ND 240: Exam 3

Vitamin D and Folic Acid

According to DGA 2020-2025 US intakes of these vitamins often fall below recommended intakes

vitamin

essential, noncaloric organic nutrient needed in tiny amount sin the diet

Vitamins Role

hlep make possible th eprocesses by which other nutrients are digested absorbed and metabolized or built into body structure

Vitamin A, Vitamin D, Vitamin E, Vitamin K

- found in fats and oils of foods

- require bile for absorption

fat soluble vitamins

B-Vitamins

Thiamin (B1)

Riboflavin (B2)

Niacin (B3)

Folate

Vitamin B12

Vitamin B6

Biotin

Pantothenic acid

Vitamin C

Vitamin Precursors

some vitamins occur in foods as these, once inside the body they are transformed chemically to one or more active forms

- transformed into active vitamins by the body

- to measure vitamin fund in food, number of true vitamins plus vitamin potentially available from its precursors

Solubility

- determines how body will absorb, transport, and store vitamins

Fat-Soluble Vitamins

Like other lipds, are mostly absorbed into the lymph and they travel in the blood and within the cells is association with protein carriers

- can be stored in liver with other lipids in fatty tissues

- needed in peirodic doses

Water-soluble vitamins

-absorbed directly into blood stream, travel freely, most not stored in tissues, risk of toxicities not as great

- needed frequently

fat-soluble vitamin dficiencies

- occur in people who undergo intestinal surgery - reduced energy nutrient absorption

- malabsorption also prevents bile production - can cause loss of vitamins dissolved in undigested fat

Fat-Soluble Vitamins Toxicities

- capacity to be stored sets stage for toxic build up

- vitamin a from high dose supplements and highly fortified foods is especially likely to reach toxic levels

Vitamin A

- first fat soluble-vitamin to be recognized

Three Active Forms in the Body

- retinol - stored in specialized cells of the liver

- liver makes retinol available to the bloodstream

- converts retinol two retinal and retinoic acid - animal foods

plant foods provide beta-carotene

Vitamin A Precursor

beta-carotene

roles of vitamin A

- sustain normal eyesight, maintenance of a healthy, clear cornea and in the the process of light perception at the retina

- vitamin A is part of rhodopsin molecule that is bleached when eye strikes the retina, vitamin A is broken off, initiating the signal that conveys the sensation of sight to the optic center in the brain

- vitamin a reunites with the pigment but a little vitamin a is destroyed each time this reaction takes place

- gene regulation:

Regulated by retinoic acid form of Vitamin A

Genes direct synthesis of proteins, including enzymes that perform the metabolic work of the tissues

Affects metabolic activities of array of tissues

Cell Differentiation:

Each type of cell develops to perform specific functions

Vitamin A is deficient, cell differentiation is impaired and goblet cells fail to mature, fail to make protective mucus ad eventually die off

Goblet cells are displaced by cells that secrete keratin, provides toughness in hair and fingernails, but in the wrong place such as skin and body linings, keratin makes the tissue surfaces dry, hard, and cracked

As dead cells accumulate on the surface, tissue becomes vulnerable to infection

In lungs displacement of the goblet mucus producing cells makes respiratory infections

Same for urinary tract

Immune Function

"anti-infective" - many of the body's defense against infection depend on an adequate supply

Without sufficient vitamin A, these genetic interactions produce an altered response to infection that weakens the body's defenses

Measles

Reproduction and Growth:

Men: participates in sperm development

Women: supports normal fetal development during pregnancy, in developing embryo vitamin A is crucial for the formation of the spinal cord, heart and other organs

Vitamin A must be present for critical bone dismantling steps

Failure to grow is one of the

night blindness

- lag in the recovery of night vision, often indicates a vitamin A deficiency

- if vitamin A runs low, lag occurs before eye can see again after a flash of bright light at night

Xerophthalmia and Blindness

Keratin accumulates and clouds eye's outer vitamin A-dependent part of cornea (keratinization)

If not corrected it can be worsened to xerosis and then progress to thickening and permanent blindness, xerophthalmia

Vitamin A Deficiency:

250,000 to 500,000 fo the world's children suffer from obvious signs of vitamin A deficiency - night blindness, diarrhea, appetite loss, and reduced food intake - half of those lose sight die in the following year

250 million children suffer from milder deficiency that impairs immunity, leaving them go to infections

