Vitamin deficiency anemia is a lack of healthy red blood cells caused when you have lower than normal amounts of certain vitamins. Vitamins linked to vitamin deficiency anemia include folate, vitamin B-12 and vitamin C.

Vitamin deficiency anemia can occur if you don't eat enough foods containing folate, vitamin B-12 or vitamin C, or it can occur if your body has trouble absorbing or processing these vitamins.

It's important to have your doctor diagnose and treat your anemia. Vitamin deficiency anemia can usually be corrected with vitamin supplements and changes to your diet.

Signs and symptoms of vitamin deficiency anemia include:

• Fatigue
• Shortness of breath
• Dizziness
• Pale or yellowish skin
• Irregular heartbeats
• Weight loss
• Numbness or tingling in your hands and feet
• Muscle weakness
• Personality changes
• Unsteady movements
• Mental confusion or forgetfulness

Vitamin deficiency usually develops slowly over several months to years. Vitamin deficiency signs and symptoms may be subtle at first, but they increase as the deficiency worsens.

Vitamin deficiency anemia develops when your body has a shortage of the vitamins needed to produce enough healthy red blood cells. Red blood cells carry oxygen from your lungs throughout your body.

If your diet is lacking in certain vitamins, vitamin deficiency anemia can develop. Or vitamin deficiency anemia may develop because your body can't properly absorb the nutrients from the foods you eat.

Causes of vitamin deficiency anemias include:

Folate deficiency anemia

Folate, also known as vitamin B-9, is a nutrient found mainly in fruits and leafy green vegetables. A diet consistently lacking in these foods can lead to a deficiency.

Deficiency can also result if your body is unable to absorb folate from food. Most nutrients from food are absorbed in your small intestine. You might have difficulty absorbing folate or folic acid, the synthetic form of folate that's added to foods and supplements, if:

• You have a disease of the small intestine, such as celiac disease
• You've had a large part of the small intestine surgically removed or bypassed
• You drink excessive amounts of alcohol
• You take certain prescription drugs, such as some anti-seizure medications

Pregnant women and women who are breast-feeding have an increased demand for folate, as do people undergoing dialysis for kidney disease. Failure to meet this increased demand can result in a deficiency.

Vitamin B-12 deficiency anemia

Vitamin B-12 deficiency can result from a diet lacking in vitamin B-12, which is found mainly in meat, eggs and milk.

However, the most common cause of vitamin B-12 deficiency anemia is a lack of a substance called intrinsic factor, which can be caused when your immune system mistakenly attacks the stomach cells that produce this substance. This type of anemia is called pernicious anemia.

Intrinsic factor is a protein secreted by the stomach that joins vitamin B-12 in the stomach and moves it through the small intestine to be absorbed by your bloodstream. Without intrinsic factor, vitamin B-12 can't be absorbed and leaves your body as waste.

People with endocrine-related autoimmune disorders, such as diabetes or thyroid disease, may have an increased risk of developing pernicious anemia.

Vitamin B-12 deficiency anemia can also occur if your small intestine can't absorb vitamin B-12 for reasons other than a lack of intrinsic factor. This may happen if:

• You've had surgery to your stomach or small intestine, such as gastric bypass surgery
• You have abnormal bacterial growth in your small intestine
• You have an intestinal disease, such as Crohn's disease or celiac disease, that interferes with absorption of the vitamin
• You've ingested a tapeworm from eating contaminated fish. The tapeworm saps nutrients from your body.

Vitamin C deficiency anemia

Vitamin C deficiency can develop if you don't get enough vitamin C from the foods you eat. Vitamin C deficiency is also possible if something impairs your ability to absorb vitamin C from food. For instance, smoking impairs your body's ability to absorb vitamin C.

Certain chronic illnesses, such as cancer or chronic kidney disease, also increase your risk of vitamin C deficiency anemia by affecting the absorption of vitamin C.

A number of factors can affect your body's vitamin stores. In general, your risk of vitamin deficiency is increased if:

• Your diet contains little to no natural vitamin food sources, such as meat, dairy, fruits and vegetables. Vegetarians who don't eat dairy products and vegans, who don't eat any foods from animals, may fall into this category.

  Consistently overcooking your food also can cause vitamin deficiency.

• You're pregnant, and you aren't taking a multivitamin. Folic acid supplements are especially important during pregnancy.
• You have intestinal problems or other medical conditions that interfere with absorption of vitamins. Abnormal bacterial growth in your stomach or surgery to your intestines or stomach can interfere with the absorption of vitamin B-12.
• You abuse alcohol. Alcohol interferes with the absorption of folate and vitamin C, as well as other vitamins.
• You take certain prescription medications that can block absorption of vitamins. Anti-seizure drugs can block the absorption of folate. Antacids and some drugs used to treat type 2 diabetes may interfere with B-12 absorption.

Being deficient in vitamins increases your risk of many health problems, including:

Pregnancy complications

Pregnant women with folate deficiency may be more likely to experience complications, such as premature birth. A developing fetus that doesn't get enough folate from its mother can develop birth defects of the brain and spinal cord.

If you're thinking of becoming pregnant, ask your doctor whether you should consider taking folic acid supplements so that your body's stores of folate will be enough to support your baby.

Nervous system disorders

While vitamin B-12 is important for the production of red blood cells, it's also important for a healthy nervous system.

Untreated, vitamin B-12 deficiency can lead to neurological problems, such as persistent tingling in your hands and feet or problems with balance. It can lead to mental confusion and forgetfulness because vitamin B-12 is necessary for healthy brain function.

