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Posts Tagged ‘vitamin b12 levels’

Is it Pernicious Anemia or Multiple Sclerosis? Part 1

Thursday, February 28th, 2013



Pernicious anemia (PA) and multiple sclerosis (MS) are both autoimmune disorders that cause fatigue, chronic pain, and physical handicaps, but that is where their similarities end. If that’s the case, why are so many doctors quick to diagnose multiple sclerosis before testing for simple vitamin B12 deficiency from pernicious anemia?

Is it Pernicious Anemia or Multiple=

Pernicious anemia

Pernicious anemia (PA) is a medical condition that causes vitamin B12 deficiency. Over time, plummeting levels of vitamin B12 cause many debilitating symptoms- muscle pain, numbness, spasms, fatigue- all as a result of diminished red blood cells and impaired neurological functioning.

Without enough vitamin B12 in your system make plenty of healthy blood cells, you wind up feeling constantly tired, unfocused, disoriented, and depressed.

Vitamin B12 is also needed to produce myelin, a substance which protects your nerve cells from harm. That’s why pernicious anemia symptoms such as chronic pain, numbness, tingling in the arms and legs, and mobility difficulties may reveal a weakened nervous system caused by insufficient vitamin B12 levels.

Gradually, depleted vitamin B12 may cause further irreparable damage to the nervous system, in addition to increased risk for stroke, heart attack, and age-related dementia.

Only immediate vitamin B12 supplementation can reverse the symptoms of pernicious anemia, and prevent future relapses.

Multiple sclerosis

Multiple sclerosis also affects the nervous system, causing severe muscle pain, paralysis, and multiple neurological problems, some of which are similar to those experienced with pernicious anemia, only on a much higher level.  People with MS struggle to manage relapses their whole lives, as it is a chronic illness that is difficult to control.

While pernicious anemia is easily treated with strict vitamin B12 supplementation, multiple sclerosis is much harder to manage, requiring various medications formulated to relieve specific symptoms.

Pernicious Anemia Misdiagnosed as MS- It Happens!

What causes multiple sclerosis?

Scientists aren’t positive exactly what causes multiple sclerosis, but they do know that Caucasian females are the highest risk factor for MS.

Like pernicious anemia, multiple sclerosis symptoms may be part of an autoimmune disorder. Scientists believe that MS may be triggered by an infection, which the immune system begins to attack. After fighting off the infection, your body continues to attack, this time mistaking your nerve cells’ myelin- the same substance supported by vitamin B12- as a threat. So the cycle continues, creating damage to the central nervous system and prolonging debilitating symptoms of multiple sclerosis.

This article continues in Part 2, including symptoms of multiple sclerosis and diagnosis…

Your turn!

Do you have any questions or suggestions?  Please leave your comments below.

Share with your friends!

If you found this article helpful, then please share with your friends, family, and coworkers by email, Facebook, or Google+.

Like this? Read more:

Pernicious Anemia and Vitamin B12 Deficiency: Which Causes Which?

Can Vitamin B12 Repair Nerve Cells?

15 Chronic Pain Causes and 15 Treatments (Vitamin B12 is one)


Multiple Sclerosis Overview

Image courtesy of A Health Blog/flickr

Can Too Much Vitamin B12 be Harmful? 5 Vitamins to Watch Out for

Tuesday, March 13th, 2012



Is it possible to get too much of a good thing, like too much vitamin B12, or too much of any vitamin, for that matter?  Experts say yes- overdoing it on certain vitamins can cause vitamin toxicity, and the damage can range from annoying to severe.  So before you down a bottle of vitamin C for immune system health, have a look at what health experts have to say about vitamin B12 and others.

Vitamin B12- How much do you need?


Vitamin B12- What is it?

Vitamin B12 (cobalamin) is a water-soluble vitamin that occurs naturally in animal-based foods like beef, chicken, fish, eggs, and milk.  Vitamin B12 supports many vital bodily functions, like shielding your nerve cells through myelin production, maintaining healthy red blood cells, aiding in DNA synthesis, enhancing cognitive functioning, and increasing stamina.