Vitamin A Toxicity:

In pregnant women, excessive vitamin A can injure the heart, spinal cord, and other tissues of a developing fetus, causing birth defects

Vitamin A Recommendations and Sources

Active form in animal sources or beta-carotene in plants

Beta-carotene in fruit and vegetables is harmless

DRI based on body weight:

Man 900 micrograms of active vitamin A

Women 700 micrograms

Tolerable Upper Intake Level - 3,000 micrograms

Found In:

Liver, fish oil, diary products - Vitamin A

Beta-carotene - fruits and vegetables, yellow coloring

1 oz of ordinary beef or pork liver delivers three times DRI for vitamin intake

- spinach, carrots, sweet potato, apricots

Beta-Carotene

- dietary antioxidant

- bright orange fruits and vegetables derive color from this

- deep greens get their color form blending of this with green leaf pigment chlorophyll

functional group of antioxidants

- beta-carotene, vitamin E, vitamin C

- antioxidant mineral: selenium

beta-carotene toxicity

-light-skinned people turn bright yellow because beta-carotene build up in fat just beneath the skin

- red colored carotenoids confer a rosy glow

beta-carotene food sources

- plants contain beta-carotene

- red beats, red cabbage, yellow corn, carrots

Vitamin D

With sunlight, the body can synthesize all it needs

In this sense, Vitamin D is not an essential nutrient

Many people may border on insufficiency

60 million people (18 percent of U.S) have low blood concentrations of vitamin D, more than 16 million have values low enough to make deficiency diseases likely to occur

DGA reports vitamin D nutrient of concern

Once in the body, vitamin D must undergo a series of chemical transformations in the liver and kidneys to be activate - once activated, vitamin D exerts profound effects on tissues

Vitamin D Role in Calcium Regulation

Member of large group of nutrients and hormones that interact to regulate blood calcium and phosphorus concentration - maintaining bone integrity

When blood calcium concentration begins to fall, vitamin D acts on three body locations to raise it. Vitamin D: - Stimulates intestinal track to increase absorption of calcium

Acts on skeleton, body's vast warehouse of stored calcium to release calcium into blood

Triggers the kidneys to recycle calcium that would otherwise be lost in urine

With these actions, normal blood calcium concentration is quickly restored

Vitamin D and calcium are inextricably linked - no matter how much vitamin D you take in, it cannot take the place of sufficient vitamin D for bone health

Functional Group for Bone Health Vitamins and Minerals

- Vitamin D, vitamin K, vitamin C

- Calcium, phosphorus, Magnesium, fluoride

Key Energy Nutrient for Bone Health

protein

Vitamin D Roles

Activated functions as a hormone

Vitamin D acts on the genetic level to affect how cells grow, multiply, and differentiate

Too Little Vitamin D in children

Rickets - abnormality of the bones, developed bowed legs because they are unable to mineralize newly forming bone material

DRI recommends to consume recommended amount of vitamin D to prevent

Deficiency in Adults of biological roles of osteocalcin and vitamin D

Osteocalcin: poor mineralization, bones become increasingly soft, flexible, weak, and deformed

Older people can suffer painful joints if their vitamin D concentrations are low

Inadequate vitamin D sets stage for a loss of calcium for the bones, which can result in fractures from osteoporosis

Likely to have low blood vitamin D values

People living in northern areas

Anyone lacking exposure to sunlight

Darker-skinned people, their breastfed infants, and their adolescent children

People with disorders that impede fat absorption

People with obesity or those who are overweight

- People who don't eat fish - vegans, milk allergy, lactose intolerance

Obesity effect on vitamin D

Impairs vitamin D status, and weight loss can help restore its normal levels

Fat-soluble vitamin D is taken up and sequestered in excess adipose tissue, thereby lowering the blood's vitamin D concentration

Weight loss reduces excess adipose tissue and restores vitamin D to the blood

Vitamin D excess

Most potentially toxic

Intoxication raises the concentration of blood calcium by withdrawing bone calcium, which can then collect in the soft tissues and damage them

Kidney and heart function decline, blood calcium spins further out of control

High blood calcium, nausea, fatigue, back pain, irregular heartbeat, and increased in urination and thirst

Sunshine Vitamin

When UV light rays from the sun reach a cholesterol compound in the human skin, the compound is transformed into a vitamin D precursor and is absorbed directly into the blood

