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The biological consequences of
malnutrition are an important public health problem; Vinicus et al. stated that
undernutrition is ‘affecting more 900 million individuals around the world.’1 Folate and vitamin B12 are important in the diet of
growing and matured individuals; as they regulate levels of homocysteine, which
can be converted to methionine, an amino acid, and latter can be used in the
formation of proteins in the body. These natural molecules are significant for
the development and maintenance of biological functions in the human body.

Folate is a salt of folic acid, it is
a B vitamin that is a vital factor in the synthesis of DNA and RNA in the
making of nucleic acid.2 It is naturally present in an abundance of
food such as citrus fruits, bread, and leafy green vegetable, making it an
easily accessible nutrient for many individuals. The British Dietetics
Association states the importance of folate in the body is linked to the
production and repair of DNA and RNA, aiding in the cell cycle and replacement
of cells, such as red blood cells. Folate has been implicated in memory
improvement and further evidence has seen that it can also protect heart
health.3 Due to being a water-soluble vitamin, folate cannot be
stored in fat cells, this means that an individual must maintain an intake of
folate in their diet.4 Causes of folate deficiency include dietary
neglect, blood disorders (such as sickle cell anaemia and chronic
myelosclerosis), and excessive urinary excretion from conditions such as acute
liver damage and chronic dialysis. Genetic factors may also play a factor; as a
mutation in the SLC46A1 gene leads to folate transporter deficiency.5 The
impact on the body from folate deficiency can lead to anaemia- a condition described
as the number of functional red blood cells is below normal in the blood6 –
where an individual can experience tiredness, feeling faint, and becoming
easily breathless; which are common symptoms associated with the deficiency. Less
common effects on the body include headaches, heart palpitations, and suffering
from tinnitus.7 Long term effects can lead to complications of the
nervous system, infertility development, and serious hearing conditions.8

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Vitamin B12 is a nutrient that aids
also in the production of nucleic acids; B12 helps in the formation and maintenance
of blood cells and nerve tissues.9 Dr Group states in an article
focusing on the functions of vitamin B12, as vitamin B12 has also been
described to be essential for the production of energy, as it provides energy
for cells, ensuring there is an adequate balance for the day.10 The
vitamin has also been associated with the formation of neurotransmitter,
serotonin, which plays an important role in the regulation of mood, and
therefore lack of B12 can lead to depression as found in a study of diabetic
patients.11 Vitamin B12 interactions with folate play an important
role in the regulation of homocysteine levels and protection against heart
disease.12 Pernicious anaemia, an autoimmune disease that cause the
immune system to attack the cells in the stomach-that produces a factor called
intrinsic factor that aids in the absorption of vitamin B12-is known as a common
cause of vitamin B12 deficiency; other causes such as Crohn’s disease also
affects the lining of the intestines from absorbing vitamin B12 due
inflammation.13 A deficiency of B12 is linked to anaemia and
psychological problems more common in older individuals. Cognitive and
behavioural changes from disorders such dementia, paranoia, and depression are
common with vitamin B12 deficiency. Neurological changes may occur with
patients feeling weakness and extreme fatigue, and tingling in the feet and
hands. 14 These changes result in permanent alterations that cannot
be easily reversed. Skin lesions and hyperpigmentation have been related to
decreased levels of B12. Mori and Ando (2001) investigated the case of a
forty-nine-year-old man, where histology had shown an increase of melanin in
the basal layer; that was later corrected with vitamin B12 supplementation.15
Long term effects of this deficiency ensure a permanent interference of nerve
activity and destruction of the myelin sheath, this damage would still present
even after treatment of vitamin B12 deficiency, as supplementation with B12
cannot repair the damage of the myelin sheath.16

            Homocysteine
is an amino acid present in the blood plasma, produced as a by-product from the
consumption of meat.17 Homocysteine is broken down and converted
into cysteine, that can be used as an amino acid during protein synthesis.
Cysteine is used as an anti-oxidant and involved in the folding and shape
maintenance of proteins; it also plays a part in metabolic reactions of
different metals in the body such as iron, zinc, and copper.18
Folate and vitamin B12 work together to ensure the levels of homocysteine are
regulated in the blood, high levels of homocysteine are associated with
decreased levels of folate and B12; as these levels are controlled in an individual’s
diet, it has commonly been linked to malnutrition. A genetic MTHFR (methylenetetrahydrofolate
reductase) mutation could also be a cause of high homocysteine levels, this affects folate and vitamin B12 interaction pathway
required to lower the homocysteine levels, as the genes change the way
individuals are able to metabolize and convert the needed nutrients and vitamins
in their diet. Other causes of these elevated levels of this amino acid are
renal diseases and thyroid hormones. Major heart diseases, including coronary
heart disease and high blood pressure, are linked to high homocysteine levels,
due to the hyperhomocysteinemia causing blood clotting, increased inflammation,
and blockage of arteries.19 Cognitive disorders, especially in older
patients, are symptoms of the elevated levels, including Alzheimer’s disease
and dementia. Children with high homocysteine levels have a greater risk for
skeletal and anatomical development abnormalities; behavioural and learning
disabilities may also occur, such as ADHD and autism.20

 

            Both folate
and vitamin B12 play important role in several biological functions and one of
these functions is maintaining a low level of homocysteine as high levels of
latter have been linked to several diseases such as diabetes, rheumatoid arthritis, and high blood pressure.21
Though they work together to maintain a healthy body, they all
have different functions to make certain those multiple diseases and disorders previously
mentioned are at a lower risk of developing. This keeps the human body a
healthy functioning system without serious biological consequences occurring.

