Last month I provided an overview about taking vitamins. What are vitamins and what are the circumstances in which people might develop deficiencies?  

Today, I would like to give some interesting case studies that will highlight some vitamin scenarios that are commonly encountered in the general population.

Case No. 1: A 46-year-old woman began to feel numbness in her hands as well as general fatigue. She also began to experience muscle cramps in her arms and legs. These symptoms had been occurring over a six-month time frame. She went to have an examination with her doctor and blood testing was done. The test showed that she had low blood calcium level, which was responsible for her symptoms.  

Further evaluation showed that her Vitamin D level was extremely low. She was prescribed Vitamin D3 and after a period of several weeks her symptoms resolved. In this case, the Vitamin D deficiency was the cause of the low blood calcium level, which was responsible for her symptoms.

There are very few foods that naturally contain Vitamin D. Fatty fish and eggs are good sources of Vitamin D. In general, sun exposure and eating foods that are fortified with Vitamin D are the main ways we get Vitamin D. The recommended dietary allowance for Vitamin D is 600 to 800 international units daily, depending on one’s age.

Case No. 2: A 58 -year-old man who was previously in good health, began experiencing falls, dizziness, fatigue and weakness over a 10-month time frame. He was a vegetarian. His family also noticed that his behavior had changed and he was increasingly irritable and emotional. He was brought in to see his doctor and during the examination it was noticed that his balance was impaired and he had an abnormal gait.

Blood testing was done which showed the following abnormalities: red blood cell, white blood cell and platelet counts were low. Further testing showed that the Vitamin B12 blood level was extremely low.

He was treated with Vitamin B12 and showed an improvement over four months, and he eventually returned to his previous level of functioning.

Vitamin B12 deficiency is most commonly caused by poor absorption and/or inadequate intake; B12 is found in liver, milk, fish, eggs and red meat. The human body needs vitamin B12 in order to manufacture healthy red blood cells as well as nerve cells. When a B12 deficiency occurs, a person may develop anemia because of impaired red blood cell production, and nerve problems because of faulty synthesis of myelin which coats nerve cells and allows them to function normally. The RDA for vitamin B12 is 2.4 – 2.8 micrograms per day; but many people need a much larger amount due to absorption problems or poor dietary intake.

Case No. 3: A 75-year-old woman reported that she developed decreased vision in her right eye about two weeks previously. She also reported that there was a black spot close to the center of her vision. She also noticed that her vision was blurry in the right eye. She went to an eye doctor who performed an examination and diagnosed her with age-related macular degeneration.

She was treated with an AREDS vitamin formulation, which consists of a combination of vitamins A, C, E and zinc and copper. This specific combination of vitamins have been shown to decrease the progression of age related macular degeneration.

This installment is a brief glimpse of some of the possible vitamin scenarios that occur commonly in clinical practice. As mentioned previously, it is best to check with your physician to see if you are at risk for developing a vitamin deficiency, or if you have any symptoms that could be benefited by taking vitamins.

Dr. Mark Roth writes about medicine for the Cleveland Jewish News. He is an internal medicine physician with University Hospitals.

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