Liver and kidneys finish converting inactive precursor to the active form of vitamin D

Darker skin people need 3 hours of direct sun

Light skin need 5 minutes

Vitamin D Recommendations:

1 to 70 need 15 micrograms

71 an dolder need 20 micrograms

UL = 100 micrograms (4,000IU)

Vitamin D Food Sources

Egg yoks, butter, cream, milk, orange juice, cereals, and margarines

Enriched cereal, sardines, salmon, sunlight, cod liver oil, fortified milk, tuna

Vitamin E

Tocopherol: compound in vegetable oil

Four tocopherol compounds are important in nutrition

Alpha, beta, gamma, and delta

Vitamin E Roles

Antioxidant and act as a bodyguard against oxidative damage

Damage occurs when highly unstable molecules (free radicals) formed during normal cell metabolism - can create a destructive chain reaction that can damage the polyunsaturated lipids in cell membranes and lipoproteins, DNA in genetic material, and working proteins of cells

Theory of Oxidative stress

- situation creates inflammation and cell damage associated with aging processes, cancer development, heart disease, diabetes, and other diseases

Vitamin E, being oxidized itself, quenches free radicals and reduces inflammation

Vitamin E protection is crucial primarily in lungs

RBC's need vitamin E's protection as they transport oxygen from the lungs to other tissues

WBC's that fight disease also depend on vitamin E, same as blood vessel linings, sensitive brain tissues, and even bones

Vitamin E Deficiency

Arises in conditions that impair fat absorption, such as cystic fibrosis because vitamin E dissolves in fat

Classic vitamin E deficiency occurs in babies before transfer of vitamins form mother

Without sufficient vitamin E, infant's red blood cells rupture (erythrocyte hemolysis) infant becomes anemic

Muscle coordination loss of normal coordination loss, loss of normal reflexes, and impaired vision and speech

Vitamin E Toxicity

Toxicity is rare

Vitamin E in supplements risk uncontrollable bleeding if they take vitamin E with some medication (anticoagulant)

Supplements of vitamin E prolong blood clotting times and increase risk of brain hemorrhages

Vitamin E recommendations

DRI 15 mg/day for adults

Tolerable Upper Intake Level - 1,000mg/day

Good Sources of Vitamin E

Safflower oil

Wheat germ

Canola Oil

Mayonnaise

Sunflower seeds

Vitamin E is easily destroyed by heat which is why raw oils and lightly processed vitamin E-rich foods are the best sources

Vitamin K Roles

Activate proteins that help clot the blood

Hospitals will administer vitamin K supplements to reduce bleeding during operation

Vitamin K is only of value in circumstances where a deficiency exists, does not improve clotting in those with other bleeding disorders

Necessary for synthesis of key bone proteins

Low blood vitamin K, bones produce an abnormal protein that cannot effectively bind the minerals that normally form bones

Vitamin K Deficiency

Few U.S. adults are likely to experience vitamin K deficiency, vitamin K can be obtained from a nonfood source - intestinal bacteria

Billions of bacteria normally reside in the intestines, and some synthesize vitamin K

Newborns are often given a dose of vitamin K at birth

Vitamin K Toxicity

Reports of vitamin K toxicity are rare, DRI has not set a UL

Induces breakage of the red blood cells and release their pigment, which colors kin yellow

Can cause the liver to release the blood cell ppigment billirubin into th eblood instead of excreting it into the bile and leads to jaundice

Vitamin K Requirements:

Men 120 micrograms/day

Women 90 micrograms/day

Good Sources of Vitamin K

Cabbage (steamed), spinach (steamed), soybeans (dry roasted), kale (cooked), asparagus (cooked), salad greens

Soybean, green, and black-eyed peas, split pea soup

Canola and soybean oils (Un hydrogenated liquid oils)

Water Soluble Vitamins

Vitamin C and B dissolve in water

In food, water-soluble vitamins easily dissolve and drain away with cooking water, and some are destroyed on exposure to light, heat, or oxygen during processing

In body, water-soluble vitamins are easily absorbed and just as easily excreted in the urine

No real storage tissues exist for any water-soluble vitamins

Are easily lost or destroyed

Don't have to worry about toxicity

Vitamin C

Scurvy - killed many members of a ship crew on a long voyage, lack of fresh fruits and vegetables