If you don’t have enough vitamin B12 in your blood, then you may get vitamin B12 deficiency, which causes symptoms like

  • fatigue
  • depression
  • frequent forgetfulness
  • brain fog
  • low attention span
  • painful “pins and needles” and numbness in the hands and feet
  • stomach problems
  • decreased motor control
  • muscular weakness
  • impaired walking

Vitamin toxicity

According to the Institute of Medicine’s list of Tolerable Upper Intake Levels, certain vitamins like vitamin B12 are safe to take in mega doses, while other vitamins must be used in moderation.  Taking too much of a certain vitamin may result in stomach discomfort, birth defects, or organ damage, according to many published studies.

Below is a list of vitamins, including recommended daily amount and risks of vitamin toxicity:

Vitamin B12

There is no upper limit for taking vitamin B12, according to the Institute of Medicine.  That means that you can experiment with as much vitamin B12 as you like without causing any damage.  Any amount that your body doesn’t use is excreted with your urine.

How much vitamin B12 do you need? Scientific evidence suggests that even people who don’t have vitamin B12 deficiency gain enormous health benefits- increased energy and mental alertness- by taking generous doses of vitamin B12.

  • One clinical study focusing on high-dose vitamin B12 found that taking 2,500-5,000 mcg of vitamin B12 every few days led to a 50%-80% increase in stamina, mental focus, and overall wellbeing after only a few weeks.
  • In a double-blind crossover study on vitamin B12 for treating tiredness, people who suffered daily fatigue but didn’t have vitamin B12 deficiency or chronic fatigue syndrome (CFS) experienced a boost of stamina, enhanced concentration skills, and improved mood after taking 5,000 mcg of vitamin B12 twice daily for two weeks.
  • Another study on people who didn’t have low vitamin  B12 levels resulted in similar findings with varied doses of vitamin B12, from 3,000 mcg four times per week to 9,000 mcg daily.

Also read: Will Vitamin B12 Boost Energy if I don’t have B12 Deficiency? YES!

Vitamin A

The upper limit for vitamin A supplementation is 3,000 IU for adult males and females.  Health experts strongly advise meeting your vitamin A requirement through dietary sources like eggs, fortified milk, and liver, as opposed to pill form.  Unless you have vitamin A deficiency, a risk factor for Crohn’s disease and celiac disease, there is no need to supplement with extra vitamin A.


Vitamin A toxicity may result in:

  • Nausea
  • Vomiting
  • Dizziness
  • Headache
  • Blurred vision
  • Muscular weakness
  • Skin peeling
  • Liver fibrosis
  • Birth defects
  • Damage to the central nervous system
  • Osteoporosis
  • 18% increased risk for lung damage.

Vitamin C

The upper limit for vitamin C is 2,000 mg per day for adult males and females.  Food source of vitamin C include citrus fruits, broccoli, sweet potatoes, and bell peppers.  While vitamin C is essential for immune system health, there is inadequate scientific proof that taking extra amounts of vitamin C will help to ward off a cold or reduce cold symptoms.


Vitamin C toxicity may result in:

  • Diarrhea
  • Stomach cramps
  • Nausea
  • Flatulence
  • Kidney stones

Vitamin D

The Institute of Medicine recommends taking no more than 100 IU of vitamin D per day, unless you have vitamin D deficiency.  While it is not possible to get too much vitamin D from sun exposure, taking excess vitamin D in pill form may cause vitamin toxicity.


Vitamin D toxicity may result in:

  • Rapid uncontrolled weight loss
  • Polyuria (excess urine secretion)
  • Heart arrhythmias
  • Heart and kidney damage from excess calcium levels in the blood
  • Kidney stones

Vitamin E

The maximum daily dose of vitamin E is 1,000 IU for adult males and females.  Dieticians recommend getting your vitamin E from food sources like wheat germ, sunflower seeds, and broccoli, as opposed to taking vitamin E pills.

Can Too Much Vitamin B12 be Harmful? 5 Vitamins to Watch Out for

Vitamin E toxicity may result in:

  • Increased risk for hemorrhagic stroke
  • Osteoporosis

Please tell us…

Do you have vitamin deficiency, such as vitamin B12 deficiency or vitamin D deficiency? How has vitamin deficiency impacted your life, now that you have been diagnosed? Are you aware of any vitamin toxicity symptoms that are not included in this article?

Spread the love…

Know anybody who could be helped by this information?  Please share this article on Facebook, Google+, or by emailing a link.

We love to hear from you…please feel free to leave comments, suggestions, or questions below!

