Question

Suzzie is a 40-year-old black lawyer. She leads an active life and uses oral contraceptives. She works out regularly and eats a very low-fat diet to manage her weight. She and her husband want to start a family. Her blood tests indicate that she has a low folate level. She has a light breakfast of fruit, a lunch of a sandwich and coffee, and a dinner of a green salad, pasta, fruit, and milk. She comes into your office for advice on how to improve her diet. What recommendations do you have for her as her nutritional counselor? • What are your concerns about her diet • What additional information do you need? • In what way could she improve her vitamin intake? • Would a supplement be useful?

Answer 1

Anemia is a condition that happens when you don’t have enough red blood cells to carry oxygen to your body’s tissues. One reason could be that you don’t have enough hemoglobin to make red blood cells. That’s a protein in red blood cells that helps carry oxygen throughout the body. You can also become anemic by not getting enough folate (vitamin B9), the natural form of folic acid found in food.

What Causes It?

You can get folic acid deficiency anemia a few different ways. Here are some examples:

You don’t eat enough foods that contain folic acid. This is the case for most people. You might not be eating enough foods like leafy green vegetables, beans, citrus fruits, or whole grains.

You drink a lot of alcohol. Over time, this makes it harder for your intestines to absorb folate.

You have stomach problems. When your small intestine isn’t working the way it should, your body has a hard time hanging on to as much folate as it needs. For instance, people with celiac disease are at risk for this type of anemia. People with cancer are, as well.

You’re pregnant. A growing baby absorbs lots of folic acid from its mother.

Symptoms of folic acid deficiency

• Poor growth
• Smooth, red and painful tongue
• Stomach and intestinal problems e.g. diarrhoea, constipation
• No appetite
• Fatigue / tiredness

Foods rich in folic acid

Meat	Legumes	Starches	Fruit and Vegetables
liver (best source)	dried beans	wholegrain breads	spinach
chicken giblets	lentils	wheat flour	beetroot
kidney	peas (dhals)	potato	brussels sprouts
egg yolk	soya products	sweet potato	broccoli
	almonds		cabbage
	nuts		asparagus
			banana
			oranges
			peaches

Important Guidelines

• Include more foods that are high in Folic Acid in the diet
• Fruit and vegetables should be eaten raw whenever possible as cooking destroys Folic Acid
• Avoid alcohol in the diet as it leads to Folic Acid deficiency
• Pregnant women have higher requirements for Folic Acidand should take Folic Acid supplement
• Increase the use of wheat flour and soya flour in baking and food preparation

Causes of vitamin B₁₂ Deficiency

• Eating a diet that contains no meat or animal products
• Poor absorption due to certain disease conditions or survey
• Surgery to the stomach or intestine
• Oral contraceptives (the "pill")
• Smoking

Symptoms of Vitamin B 12 Deficiency
Similar symptoms to that of Folic Acid deficiency (see above) including:

• Nerve damage
• Numbness in hands and feet
• Tingling (pins and needles) in hands and feet
• weakness in legs
• Pale skin

  Foods rich in Vitamin B₁₂
  Meat: liver (best source); beef/mutton; chicken; pork/ham; fish; whole egg

  Dairy products: milk; cheese; yogurt

  Important Guidelines

• Include more foods high in Vitamin B₁₂ in the diet.
• Liver should be included more often in the diet as it is an excellent source of Vitamin B₁₂, Folic Acid, iron and other important nutrients.
• Strict vegetarians, who do not have dairy products, may require Vitamin B₁₂ supplements