Absorbic acid - Vitamin C

DRI for Vitamin C

Men 90mg/day

Women 75mg/day

Smokers add 35mg/day

Vitamin C Tolerable Upper Intake Level

Adults 2,000mg/day

Functions of Vitamin C

Collagen synthesis (strengthens blood vessel walls, forms scar tissue, provides matrix for bone growth), antioxidant, restores vitamin E to active form, supports immune system, boosts iron absorption

Vitamin C Deficiency

Scurvy with pinpoint hemorrhages, fatigue, bleeding gums, bruises; bone fragility, joint pain, poor wound healing, frequent infections

Vitamin C Toxicity

Nausea, abdominal cramps, diarrhea, rashes; interference with medical tests and drug therpaies in susceptible people aggravation of gout or kidney stones

Good Sources of Vitamin C

Sweet Red pepper

Brussel sprouts

Grapefruit

Sweet Potato

Orange Juice

Green Pepper

Broccoli

Strawberries

Bok Choy

Roles of Vitamin C in the Body

Connective Tissue:

Enzymes involved in the formation and maintenance of the protein collagen depend on vitamin C for their activity

Vitamin C also participates in other synthetic reactions, production of carnitine (important compound for transporting fatty acids within the cells and in the creation of certain hormones

Antioxidant Activity

Protects substances found in foods and in the body from oxidation by being oxidized itself

Cells of immune system maintain high concentration of vitamin C to protect themselves from free radicals that they generate to use during assaults on bacteria and other invaders

In intestines, vitamin C protects iron from oxidation and promotes its absorption

Once in blood, vitamin C protects sensitive blood constituents from oxidation, reduce tissue inflammation, and helps to maintain the body's supply of vitamin E by protecting it and recycling it to its active form

Acts as a prooxidant by activating oxidizing elements, such as iron and copper

Vitamin C Supplements in Curing a Cold

Research fails to support this believe

Sufficient vitamin C is important to certain white blood cells of the immune system that act as primarily defenders against infection

Vitamin C Deficiency Symptoms and Intakes

Symptoms can be attributed to the breakdown of collagen in absence of vitamin C: loss of appetite, growth cessation, tenderness to touch, weakness, bleeding gums, loose teeth, swollen ankles and wrists, tiny red spots on the skin where blood has leaked out of capillaries

Anemia - vitamin C helps absorb and use iron

People who smoke or have low incomes are at risk for deficiency

Vitamin C Toxicicty

Vitamin C in pill form can lead to huge doses, can lead to altered insulin response to carbohydrates

Scurvy symptoms include anemia, pinpoint hemorrhages, and pian

Who Should Avoid Vitamin C Supplements

People taking anticlotting medications - may counteract drugs effect

Kidney disease tendency toward gout

Abnormal vitamin C metabolism is prone to form kidney stone

Adverse effects: nausea, abdominal cramps, excessive gas, and diarrhea

Vitamin C Upper Limite

2,000mg

Vitamin C DRI

90 mg men

75 mg women

Smokers

125mg men

110 mg women

Foods that Supply Vitamin C

Fruits and vegetables

Orange juice, Salad, broccoli, Potatoe - 300 mg

Vulnerable to heat and destroyed by oxygen

Losses occur when food is cut, processed, and stored

White potatoes contribute significantly to vitamin C intakes, despite providing less than 10mg per half cup serving

B Vitamins

- B vitamins functions as part of coenzymes

• B1 (Thiamin): Helps convert carbohydrates into energy and supports nerve function. (Found in whole grains, pork, beans, and cereals) [1, 2, 3]

• B2 (Riboflavin): Aids energy metabolism and maintains healthy skin and vision. (Found in dairy, eggs, meat, and green vegetables) [1, 2, 3, 4]

• B3 (Niacin): Supports DNA repair and cellular energy production (high doses can cause temporary flushing). (Found in poultry, fish, meat, and grains) [1, 2, 3]

• B5 (Pantothenic Acid): Essential for synthesizing fatty acids and coenzymes involved in energy release. (Found in avocados, broccoli, meat, and whole grains) [1, 2]

• B6 (Pyridoxine): Involved in amino acid processing, immune function, and brain health (excessive long-term supplementation can cause nerve damage/neuropathy). (Found in poultry, fish, potatoes, and bananas) [1, 2, 3]