Without treatment for vitamin B-12 deficiency, neurological complications can become permanent. Vitamin B-12 deficiency can cause these and other health problems before it leads to anemia.

Scurvy

Vitamin C deficiency can lead to scurvy. Signs and symptoms of this rare disease include bleeding under the skin and around the gums.

Choose a healthy diet

You can prevent some forms of vitamin deficiency anemias by choosing a healthy diet that includes a variety of foods.

Foods rich in folate include:

• Dark green leafy vegetables
• Nuts
• Enriched grain products, such as bread, cereal, pasta and rice
• Fruits and fruit juices

Foods rich in vitamin B-12 include:

• Eggs
• Fortified foods, such as breakfast cereals
• Milk, cheese and yogurt
• Meat and shellfish

Foods rich in vitamin C include:

• Broccoli
• Citrus fruits and juices
• Strawberries
• Green peppers
• Tomatoes

Most adults need these daily dietary amounts of the following vitamins:

• Vitamin B-12 — 2.4 micrograms (mcg)
• Folate or folic acid — 400 mcg
• Vitamin C — 75 to 90 milligrams

Pregnant and breast-feeding women may require more of each vitamin.

Consider a multivitamin

If you're concerned about getting enough vitamins from the food you eat, ask your doctor whether a multivitamin may be right for you. Most people get enough vitamins from the foods they eat. But if your diet is restricted, you may wish to take a multivitamin.

Don't smoke

Smoking interferes with the absorption of nutrients, such as vitamin C, so it can raise your risk of a vitamin deficiency.

If you smoke, quit. If you don't smoke, don't start. If you've tried to quit on your own and haven't been successful, talk with your doctor about strategies to help you quit.

Drink alcohol in moderation, if at all

Alcohol can contribute to vitamin deficiency anemia. If you choose to drink alcohol, do so in moderation. For healthy adults, moderate drinking is generally considered to be:

• Two drinks a day for men age 65 and younger
• One drink a day for men older than age 65
• One drink a day for women of any age

A drink is 12 ounces (355 milliliters) of beer, 5 ounces (148 milliliters) of wine or 1.5 ounces (44 milliliters) of 80-proof distilled spirits.

Doctors diagnose vitamin deficiency anemias through blood tests that check:

• The number and appearance of red blood cells. People with anemia have fewer red blood cells than normal.

  In vitamin deficiency anemias related to a lack of vitamin B-12 and folate, the red blood cells appear large and underdeveloped. In advanced deficiencies, the numbers of white blood cells and platelets also might be decreased and look abnormal under a microscope.

• The amount of folate, vitamin B-12 and vitamin C in your blood. Folate and vitamin B-12 levels are measured at the same time because these deficiencies can cause similar signs and symptoms.

Additional tests for B-12 deficiency

If blood tests reveal a vitamin deficiency, your doctor may perform other tests to determine the type and cause, such as:

• Antibodies test. Your doctor may draw a sample of your blood to check for antibodies to intrinsic factor. Their presence indicates pernicious anemia.
• Methylmalonic acid test. You may undergo a blood test to measure the presence of a substance called methylmalonic acid. The level of this substance is higher in people with vitamin B-12 deficiency.

Treatment for vitamin deficiency anemia includes supplements and changes in diet.

Folate deficiency anemia treatment

Treatment involves eating a healthy diet and taking folic acid supplements as prescribed by your doctor. In most cases, folic acid supplements are taken orally.

Once your body's level of folate increases to normal, you may be able to stop taking the supplements. But if the cause of your folate deficiency can't be corrected, you may need to take folic acid supplements indefinitely.

Sometimes folate deficiency and B-12 deficiency occur at the same time. Treatment of the folate deficiency without treatment of the vitamin B-12 deficiency may make your symptoms worse.

Vitamin B-12 deficiency anemia treatment

If you have pernicious anemia, injections of vitamin B-12 are recommended for treatment. If you and your doctor consider your taking vitamin B-12 supplements orally, you'll need careful monitoring by your doctor.

If you have vitamin B-12 deficiency due to other causes, such as vitamin B-12 not being absorbed because of gastric bypass surgery, vitamin B-12 injections also are usually recommended.

At first, you may receive the shots as often as every other day. Eventually, you'll need injections just once a month, which may continue for life, depending on your situation.

For milder cases of vitamin B-12 deficiency, treatment may involve changes to your diet and vitamin B-12 supplements in pill form or as a nasal spray.

Vitamin C deficiency anemia treatment

Treatment for anemia related to vitamin C deficiency is with vitamin C tablets. Additionally, you increase your intake of foods and beverages that contain vitamin C.

If you suspect that you have vitamin deficiency anemia, you're likely to start by seeing your family doctor or a general practitioner. However, in some cases, you may be referred to a doctor who specializes in treating blood disorders (hematologist).

Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications as well as any vitamins or supplements you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. For vitamin deficiency anemia, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Could anything else be causing my symptoms?
• Is my condition likely temporary or long lasting?
• What treatment do you recommend?
• Are there any alternatives to the approach that you're suggesting?
• I have another health condition. How can I best manage these conditions together?
• Are there any foods I need to add to my diet?
• Are there any brochures or other material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment anytime that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did you begin experiencing symptoms?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Are you a vegetarian?
• How many servings of fruits and vegetables do you usually eat in a day?
• Do you drink alcohol? If so, how often, and how many drinks do you usually have?
• Are you a smoker?