Folate fortification may mask B12 deficiency

Related tags Folic acid

Mandatory addition of folic acid to cereals and grains in the US
may be dangerously concealing vitamin B12 deficiency in the
elderly, said a scientist this week. B12 is needed to protect
against deterioration of brain cells.

A mandated food additive aimed at better fetal development could be simultaneously increasing health risks for seniors. Scientists said this week that folic acid fortification of cereals and grains in the US may be dangerously concealing vitamin B12 deficiency in the elderly.

Dr Ralph Green, speaking at the American Association for Clinical Chemistry (AACC) meeting in Philadelphia this week, claims that higher levels of folic acid intake prevent the anemia produced both by folic acid and B12 deficiencies. This means that elderly people will not be alerted to low levels of B12 which can cause deterioration in brain health.

Emerging evidence also points to B12 deficiency as an increasingly common reason behind high levels of homocysteine in the blood, which in turn are believed to lead to significantly greater risk for cardiovascular diseases, say scientists.

Vitamin B12 is stored in the liver, kidneys, and tissues of the body. Consumed through food sources such as meat, liver, fish, yogurt, and many dairy products, it can also be taken through injections and supplements. B12 helps build red blood cells and keeps the nervous tissues in good shape. Deficiency of the vitamin can result in anemia (lower levels of red blood cells) and damage to the nervous system.

Dr Green explains that normal metabolism of homocysteine requires at least three or four vitamins: vitamin B12, folic acid, vitamin B6, and riboflavin. As with deficiencies of B12, deficiencies of folic acid (folate) can also cause high levels of homocysteine. The metabolism of these two vitamins is closely intertwined and deficiency of either one produces identical effects of anemia, said the scientist.

Deficiencies of both are commonly found among the elderly, with an estimated 15 per cent of those over age 60 having varying degrees of B12 deficiency. Moreover, it is thought that 3 per cent of those over 65 will develop pernicious anemia, a reduction in the number of red blood cells due to malabsorption of the vitamin.

Mandated folic acid in the diet, required by 1998 legislation to be added to all cereals and grains, may be eliminating anemia, and with it the fatigue, the most obvious manifestation of B12 deficiency in the elderly, thus allowing the deficiency to remain undetected.

According to scientists, the longer a person's B12 deficiency goes undetected, the longer their brains and nervous systems will undergo progressive deterioration, culminating in a greater risk for the Alzheimer's-like dementia as well as paralysis.

But fortification has resulted in a 20 per cent overall reduction in neural tube defects, with folic acid deficiency in the nation overall plummeting from 21 per cent to just 1 per cent.

The key to preventing B12 deficiency therefore could be through a balanced diet, said the scientist, particularly among the elderly. But some individuals, despite following a nutritious diet plan, may not be able to absorb a food's vitamins.

Vegans (strict vegetarians who do not eat fish or eggs), and those taking medications which block stomach acid production and thus B-12 absorption, are at highest risk for the deficiency. Yet H-pylori, a corkscrew shaped bacterium responsible for a variety of stomach ailments, occurs quite commonly in some populations and can also impair the normal absorption of vitamin B12.

Dr Green, professor and chair of the Department of Pathology at the University of California-Davis Health System and pathologist-in-chief at the University of California-Davis Medical Center, Sacramento, California, recommended annual screening to rule out deficiency, which could be corrected by B12 supplements.

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