Vitamins and minerals are nutrients your body needs to produce blood cells, maintain healthy bones and nerves, support the immune system, generate energy, and perform many other important functions.
 

Vitamin D Deficiency

Vitamin D helps the body absorb calcium and phosphorus and is important for maintaining healthy bones and muscles. It also aids in brain, nerve, and immune function.
 

What Causes Vitamin D Deficiency?
 

• Poor intake (fatty fish; egg yolks; fortified milk, juice, and cereals)

• Chronic kidney disease — the kidneys are responsible for converting vitamin D into its active form; advanced kidney disease can interfere with normal vitamin D metabolism.

• Chronic liver disease — can interfere with vitamin D metabolism.

• Celiac disease — intestinal damage can reduce absorption of vitamin D.

• Crohn's disease — particularly with significant small-intestinal disease or resection 

• Exocrine pancreatic insufficiency/chronic pancreatitis — poor fat digestion can reduce absorption of fat-soluble vitamins, including vitamin D.

• Bariatric surgery — can reduce vitamin D and calcium absorption.

• Obesity — vitamin D deficiency is more common because vitamin D becomes distributed into a larger amount of body tissue.

• Limited sunlight exposure

• Older age — the skin becomes less efficient at producing vitamin D.

• Certain medications — chronic glucocorticoid/steroid use, some anti-seizure medications (phenytoin, phenobarbital, and carbamazepine)

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What Are the Symptoms?
 

• Bone pain

• Muscle weakness

• Increased risk of fractures

• Loss of bone mineral density

• Rickets in children (bowed legs)

What are some diagnostic tests for it?
 

-25-hydroxyvitamin D [25(OH)D] blood test
-May cause low calcium levels

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Vitamin B12 Deficiency

Vitamin B12 is necessary for:

• Red blood cell production

• DNA synthesis

• Nerve function

The body stores relatively large amounts of vitamin B12, so deficiency may develop gradually.

What Causes B12 Deficiency?

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• Atrophic gastritis — reduced stomach acid and changes in the stomach lining can interfere with release and absorption of B12, iron from food. Usually caused by H. Plyori, autoimmune conditions)

• Crohn's disease involving the terminal ileum — B12 is absorbed primarily in the terminal ileum.

• Celiac disease and other significant malabsorption disorders

• Bariatric surgery

• Removal of part of the stomach or terminal ileum

• Certain other gastrointestinal disorders

• Vegan diets or poor intake of animal foods. 

• Medications (PPIs (Nexium, Protonix), H2 blockers (Pepcid), metformin)

What Are the Symptoms of B12 Deficiency?
 

• Fatigue

• Weakness

• Pale skin

• Shortness of breath with exertion

• Sore or smooth tongue

• Numbness or tingling

• Balance problems

• Difficulty walking

• Memory or cognitive changes
   

What are some diagnostic tests for it?
 

• CBC (possibly macrocytic anemia)

• Serum vitamin B12, if borderline then methylmalonic acid and homocysteine 

-Intrinsic-factor antibodies or anti-parietal cell antibodies if autoimmune atrophic gastritis, pernicious anemia suspected

-A normal CBC does not completely exclude B12 deficiency

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Iron Deficiency
 

Iron is required to produce hemoglobin, the protein within red blood cells that carries oxygen throughout the body. Iron deficiency can exist before anemia develops.

What Causes Iron Deficiency?
 

• Heavy menstrual bleeding

• Gastrointestinal bleeding from peptic ulcers
   

• Poor intake (red meat, seafood, fortified foods)

• Gastritis

• Gastrointestinal cancers

• Colon polyps or other sources of intestinal bleeding

• Inflammatory bowel disease

• Celiac disease — can impair iron absorption and may occasionally present primarily as unexplained iron deficiency.

• Bariatric surgery

• Other gastrointestinal malabsorption disorders

• Pregnancy

• Medications (acid-reducers, NSAIDs, anticoagulants, antiplatelets

What Are the Symptoms of Iron Deficiency?

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• Fatigue

• Weakness

• Reduced exercise tolerance

• Shortness of breath with activity

• Dizziness

• Headaches

• Palpitations

• Pale skin

• Craving and chewing ice

• Restless Legs

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What are some diagnostic tests for it?

-Complete Blood Count (possibly hypochromic, microcytic anemia)​
-Iron Panel (low ferritin...)

Thiamine (Vitamin B1) Deficiency

What are some contributing factors?
 

• Chronic alcohol use

• Poor intake

• GI malabsorption disorders

• Loop diuretics

What are the symptoms of B1 Deficiency?
 

• Wernicke Encephalopathy (confusion, ataxia - trouble walking, ophthalmoplegia - eye muscle weakness)

• Korsakoff Syndrome - advanced stage with severe memory loss

• Dry beriberi - peripheral neuropathy (muscle weakness, numbness or tingling)

• Wet beriberi - heart failure
   

What are some diagnostic tests for it?

-fasting whole-blood thiamine specialized test

Folate (Vitamin B9) Deficiency
 

Folate is important for DNA synthesis and normal red blood cell production.

What causes B9 Deficiency?
 

• Poor dietary intake (eggs, leafy greens)

• Excessive alcohol use

• Malabsorption

• Pregnancy

• Certain medications (methotrexate)

• Increased physiological requirements

What are the symptoms of B9 Deficiency?
 

• Fatigue

• Weakness

• Pale skin

• Shortness of breath, particularly with activity

• Dizziness or lightheadedness

• Headaches

• Rapid heartbeat or palpitations

• Sore, red, or smooth tongue (glossitis)

• Mouth sores

• Reduced appetite

• Irritability or difficulty concentrating

What are some diagnostic tests for it?

-CBC
-Fasting serum folate
-Sometimes homocysteine and methylmalonic acid

Magnesium Deficiency

Magnesium serves many funuctions in the body, especially related to the heart, muscle, nerve, metabolism, and more.  

What causes Magnesium Deficiency?
 

• Chronic diarrhea

• Persistent vomiting

• Crohn disease

• Celiac disease

• Other malabsorption disorders

• Excessive alcohol use

• Poor nutritional intake (seeds, nuts, whole grains, leafy greens)

• Certain kidney disorders that cause excessive urinary magnesium loss

• Uncontrolled diabetes with significant urinary losses

• Medications - Loop diuretics (furosemide), thiazide diuretics (hydrochlorothiazide), chronic proton-pump inhibitors (Protonix, Nexium), certain chemotherapy medications (cisplatin), certain immunosuppressive medications (tacrolimus and cyclosporine)
   

What are the symptoms?
 

• Muscle cramps

• Weakness

• Tremor

• Abnormal heart rhythms

• Numbness or tingling

• Seizures in severe cases
   

What are some diagnostic tests for it?

-usually blood magnesium level
-maybe low calcium and potassium levels

Calcium Deficiency
 

Calcium is essential for bone health, muscle contraction,​ nerve transmission, and heart function. 

What causes Calcium Deficiency?
 

• Vitamin D deficiency

• Parathyroid disorders

• Chronic kidney disease

• Severe magnesium deficiency

• Certain medications (Bisphosphonates and Denosumab)

• Some acute illnesses

What are the symptoms of Calcium Deficiency?
 

• Tingling around the mouth

• Numbness or tingling of the hands and feet

• Muscle cramps or spasms

• Abnormal heart rhythms

• Seizures in severe cases

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