Read more about vitamin B12 deficiency:

Tired of being Tired all the Time…It’s Tiring!

Diagnosing Vitamin B12 Deficiency and Pernicious Anemia: Top 10 Tests

What are the Symptoms of Pernicious Anemia- B12 deficiency?


Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels, Vitamins

Dietary Supplement Fact Sheets

Vitamin B-12: placebo or neglected therapeutic tool?

A pilot study of vitamin B12 in the treatment of tiredness

Deficiencies You Can Deal With


YaiSirichai, winnond, Toa55, zirconicusso, healingdream

Diagnosing Vitamin B12 Deficiency and Pernicious Anemia: Top 10 Tests

Monday, February 27th, 2012



If you feel fatigued, and suspect B12 deficiency, then see your doctor immediately.  Before diagnosing vitamin B12 deficiency or pernicious anemia, your doctor will run a vitamin B12 blood test for vitamin B12 levels in your blood, in addition to measuring your red blood cells and homocysteine levels.  Here are ten tests still used today to diagnose vitamin B12 and pernicious anemia.


Vitamin B12 deficiency symptoms:

Vitamin B12 deficiency can be difficult to catch, because it masks itself as many other conditions.  Sometimes, B12 deficiency occurs as a secondary side effect of a primary illness like fibromyalgia, Crohn’s disease, or celiac disease.  Other times, vitamin B12 deficiency symptoms are overlooked because of underlying conditions such as depression or diabetes.

The most common symptoms of vitamin B12 deficiency and pernicious anemia are:

  • Constant fatigue that is not relieved by sleep and does not result from overexertion
  • Depression, long-term
  • Anxiety
  • Aggressive behavior that is unusual
  • Paranoia
  • Difficulty focusing or paying attention
  • Memory loss
  • Frequent forgetfulness
  • “Brain fog”
  • Forgetting words on “tip of tongue”
  • Forgetting numerical codes like phone numbers or PINs
  • Hallucinations
  • Painful tingling and numbness in extremities (hands, feet, arms, and legs)
  • “Pins and needles”
  • Painful tingling or burning sensation in tongue and mouth
  • Red, swollen tongue
  • Altered taste perception
  • Decreased balance and muscular coordination
  • Frequent stumbling and dropping things
  • Diarrhea
  • Sleep difficulties


What are the Symptoms of Pernicious Anemia- B12 deficiency?

10 Tests that diagnose vitamin B12 deficiency and pernicious anemia

1) Serum vitamin B12 level: First, your physician will request a vitamin B12 blood test to determine if your vitamin B12 blood (cobalamin) levels are indeed low.  Usually, if test results are positive, then vitamin B12 supplementation begins immediately. 

The vitamin B12 blood screening is the most important test for diagnosing vitamin B12 deficiency, and if you respond well to vitamin B12 supplements, then further testing is not usually required.

However, if your doctor suspects pernicious anemia, then he might order one or more of the following additional tests:

2) Complete blood count (CBC): A blood test to screen the amount of red and white blood cells.  With pernicious anemia, your red blood cells become engorged and misshapen, resulting in low distribution of red blood cells throughout your body.

3) Serum folate level:  Many people who have vitamin B12 deficiency also are deficient in the B vitamin folate.

4) Serum  lactate dehydrogenase (LDH): Your doctor might order a blood test measuring LDH levels.

5) Reticulocyte count: This test looks for reticulocytes (slightly immature red blood cells).

6) Homocysteine test:  High homocysteine levels in your blood may indicate vitamin B12 deficiency, folate deficiency, or vitamin B6 deficiency.

7) Gastrin level: a test measuring the amount of the hormone gastrin in your blood may help doctors diagnose the cause of vitamin B12 deficiency.

8) Methylmalonic acid (MMA) test- With vitamin B12 deficiency, methylmalonic acid levels go up.  The MMA test provides more proof of the existence of vitamin B12 deficiency.

9) Intrinsic factor antibody test:  Pernicious anemia is an autoimmune disorder in which sufferers are not able to product intrinsic factor, a necessary hormone for absorbing vitamin B12.  Before diagnosing pernicious anemia, your doctor has to confirm the existence of an antibody in your system that inhibits intrinsic factor production, thereby causing vitamin B12 deficiency.

