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Vitamin B Deficiencies: Signs & Causes

Are you vulnerable?

How to Avoid deficiencies?

A vitamin is characterized by the fact that, in its absence, key physiologic processes are blocked that can result in serious health consequences. This is made especially clear when we look at the role of B vitamins.

B vitamins act as co-enzymes in thousands of molecular processes in the body, and we have learned more about their unique functions by examining what happens when they aren’t present than when they are. The concept of “characterizing by deficiency” has led to incredible discoveries, while highlighting the importance of prevention. So, while you may not notice when you have sufficient or slightly low levels of B vitamins, you definitely begin to notice as the deficiencies become more pronounced.

While its ideal to know what your blood levels for the B vitamins are before supplementing- it is not always necessary for the treatment and prevention of certain deficiencies. This is due to the fact that most (though not all) B vitamins are well tolerated and have a low toxicity profile. An exception to this is niacin which can be toxic at very high doses. Further, as they are water soluble, excess concentrations are easily excreted in urine.

Unfortunately, this same notion has led to the development of some ineffective, unbalanced supplements. Understanding how specific deficiencies occur and what symptoms they cause helps us with more targeted and appropriate supplementation regimes, meaning you can supplement the right vitamin in the right form, at the right dose, at the right time. A truly orthomolecular approach.

Who is at Risk?

Before we get further into how to treat suspected deficiencies we must understand why they occur, who is at risk, and what signs and symptoms to look for. In general, a deficiency can be the result of 4 major factors:

  • Blocked production or genetic abnormalities
  • Inadequate or insufficient intake
  • Poor absorption or lifestyle
  • Competing or antagonistic molecules

Common Vulnerable Populations

As such, some common vulnerable populations are individuals who are more susceptible to one or more of these factors. These include:

  • The elderly
  • Those with restrictive diets such as vegans or vegetarians
  • Those suffering from chronic antibiotic use
  • Smokers
  • Individuals with malabsorptive concerns such as: Crohn’s, Celiac, Ulcerative colitis, IBS

The chart below breaks down specific B vitamin deficiencies. We refer to both the standard and active forms of each as well as the signs and symptoms, causes, and vulnerable populations. Also included is Health Canada’s recommended dietary allowance (RDA). These RDA values are based on general adult population statistics. It’s important to remember that individual requirements will vary based on: current health status, nutrition, exposure to toxins, exposure to medical treatments, and many other factors. Further, these ranges do not address specific health benefits that may be related to higher doses.

NAME | B1 THIAMINE


ACTIVE FORMS | salbutiamine, befotiamine

RECOMMENDED DIETARY ALLOWANCE | 1.2/1.1mg(men/women)

SIGNS OF DEFICIENCY | The most serious deficiencies can lead to degenerative nerve disorders such as beriberi (wet and dry), Wernicke-korsakoff syndrome (know as cerebral beriberi), as well as alcohol neuritis.

  • Dry beriberi presents with burning feet, loss of balance, and limb weakness.
  • Wet beriberi also includes cardiovascular symptoms such as ederma, tachycardia (racing heart) and heart failure in severe cases.
  • Cerebral beriberi includes dementia, psychosis, amnesia and ataxia.
  • Thiamin deficiency has been linked to Type II Diabetes.

CAUSES OF DEFICIENCY | In underdeveloped countries, B1 deficiencies are usually found were foods made from white flour are staples. In the developed world, where such foods are often fortified with thiamin, the main reasons for deficiencies are alcohol consumption (which impairs thiamin absorption) and poor dietary choices.

Thiamine dificiency has also been linked to unstable blood sugar levels, particularly in the formation of advanced glycation end products (AGEs). AGEs are cellular proteins that are damaged as a result of being exposed to glucose without the mediating action of a coenzyme.

POPULATION AT RISK OF DEFICIENCY

  • Chronic or excesive alcohol consumption
  • Diets high in processed flours

NAME | B2 RIBOFLAVIN


RECOMMENDED DIETARY ALLOWANCE | 1.3/1.1 mg (men/women)

SIGNS OF DEFICIENCY | Ariboflavinosis is the specific condition caused by riboflavin deficiency. Symptons include sores around the mouth and swelling of the throat, cheilosis(cracks on the lips), and glossitis (inflammation of the tongue). Riboflavin deficiency may also cause seborrheic dermatitis cataract formation and decreased neurotransmitter function.

CAUSES OF DEFICIENCY | A number of factors can lead to increased loss, or poor absortion of riboflavin including: poor diet, liver and endocrine disorders, and chronic diarrhea.

POPULATION AT RISK OF DEFICIENCY

  • Oral contraceptive pills decrease absortion of riboflavin.

NAME | B3 NIACIN


ACTIVE FORMS | Nicotinic acid, nicotinamide, Inositol, hexaniconicotinate

RECOMMENDED DIETARY ALLOWANCE | 16/14 mg (men/women)

SIGNS OF DEFICIENCY | One of the most well characterized B-vitamin deficiencies is that of niacin. This is due to the fact that it can rapidly develop into a disease known as pellagra, characterized by dermatitis, insomnia, diarrhea, weakness, progressive cognitive decline and eventually death.

CAUSES OF DEFICIENCY | A deficiency in the essential amino acid tryptophan and vitamin B2 can cause a niacin deficiency. This is because vitamin B2 helps convert tryptophan into niacin.

