption of folic acid in the blood.
How Vitamin B12 (cobalamin) interacts with medications?
- Gastric acid inhibitors include proton pump inhibitors, such as omeprazol, to treat gastroesophageal reflux disease and peptic ulces, and histamine 2-receptor antagonists, such as ranitidine, to treat allergies, reduces the secretion of stomach acid and at the same time the absorption of Vitamin B12.
- Metformin, to treat diabetes, reduces the absorption of Vitamin B12 and its amount in the blood.
Top foods rich in Vitamin B9 (folate, folic acid)
Top foods rich in Vitamin B12 (cobalamin)
What are the symptoms of Vitamins B9 (folate, folic acid) und B12 (cobalamin) deficiency?
- The main symptom of Vitamins B9 (folate, folic acid) and B12 (cobalamin) deficiency is anemia. This means that your body is not getting enough oxygen. Fatigue, weakness, pale or yellowish skin and mucous membranes occur. If you have heart or lung disease, your body does not get enough oxygen. With anemia, the situation worsens with symptoms such as shortness of breath or chest pain.
- Another symptom unique to Vitamin B12 (cobalamin) deficiency is various damage to the nervous system. It is characterized by impaired sensations in the extremities (also called peripheral neuropathy), gait disorders, depression, impaired cognitive functions such as learning, memory.
- Another interesting and only Vitamin B12 (cobalamin) deficiency characteristic is the raspberry-colored tongue.
How to diagnose Vitamins B9 (folate, folic acid) und B12 (cobalamin) deficiency?
- First, anemia (low hemoglobin and/or erythrocytes) is seen in the blood. In the absence of Vitamins B9 (folate, folic acid) and B12 (cobalamin), erythrocytes become large and strongly red, and in the absence of iron, they become small and pale. Both cannot carry oxygen properly. Mean Corpuscular Volume (MCV) is used to measure the size of erythrocytes and Mean Corpuscular Hemoglobin (MCH) is used to determine their color. All of these parameters can be seen in a general blood test and used to decide which vitamins or mineral deficiencies to look for next. The normal values of these parameters are given in the table. Keep in mind that they are different for children and the elderly.
- The next step is to determine the levels of Vitamins B9 (folate, folic acid) and B12 (cobalamin) in your blood.
Different supplements of Vitamins B9 (folate, folic acid) und B12 (cobalamin)
- Whether Vitamins B9 (folate, folic acid) and B12 (cobalamin) will be given as tablets or intravenously depends on the cause of deficiency. If the cause is malnutrition, tablets can be prescribed. Following gastrointestinal surgery, these vitamins are given intravenously as intestinal absorbtion is reduced.
- Intravenous Vitamin B12 is usually well tolerated and is a convenient method for the patient who does not want to take the tablets regularly. The duration and frequency of treatment depend on the cause and severity of the deficiency. In the hospital, Vitamin B12 can be given several times a week, and going to the family doctor once or twice a month may be enough.
- Folic acid is given to women planning a pregnancy. It begins four weeks before pregnancy and continues into the first trimester. The goal is to reduce the risk of neural tube defects of the fetus.
Why Vitamin B9 (folate, folic acid) is best given in combination with Vitamin B12 (cobalamin)?
Administration of vitamin B9 alone may mask the deficiency of Vitamin B12 and exacerbate the neurological symptoms caused by its deficiency (although the exact mechanism of action is unclear).
References
- https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-vitamin-b12-and-folate-deficiency
- https://www.uptodate.com/contents/treatment-of-vitamin-b12-and-folate-deficiencies
- https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
- https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
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About Me
I’m the co-founder of the Health Explorior, a health and wellness project. I specialize in internal medicine and endocrinology. The main areas of interest are healthy diet, preventive medicine, mental health, and philosophical-spiritual human nature.
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