Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency
Recent NHS figures have brought a startling revelation to light – more than 800,000 patients were admitted to hospitals with malnutrition and nutritional deficiencies in 2022, highlighting a growing crisis in health and diet within England and Wales.
The comprehensive study shed light on the escalating issue of nutrition-related hospital admissions, which have surged by over 39 percent in the last decade.
Among these, the deficiencies in three crucial nutrients – iron, vitamin B12, and vitamin D – stand out due to their severe impact on health and wellbeing.
Contrary to what might be assumed, these deficiencies are not the result of an increase in meat and dairy-free diets but coincide with a stark rise in food insecurity.
Recent surveys by the Food Foundation reveal a grim picture of hunger and skipped meals – 5.9 percent of adults went a whole day without eating due to budget constraints, 15 percent skipped meals, and 21 percent of households with children experienced food insecurity.
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Cold hands and feet can be a sign of iron deficiency (Image: GETTY)
So, what are the signs of deficiency and what can we do to avoid low intakes of these nutrients in our diet to avoid becoming part of this silent epidemic?
Iron
There’s been an overall 5 percent reduction in iron intake over the past 20 years. During the last decade, teenagers failing to achieve the Lower Recommended Nutritional Intake (LRNI) has dropped from 32 percent to 24 percent and the number of women failing to achieve the LRNI of iron has gone from 27 percent to 25 percent, according to the survey.
Iron is important for making haemoglobin, a protein contained in red blood cells that transports oxygen around the body. If you do not have sufficient iron, then you will not be able to produce enough healthy red blood cells, and this can lead to a condition called anaemia.
Iron plays a role in the development and efficiency of the immune system. Having adequate iron in your diet helps to ensure the proliferation and maturation of immune cells such as lymphocytes which are needed to help fight infections. A study including over 1,400 people found that iron deficiency was an independent predictor of respiratory tract infections like the common cold and that postoperative infections, including those of the urinary tract, were more common amongst people with low levels of iron.
Signs of deficiency
Cracking lips, thinning hair, white spots on nails, split brittle nails, recurrent mouth ulcer, sore tongue, cold hands and feet, dizziness, tiredness, recurring colds during the winter months.
Sources of iron
Liver, kidney, meat, dried fruit, fortified breakfast cereals, beans, eggs, wholegrains such as brown rice, most dark leafy green vegetables.
Expert verdict
Nutritionist Rob Hobson said: “A lack of iron is among the most common mineral deficiencies. The most absorbable form is the haem iron found in meats and seafood which is incorporated into protein. Plants provide iron in a non-haem form whose absorption is boosted by vitamin C. The EU recommended intake for iron is 14 mg per day. Try Healthpan’s Ironcare, (120 tablets £7.95) a stomach-friendly 14mg daily that also has the added benefits of B vitamins and copper and vitamin C to help with absorption. Women with heavy periods, or who feel tired all the time, may benefit from a blood test to see if they need an iron supplement.”
Mouth ulcers can be a sign of vitamin B12 deficiency (Image: GETTY)
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Vitamin D
Vitamin D deficiency is common in the UK and particularly during the winter months when the exposure to adequate sunlight is limited. The National Diet and Nutrition Survey showed around one in six adults in the UK have low levels of vitamin D in their blood. Some groups of the population are at greater risk than others such as pregnant and breastfeeding women, young children under five, people over the age of 65 and those with darker skin tones such as African, African-Caribbean, and South Asian.
Current recommendations advise that everyone consider taking a daily vitamin D supplement of 10 micrograms from October to March to help avoid deficiency and keep bones and muscles healthy. Vitamin D is available in different forms such as drops, sprays, or capsules and tablets (for example, Healthspan Vitamin D3, 10mcg 240 tablets £9.95).
Lack of vitamin D is associated with reduced bone mineralisation and bone thinning/deformity diseases such as rickets in children and osteopenia and osteoporosis in adults. Vitamin D is needed for the absorption of calcium into bones to keep them strong. This is especially important for children and teenagers as they are laying the foundation of their bone density during this age.
Signs of deficiency
Rickets (children), bone pain, muscle pain, osteomalacia (adults bone softening), increased sensitivity to pain, tingly ‘pins and needles’ sensation in hands and feet, muscle cramps, depression.
Sources of vitamin D
The richest dietary source of vitamin D3 is oily fish (salmon, mackerel, herring, and sardines). Some is also found in eggs, dairy products, meat, and fortified foods. Mushrooms exposed to UV light supply small amounts of vitamin D2.
Expert verdict
Rob said: “Low levels of vitamin D are common in the UK during the winter months so I would always recommend taking a supplement. There are some foods you can include in your diet to increase your intake, but they are limited. Try including a serving of enriched mushrooms daily which can be added to all sorts of dishes (breakfast with eggs is a good option) and eat two servings of oily fish each week.”
Vitamin B12
According to figures found in the National Diet and Nutrition Survey around 6 percent of adults have blood serum levels low enough to indicate deficiency. Those at particular risk of deficiency include vegans and vegetarians because natural foods sources are limited to animal foods which is why they are recommended to supplement their diet. An example of this is Viridian B12 liquid, 50ml,100 percent fermented active ingredients £7.95 www.viridian-nutrition.com.
This essential vitamin is used in the conversion of food into energy and is required by the body to make healthy red blood cells and prevents against a type of anaemia called megaloblastic anaemia.
It also helps to keep your nervous system healthy through its role in maintaining the nerve covering called the myelin sheath. Evidence from animal and human studies shows that B12 also has neuroprotective and anti-inflammatory properties, and intervention studies in humans have reported beneficial effects of better B12 status or B12 therapy in multiple sclerosis, Parkinson’s disease, myalgic encephalomyelitis, autism.
Signs of deficiency
Brain fog, memory problems, cognitive impairment, insomnia, depression, irritability, fatigue, anaemia, muscle weakness, mood swings, tingly ‘pins and needles’ sensation in hands and feet. Mouth ulcers, disturbed vision, sore red tongue.
Sources include
Meat, fish, shellfish, poultry, liver, milk, eggs, cheese, yeast extract (marmite), fortified breakfast cereals and some plant-based milk alternatives.
Expert verdict
Rob Hobson said: “A lack of vitamin B12 in the diet is a key concern for those who avoid animal foods so I would always recommend taking a supplement or seeking out fortified foods to include in the diet. The EU recommended intake for iron is 1.5 mg per day. People over 65 may also want to keep a check on their levels of B12 especially if they are experiencing symptoms such as tiredness, fatigue, mood swings or memory recall issues.”