POPULATION AT RISK OF DEFICIENCY

  • Traditionally, high corn diets were associated with niacin deficiency. However, any restrictive diets can result in the deficiency. Alcoholics, and individuals undergoing long term chemotherapy regimes and dialysis are at higher risk for deficiency.

NAME | B5 PANTETHINE


Pantothenic acid

RECOMMENDED DIETARY ALLOWANCE | 5 mcg (men/women)

SIGNS OF DEFICIENCY | Symptoms of vitamin B5 deficiency are widespread due to the fact that it is required to produce a very important cellular energy molecule called coenzyme CoA. Symptoms of the deficiency can appear to be excessive stress or “burnout”, depression, fatigue, insomnia, and even parasthesias (burning and tingling in feet).

CAUSES OF DEFICIENCY | The formation of pantethine in the body is carefully regulated and reaches a maximum at a certain level. In some people, this level is not high enough for optimal health. Deficiency may also be due to high levels of biotin competing for absorption.

POPULATION AT RISK OF DEFICIENCY

  • Severe malnutrition, diets with highly processed, frozen and canned foods have less B5.
  • Oral contraceptive pills increase B5 requirements.

NAME | B6 PYROXIDINE


Pyridoxal-5′-phosphate (P-5-P; P5P)

RECOMMENDED DIETARY ALLOWANCE | < 50 years old : 1.3 mg (men and women) , > 50 years old 1.7mg (men), 1.5mg (women)

SIGNS OF DEFICIENCY | P5P deficiency is associated with depression, irritability, confusion, and neuropathy. It can lead to anemia, dermatitis, hypertension, elevated levels of homocysteine and water retention, insomnia, premenstrual tension, muscle twitching, convulsions, and kidney stones.

CAUSES OF DEFICIENCY | While B6 deficiencies are rarer than others many drugs inhibit absorption including: anti-inflammatory, OCP, and drugs for treatment of Parkinsons disease.

POPULATION AT RISK OF DEFICIENCY

  • Alcoholics are at highest risk
  • Tuberculosis patients
  • Parkinson’s patients

NAME | B7 BIOTIN


RECOMMENDED DIETARY ALLOWANCE |30 mcg (men/women)

SIGNS OF DEFICIENCY | The most characteristic feature of a biotin deficiency is a facial rash (around the eyes, mouth and genitals). Biotin deficiency also appears as alopecia, conjunctivitis, dermatitis, and neurological symptoms such as numbness/tingling, visual changes.

CAUSES OF DEFICIENCY | May be due to high levels of Pantetheine competing for absorption. Biotin is also rapidly depleted by common anti-seizure medications. Avidin (found in egg whites) binds biotin and causes deficiency.

POPULATION AT RISK OF DEFICIENCY

  • Individuals who have been on feeding tubes for prolonged periods of time are often not having biotin added to formulas.
  • Diets with >10egg whites per day.
  • There are also a number of well-known metabolic disorders that block enzymes and transport of biotin.
  • Pregnant women also have a higher requirement for biotin and may become deficient if not supplemented.

NAME | B12 COBALAMIN


Cyanocobalamin, Methylcobalamin, Hydroxocobalamin, Adenosylcobalamin

RECOMMENDED DIETARY ALLOWANCE | 2.4 mcg(men/women)

SIGNS OF DEFICIENCY | A deficiency in vitamin B12 can cause:

  • Megaloblastic anemia
  • Cognitive changes and dementia
  • Fatigue
  • Peripheral neuropathies such as numbness tingling, tremors
  • High levels of homocysteine (ie. increased cardiovascular risk)
  • Depression and mood disturbances
  • Changes in gait
  • Poor balance
  • Susceptibility to infection and facial pallor

CAUSES OF DEFICIENCY | Poor diet, Impaired microbiota, Pernicious anemia, Malabsorption, Use of antacid medications.

POPULATION AT RISK OF DEFICIENCY

  • Elderly
  • Vegans (low methionine diets) and vegetarians
  • Chronic antibiotic use
  • Smokers
  • Crohn’s, Celiac, Ulcerative colitis or other malabsorption conditions
  • Genetic Factors

NAME | FOLATE


Folic Acid

RECOMMENDED DIETARY ALLOWANCE | 400 mcg (men/women)

SIGNS OF DEFICIENCY | Folate deficiency can cause a number of health problems with the most documented being neural tube defects in a developing fetus during pregnancy. Symptoms of folate deficiency include: weakness, fatigue, irritability, headaches, difficulties in cognitive function, mood imbalances, cramps, palpitations, shortness of breath, and can lead to more serious health problems.

CAUSES OF DEFICIENCY | Certain medical conditions can actually lead to secondary folate deficiencies through decreased absorption or an increase in the body’s demand for folate. These include alcoholism, Crohn’s disease, lymphoma or amyloidosis of the small intestine, diabetic enteropathy, gluten sensitivity, sickle cell disease, chronic exfoliative skin disorders, and of course, pregnancy.

POPULATION AT RISK OF DEFICIENCY

  • Smokers are particularly susceptible to deficiency.
  • Pregnant women also have a significantly greater need for sufficient amounts.

References

Shenkin A. Adult micronutrient requirements. In: Payne-James J, Grimble G, Silk D, editors. Artificial nutritionsupport in clinical practice. London: GMM; 2001:193–212.

Institute of Medicine. 1998. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: TheNational Academies Press. https://doi.org/10.17226/6015

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About The Author

ND, BSc, AOR Medical Advisor

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