• B7 (Biotin): Helps metabolize fats, carbohydrates, and proteins. (Found in eggs, nuts, seeds, and sweet potatoes) [1, 2]

• B9 (Folate / Folic Acid): Crucial for DNA synthesis and prenatal nervous system development. (Found in leafy greens, beans, and fortified grains) [1, 2, 3, 4]

• B12 (Cobalamin): Necessary for red blood cell formation and neurological function. (Found almost exclusively in animal products and fortified foods, making supplementation important for vegans) [1, 2, 3, 4]

Coenzyme (B-vitamins)

small molecule that combines with an enzyme and activates it

Substance is attracted to active site and snaps into place, enabling reaction to proceed instantaneously

Shape of each enzyme give is specific job

Without coenzyme, it is useless

Roles of B vitamins

Energy Release and Protein Synthesis:

B vitamins do not directly supply body with energy

Helpers - B vitamins help body use macronutrients for fuel

Active forms of the B vitamins - thiamin, riboflavin, niacin, pantothenic acid, and biotin - participate in the release of energy from carbohydrate, fat, and protein

Vitamin B6 helps the body use amino acids to synthesize proteins; the body then puts the proteins to work in many ways - to build new tissues, make hormones, fight infections, or serve as fuel for the energy

Cell Replication

Folate and vitamin B12 help cells to multiply

Involved directly or indirectly in energy metabolism

B Vitamin Defecies:

Lack of energy

Every cell is affected

Nausea, severe exhaustion, irritability, depression, forgetfulness, loss of appetite and weight, pain in muscles, impairment of the immune response, loss of control of the limbs, abnormal heart action, severe skin problems, swollen red tongue, cracked skin at corners of the mouth, teary or bloodshot eyes

Digestive tract and blood are damaged

In children, full recovery may be impossible - permanent brain damage

Thiamin

Critical role in energy metabolism of all cells

Occupies special site on nerve cell membranes

Nerve processes and their repsonding tissues, muscles depend heavily on thiamin

Deficiency:

Beriberi

Deficiency Today:

Wernicke-Korsakoff Sindorf: alcohol abuse - impairs absorption of thiamin from digestive tract and hastens its excretion in the urine

Apathy, irritability, mental confusion, disorientation, memory loss, jerky eye movements, staggering gait

Thiamin DRI

Men 1.2mg/day

Women 1.1 mg/day

Good Sources of Thiamin

Enriched pasta, pork chop, green peas, waffle, enriched wheat bagel, enriched cereal, sunflower seeds, baked potatoe, black beans

Pregnant and lactating demand more thiamin

Effects of Food Processing on Vitamins:

Canned or Forzen

After harvest, cellular enzymes in fruits and vegetables continuously break down vitamins, causing significant losses over time

Freezing slows enzymatic breakdown and preserves almost all vitamins present at harvest

Canning - heating process denatures enzymes and stop enzymatic vitamin destruction, also destroys a small amount of vitamins

Commercial Processing

Commercial frying destroys all vitamin E in oil

Extrusion: used to make many ultra-processed foods look pretty and taste delicious but exposure to the heat and oxidation destroys 30 percent of vitamin A, 50 percent of vitamin K and 90 percent of vitamin C

Prevent enzymatic destruction:

Refrigerate most fresh fruit, vegetables and juices to slow breakdown of vitamins

Store milk and enriched grain products in opaque containers to protect riboflavin form light, which destroys it

Store cut fruit and vegetables in refrigerator in airtight wrappers

Prevent heat destruction or losses:

Wash intact fruit and vegetables before cutting or peeling

Cook fruit and vegetables in a microwave oven, or quickly stir fry or steam them to preserve heat-sensitive vitamins

Recapture dissolved vitamins by using cooking water for soups, stews, or gravies

Avoid high temperatures and long cooking times

Riboflavin:

Coenzymes in energy metabolism pathways of all cells

When thiamin is deficient riboflavin may be lacking too

Riboflavin deficiency symptoms:

cracks at corners of mouth, sore throat, hypersenstivity to light may go undetected

Tracked in children who diets lack milk and meat products

Riboflavin Recommendations

Recommendations:

UV light and irritation destroy riboflavin

Milk is sold in carboard or opaque containers

Riboflavin DRI

- men 1.3 mg/day

Women 1.1 mg/day

Riboflavin Sources

- Beef liver, cottage cheese, enriched cereal, spinach, milk, plain yogurt, pork chop, mushrooms