10) Bone marrow staining: Sometimes, your physician might require a bone marrow biopsy in order to determine other potential causes of pernicious anemia or general red blood cell disorders.


Do you have Franken-DNA from Pernicious Anemia?

What about the Schilling test for vitamin B12 deficiency?

In the past, doctors have used the Schilling test to diagnose vitamin B12 deficiency.  The Schilling test involves swallowing harmless, radioactive doses of vitamin B12 and tracking its progress in your body.  However, because it involves fasting and the use of low-dose radiation, and because it may cause side effects like nausea, the Schilling test is rarely used.

Schilling test—a test in which a harmless amount of radiation is used to assess whether a vitamin B12 deficiency exists (rarely used)

Vitamin B12 supplementation

Once diagnosed with vitamin B12 deficiency, your doctor will likely prescribe vitamin B12 shots, beginning with 1000 mcg of vitamin B12 per week. 

These B12 shots are only available upon prescription.

  • After the first month, B12 shots may be decreased to once per month, upon doctor’s orders.
  • If B12 deficiency symptoms (fatigue, muscular pain, and brain fog) continue despite vitamin B12 injections, you may supplement with additional over-the-counter (OTC) vitamin B12.
  • Once your vitamin B12 levels are normal, your doctor will likely stop vitamin B12 shots in favor of OTC vitamin B12.
  • Sublingual vitamin B12 are an OTC option that may require supplementation two or three times per day.  Side effects may include unpleasant taste and burning, tingling sensation on the tongue.
  • Note: Sublingual vitamin B12 must be dissolved under the tongue as indicated; if they are chewed or swallowed, then vitamin B12 will not be absorbed.

Please tell us…

  • Aside from taking the blood test for vitamin B12, have you received any of the other tests mentioned?
  • Please share your experience with vitamin B12 supplementation.
  • We welcome all comments, questions, or suggestions!

Spread the love…

Please share this article with your friends, family, or anybody you care about!

Read more about vitamin B12 deficiency and pernicious anemia:

WhichTests check Absorption of Vitamin B12?

Vitamin B12- How much do you need?


Anemia – B12 deficiency

Vitamin B12 Deficiency Anemia – Exams and Tests

Vitamin B12 Deficiency


ZaldyImg, takacsi75

Four Reasons to check your Vitamin B12 Levels with Crohn’s Disease

Monday, February 20th, 2012



If you suffer from Crohn’s disease, then check your vitamin B12 levels often.  One side effect of Crohn’s is pernicious anemia from vitamin B12 deficiency, in addition to Crohn’s symptoms like stomach cramping, diarrhea, and vomiting.

Not surprisingly, there are several reasons why vitamin B12 deficiency occurs with Crohn’s disease.  Here are the four top reasons to check your vitamin B12 levels if you suffer from inflammatory bowel disease (IBD).

Four Reasons to check your Vitamin B12 Levels with Crohn’s Disease

1- Symptoms of Crohn’s disease

Crohn’s disease, sometimes called ileitis, is an illness of the gastrointestinal (GI) tract that damages the bottommost part of the small intestinal, the terminal ileum.  Symptoms of Crohn’s disease include chronic diarrhea caused by swelling of the small intestine, excruciating stomach cramps caused by intestinal strictures, fever, weight loss, and rectal bleeding.

The ileum is an important part of your digestive system for vitamin B12 absorption- without it, your body would be unable to extract vitamin B12 (cobalamin) and dispense it into your blood supply.  

If Crohn’s disease has caused irreparable inflammation of your terminal ileum, you are at high risk for symptoms of vitamin B12 deficiency.

Vitamin B12 deficiency symptoms include:

  • Chronic fatigue
  • Depression
  • Anxiety
  • Short-term memory loss
  • Difficulty concentrating
  • Unclear thinking, or “brain fog”
  • Muscular twitching
  • Painful tingling and numbness in hands and feet
  • Sore, red tongue
  • Burning mouth sensations
  • Frequent clumsiness and stumbling

Once vitamin B12 deficiency is diagnosed, you may choose to take vitamin B12 shots, which are only available upon prescription.

2- Crohn’s disease medications

Whenever digestive disorders are present, vitamin B12 levels are low.  Certain medicines used to treat Crohn’s disease may cause symptoms that typically interfere with vitamin B12 absorption, such as diarrhea, vomiting, and acid reflux. 

