Lucinda Harms, RPh, discusses vitamin B12 and folic acid deficiencies in people with celiac disease and offers supplement advice.
B12 and folic acid deficiencies may commonly occur in patients with celiac disease (CD). Vitamin B12 deficiency was considered to be infrequent as it affects different sections of the intestine than does celiac, but we now know that it is a very important deficiency in patients with CD. Studies have reported 8-41% of patients with CD suffer from a deficiency of B12. We need B12 to make red blood cells and when we have insufficient B12 to make red blood cells, we can feel weak and tired. A deficiency can also cause lightheadedness, pale skin, sore, red tongue or bleeding gums, upset stomach, weight loss, diarrhea or constipation. B12 may be taken sublingually (under the tongue) which avoids the issue of absorption in the intestines all together. This may be a preferred route in a patient with celiac disease, at least until the gut can heal, allowing for improved absorption. This is also a preferred route for people, as they age, who may have inadequate amounts of intrinsic factor in the stomach, which is necessary for the absorption of vitamin B12.
Folic acid is absorbed in the jejunum, where the initial sections can be inflamed by celiac disease, causing a deficiency due to malabsorption. It is critical to ensure that patients with celiac disease who are planning to become pregnant get sufficient folic acid because of the increased likelihood of neural tube defects with insufficient folic acid. Recent studies suggest that those being treated with proton pump inhibitors should use the methylated form of folic acid. This form is the form that the body can use and does not require activation. Mild folic acid deficiency may not produce any symptoms, but as folic acid deficiency progresses, the following common symptoms of anemia may develop: weakness, fatigue, lightheadedness, forgetfulness, irritability, pale appearance (pallor), lack of appetite and weight loss, and difficulty concentrating or focusing attention.
In good health,