Niacin

Participates in energy metabolism of every cell

Niacin Deficiency

Pellagra

Symptoms known as four D's:

Diarrhea, dermatitis, dementia, and ultimately death

Niacin Pharmacology and Toxicity

Niacin is relatively harmless, but large doses have been associated with liver injury, digestive upset, impaired glucose tolerance, serious infection, muscle weakness, and rarely, vision disturbances

Niacin "

Key nutrient that but any protein containing sufficient amounts of tryptophan well serve in its place

A person eating adequate protein, will not be deficient in niacin

Coenzymes help with energy metabolism

Niacin Equivalents:(NE)

measure that takes available tryptophan into account

Niacin DRI and UL

Men: 16mg/day

Women 14mg/day

Tolerable Upper Intake Level

35mg/day

Niacin Toxicity

Painful flush, hives, and resh, excessive sweating; blurred vision; liver damage, impaired glucose tolerance

Sources of Niacin

Chicken breast, pork chop, baked potato, peanuts, tuna, enriched cereal, mushroom

Folate:

To make new cells, tissues must have the vitamin folate

Each new cell must be equipped with the new genetic material - copies of the parent cell's DNA

Folate helps synthesize DNA and regulate its activities - also participates in the metabolism of vitamin B12 and several amino acids

Folate Deficiency:

Dietary pattern too low in folate or illness that impair folate absorption, increase folate excretion, require medication that interacts with folate, increases the body's folate need

Anemia

Immature red and white blood cells and the cells of the digestive tract divide most rapidly and therefore are most vulnerable to folate deficiency

Definicies of folate cause anemia, impaired immunity, and abnormal digestive function

Malabsorption because the two vitamins work as teammates in producing red blood cells

Folate and Cancer:

Research links a chronic deficiency of folate with greater risks for developing breast cancer, prostate cancer, and other cancers

Research also suggests that high dose from supplements may speed up cancer

Folate and Drug Interactions

Folate is most likely of al vitamins to interact with medications

Drugs, even aspirin, have been shown to interfere with the body's use of folate

Folate Enrichment

By consuming enough folate before and during pregnancy a woman can reduce her child's risk of having a neural tube defect (NTD)

NTD range from slight problems in the spine to intellectual disabilities severely diminished brain size, and death shortly after birth

Arise in first days or weeks of pregnancy, long before most women suspect they are pregnant

Most young women eat too few fruits and vegetables to supply even half the folate they need

FDA ordered all enriched grain products to be fortified with and absorbable form of folate, folic acid

Folate Toxicity/UL

UL = 1,000 micrograms/day

Folate make a subclinical deficiency of vitamin B12

Folate Recommendations

DRI healthy adults 400 micrograms per day

Adive all women of childbearing age to consume 400 micrograms of folic acid form supplements or enriched foods

Folate Food Sources

Leafy green vegetables, spinach, turnip greens, legumes, asparagus, beef liver, pinto beans, avocado, lentils, enriched cereal, beets

Heat and oxidation destroy folate in foods, lightly cooked fresh vegetables are the best

Vitamin B12

Closely related to folate

Functions as part of coenzymes needed in cell replication and it helps maintina the protective sheath that surround and protect nerve fibers, allowing them to function properly

Vitamin B12 Deficiency

Without sufficient vitamin B12, folate fails to do its blood-build work, so vitamin B12 deficiency causes an anemia identical to that caused by folate

Symptoms: presence of large, immature red blood cells

Administer of folate clears this up, but detection of B12 goes undetected

Damaged nerve sheaths, creeping paralysis, and general malfunctioning in the elderly, worsening dementia

B12 Malabsorption

Stomach produced too little acid to liberate vitamin B12 from food

Intrinsic facto: compound made by the stomach and needed for absorption is lacking

Once stomach acid frees vitamin B12 from the food, protein sthat bind it, intrinsic factor attaches to the vitamin and the complex is absorbed into the bloodstream

- Anemia of vitamin B12 deficiency caused by lack of intrinsic factor is known as pernicious anemia

B12 DRI

Adults 2.4 micrograms/day

B12 Deficiency

Pernicious anemia, Anemia (large cell), smooth tongue, tingling or numbness, fatigue, memory loss, disorientation, degeneration of nerves progressing to paralysis