These medications often include anti-inflammatory drugs such as mesalamine medicines and immune system suppressors, such as Methotrexate (Rheumatrex).

Crohn’s- 9 Irritable Bowel Disease (IBD) Myths to Ignore

Only vitamin B12 supplements that bypass the digestive system can provide the benefits of vitamin B12.

Left untreated, pernicious anemia from B12 deficiency can cause neurological damage, osteoporosis, and in extreme cases, death.

3- Gastrointestinal (GI) surgery

FOUR REASONS TO CHECK YOUR VITAMIN B12 LEVELS WITH CROHN’S DISEASE, B12 PATCHAny GI surgery that involves removal or reduction of the ileum results in vitamin B12 deficiency.  In Crohn’s disease, resection surgeries such as ileostomy necessitate lifelong supplementation of prescribed vitamin B12 shots.

Similarly, gastric bypass patients can no longer digest vitamin B12 in the stomach, and must get vitamin B12 injections indefinitely.

Sometimes, even routine vitamin B12 shots don’t provide full relief from  B12 deficiency symptoms like fatigue, depression, nerve pain, and brain fog. 

In such cases, many opt for nonprescription OTC vitamin B12 for extra energy and mental stamina between vitamin B12 jabs.

4- Crohn’s and diet

People suffering from IBD (Crohn’s disease, ulcerative colitis) are required to follow restrictive diets excluding many foods that may irritate the digestive system.  Fruits and vegetables that are uncooked may be red flag items, in addition to food sources of vitamin B12, such as meat, poultry, fish, milk, and eggs.

Ten Foods to avoid if you have Inflammatory Bowel Disorder

Additionally, stomachaches, nausea, and diarrhea make it hard for Crohn’s disease sufferers to eat nutritious, filling meals.  As a result, people with Crohn’s often suffer from excess weight loss and malnourishment.

One of the leading types of malnourishment today is pernicious anemia from vitamin B12 deficiency.

Besides Crohn’s disease patients, other people at risk for vitamin B12 deficiency are:

  • Diabetics on metformin
  • GERD patients using protein pump inhibitors (PPIs)
  • Patients with secondary gastrointestinal symptoms, such as fibromyalgia, celiac disease, autism, or migraine sufferers
  • Gastric bypass patients
  • Elderly individuals
  • Alcoholics
  • Vegans

Please tell us…

Are you a Crohn’s disease patient?  If so, what vitamin B12 supplements do you use?

Please tell us if you have found this article helpful and informative.  As always, we welcome your comments!

Spread the love…

Please share this article with your friends, family, or anybody you care about!

Read more about vitamin B12 deficiency and Crohn’s disease:

Gastrointestinal Surgery for Crohn’s (IBD) and B12 Warnings

Gut Bugs:Winning the Bacteria Battle


Crohn’s Disease – National Digestive Diseases Information Clearinghouse

Crohn’s Disease- MayoClinic.com


Wikimedia, photl, Fotolia.com

Brain Drain Medications- Drugs that Drain the B12 out of you

Monday, November 21st, 2011



You might not realize this, but your prescription medications could be giving you vitamin B12 deficiency; certain drugs drain B12 from your system and prevent you from absorbing vitamin B12- cobalamin- naturally from food sources.  If you currently take any of the following medications, then you could be at risk for severe neurological damage.


Who is at risk for getting vitamin B12 deficiency?

Vitamin B12 is a water-soluble vitamin that occurs naturally in most animal protein sources; beef, chicken, turkey, fish, shellfish, mussels, eggs, milk, cheese, and yogurt are all rich in this essential B vitamin.  Unless you follow a vegan diet, you probably ingest sufficient amounts of B12.

However, there are certain conditions, demographics, and lifestyle choices that can inhibit your body’s ability to absorb vitamin B12, regardless of how many hamburgers you eat.  They are:

  • Being among the elderly
  • Suffering from gastrointestinal disease, such as Celiac, Crohn’s, or Irritable Bowel Syndrome (IBS)
  • Submitting to bariatric surgery
  • Lacking the ability to produce intrinsic factor, a hormone that aids in vitamin B12 absorption
  • Suffering from fibromyalgia, or other autoimmune diseases


Here’s Your Brain on B12 Deficiency- Memory Loss and Aging

Which medications deplete vitamin B12 levels?

