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Diet and Nutrition

B12 and iron deficiency



I just had my blood work examined. My cells were normal sized, but I had an iron deficiency as well as a vitamin B12 deficiency. What created that "normal" size cell appearance were the shrunken iron deficient cells and the enlargement of the vitamin b12 cells. I have begun my B12 shots and iron supplementation.

My question is this, I have been informed that it is not common to have both deficiencies, have you had any experience with cases like this and what in the world would cause it other than my stomach doesn’t absorb B12? It seems like there is a deeper cause.

My mother had a vitamin B12 deficiency and she ended up with dementia at 57 that evolved into Alzheimer’s and she died at 67. I don’t want this to be my path as well.

Thank you.


Thanks for your question.  It is not uncommon to have 2 vitamin or mineral deficiencies at the same time.  Since food sources of iron (a mineral) and B12 (a vitamin) are very similar, it is very possible to be deficient in both.

Vitamin B12 is only found in animal foods (meat, poultry, fish, dairy products, eggs, etc).  If you are vegetarian or completely vegan, you are at higher risk for this deficiency.  Certain conditions also put you at higher risk for this deficiency. 

For example, if you take medications that affect stomach acid (such as TUMS or ulcer medications), absorption of B12 is decreased.  If you have had any type of gastric or intestinal surgery (such as gastric bypass), the absorption of this nutrient would also be affected.  Absorption of B12 occurs in the ileum- the lowest part of the intestine.  If you've had any type of surgical procedures involving the lower intestine, absorption would also be hindered.

Iron deficiency is more commonly seen than B12 deficiency and can occur due to poor diet, gastrointestinal bleeding (such as an ulcer), or gastric bypass surgery.  Excessive supplemental calcium (such as TUMS), can also bind iron.

Food sources of iron include meat, fish, poultry, eggs, iron fortified breads and cereals, black strap molasses, dried fruit such as raisins and green leafy vegetables.  Eating foods high in vitamin C (such as strawberries, bell peppers, tomatoes or citrus fruit or juice) along with iron fortified foods, will enhance the absorption of iron.

I am sorry to hear of your mother's dementia.  Vitamin B12 is often checked in the elderly as deficiency can cause memory loss and confusion.  It sounds as though your doctors are treating your deficiencies appropriately.  Best of luck.

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Response by:

Lisa Cicciarello Andrews, MEd, RD, LD Lisa Cicciarello Andrews, MEd, RD, LD
Adjunct Faculty
University of Cincinnati