Certain medications may prevent your body from digesting vitamin B12- heartburn drugs, for example.  If you experience symptoms such as chronic fatigue, memory loss, depression, brain fog, tingling or prickly sensations in your hands and feet, or altered sense of taste, you might have depleted your stores of vitamin B12.  The only way to be certain is to get your vitamin B12 levels checked with a blood screening.


The following prescription drugs drain vitamin B12:

Anti-inflammatory medications

  • Beclomethasone
  • Budesonide
  • Dexamethasone
  • Fluticasone
  • Hydrocortisone
  • Methylprednisolone
  • Mometasone Furoate
  • Prednisone
  • Triamcinolone

Antibiotic medications

  • Aminoglycosides
  • Cephalosporin
  • Chloramphenicol
  • Macrolides
  • Penicillin Derivatives
  • Quinolones
  • Sulfa drugs
  • Tetracycline Derivatives

Anticonvulsant medications

  • Phenobarbital


  • Ethinyl Estradiol and Desogestrel
  • Ethinyl Estradiol and Levonorgestrel
  • Ethinyl Estradiol and Norethindrone
  • Ethinyl Estradiol and Norgestimate

Cholesterol lowering medications

  • Cholestyramine
  • Colestipol

Diabetes medications

  • Metformin

Gout medications

  • Colchicine

Heart medications

  • Potassium Chloride

Proton pump inhibitors- heartburn drugs

  • Lansoprazole
  • Omeprazole

Ulcer medications

  • Cimetidine
  • Famotidine
  • Nizatidine
  • Ranitidine Bismuth Citrate
  • Ranitidine Hydrochloride

Read more about preventing vitamin B12 deficiency:

Low B12 means Low Thyroid- Hypothyroidism and B12 Deficiency


Drugs that Deplete: Vitamin B12 (Cobalamin)

Dietary Supplement Fact Sheet: Vitamin B12

Image credits, from top:

Pixomar, africa, Ambro, TeddyBear[Picnic]

Vegetarian Diets, Pregnant Women and Vitamin B12

Wednesday, June 9th, 2010

A study done in Germany demonstrates that pregnant vegetarian women may not have an adequate supply of vitamin B12. This study was performed at the German Institute of Human Nutritrion in Postdam-Rehbrücke located in Nuthetal, Germany.

Vitamin B12 is only found naturally in foods derived from animal sources. However, many women are opting to restrict themselves to diets of predominantly plant origin in the belief that this will increase their lifespan and reduce the likelihood of death from heart disease.

Many pregnant vegetarians are choosing to include eggs and milk in their diets to supply them with vitamin B12, which is necessary for proper nerve formation in the fetus. Hence, their diet is referred to as the “lacto-ovo-vegetarian diet.” This particular study in Germany was done in reaction to other studies that showed that infants born to mothers on strictly vegetarian (vegan) diets were deficient in vitamin B12.

A woman who is B12 deficient is at a greater risk during pregnancy for pre-eclampsia and other pregnancy-related complications. Furthermore, the fetus is at greater risk for neural tube defects. A breast-fed infant of such a woman has a greater likelihood for developmental abnormalities and growth failure.

The purpose of the study in Germany was just to compare the blood plasma vitamin B12 levels of women who ate a traditional western diet (meat eaters) with women on a vegan diet and ovo-lacto-vegetarian diet.

Over one hundred pregnant women were recruited for the study and divided into three groups: The ovo-lacto-vegetarian group, the low-meat eater group, and the control group. The ovo-lacto-vegetarians were women who never ate meat at all in the three years prior to the study. The women in the control group were not on any diet (regular meat eaters). Blood samples were taken from all the women throughout their pregnancies.

As far as Body Mass Index (BMI) is concerned, the vegetarians and low-meat eaters had lower pre-pregnancy BMIs than the control group (meat eaters).

With regard to B12 concentrations, the vegetarian and low-meat eaters had much lower levels of vitamin B12.  There was not much difference between the vegetarian and the low-meat eaters groups.

In summary, the study demonstrates that women on vegetarian diets are at greater risk for a B12 deficiency, thus placing their infants at a greater risk for neural tube defects.

If you are pregnant and do not eat much meat, it is highly recommended that you supplement your diet with vitamin B12.

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