 

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References:

1.      
Martins VJB, Toledo Florêncio TMM, Grillo LP,
Franco Mdo CP, Martins PA, Clemente APG, et al. Long-Lasting Effects of
Undernutrition. Int J Environ Res Public Health Internet. 2011 cited 2017
Oct 26; 8(6):1817-46. Available from: http://dx.doi.org/10.3390/ijerph8061817.
DOI:10.3390/ijerph8061817

2.      
Medical Definition of Folate Internet. 2017
cited 2017 Oct 26. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=3494.

3.      
Healthline. Folate Deficiency Internet.
Healthline; 2016 updated 2016-07-26; cited 2017 Oct 26. Available from: https://www.healthline.com/health/folate-deficiency.

4.      
Healthline. Folate Deficiency Internet.
Healthline; 2016 updated 2016-07-26; cited 2017 Oct 26. Available from: https://www.healthline.com/health/folate-deficiency

5.      
Patient. Folate Deficiency. Folic acid
deficiency information. Patient Internet. Patient; 2017 cited 2017 Oct 26.
Available from: https://patient.info/doctor/folate-deficiency.

6.      
Tortora GJ, Derrickson B. Principles of anatomy
and physiology. 14th ed. John Wiley & Sons; 2014

7.      
WebMD. Folic Acid Deficiency Anaemia (Low
Folate) Internet. 2017 cited 2017 Oct 26. Available from: https://www.webmd.com/a-to-z-guides/folic-acid-deficiency-anemia

8.       NHS
Choices. Vitamin B12 or folate deficiency anaemia Internet. Department of
Health; 2016 updated 2016-30-11; cited 2017 Oct 26. Available from: https://www.nhs.uk/conditions/Anaemia-vitamin-B12-and-folate-deficiency/Pages/Introduction.aspx.

9.      
Health NIo. Office of Dietary Supplements –
Vitamin B12. 2017.

10.   Group
DE. 7 Important Functions of Vitamin B12 Internet. Global Healing Center;
2015 updated 2015-03-19; cited 2017 Oct 26. Available from:
https://www.globalhealingcenter.com/natural-health/7-functions-of-vitamin-b12/.

11.  
Biemans E, Hart HE, Rutten GE, Cuellar Renteria
VG, Kooijman-Buiting AM, Beulens JW. Cobalamin status and its relation with
depression, cognition and neuropathy in patients with type 2 diabetes mellitus
using metformin. Acta Diabetol Internet. 2015 cited Apr; 52(2):383-93.
Available from: http://dx.doi.org/10.1007/s00592-014-0661-4.
DOI:10.1007/s00592-014-0661-4.

12.  
Group DE. 7 Important Functions of Vitamin B12
Internet. Global Healing Center; 2015 updated 2015-03-19; cited 2017 Oct
26. Available from: https://www.globalhealingcenter.com/natural-health/7-functions-of-vitamin-b12/.

13.  
NHS Choices. Vitamin B12 or folate deficiency
anaemia Internet. Department of Health; 2016 updated 2016-30-11; cited 2017
Oct 26. Available from: https://www.nhs.uk/conditions/Anaemia-vitamin-B12-and-folate-deficiency/Pages/Introduction.aspx

14.  
Healthline. The Symptoms of Vitamin B Deficiency
Internet. Healthline; 2016 updated 2016-12-10; cited 2017 Oct 26. Available
from: https://www.healthline.com/health/symptoms-of-vitamin-b-deficiency.

15.  
Mori K, Ando I, Kukita A. Generalized
hyperpigmentation of the skin due to vitamin B12 deficiency. J Dermatol
Internet. 2001 cited May; 28(5):282-5. Available from: http://dx.doi.org/

16.  
Gate SF. Vitamin B12 Deficiency & Its
Long-Term Effects Internet. SF Gate; 2017 cited 2017 Oct 26. Available
from: http://healthyeating.sfgate.com/vitamin-b12-deficiency-its-longterm-effects-6144.html.

17.  
MedicineNet. Medical Definition of Homocysteine
Internet. 2017 cited 2017 Oct 26. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=13486

18.  
eMedicineHealth. Homocysteine Levels: Normal
& Elevated Ranges, Tests & Treatments Internet. 2017 cited 2017 Oct
26. Available from: https://www.emedicinehealth.com/homocysteine/article_em.htm.

19.  
 Ganguly
P, Alam S. Role of homocysteine in the development of cardiovascular disease.
Nutrition Journal Internet. 2015 cited 8 December 2017;14(1). Available
from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326479/

20.  
Food is Medicine, Dr.Axe. Homocysteine Balance:
The Little-Known Way to Protect Your Heart Internet. 2016 updated
2016-09-23; cited 2017 Oct 26. Available from: https://draxe.com/homocysteine-levels/.

21.  
Life-enhancement.com. Controlling High
Homocysteine Levels…And The Diseases They Cause Internet. 2018 cited 4
January 2018. Available from: http://www.life-enhancement.com/magazine/article/1091-controlling-high-homocysteine-levelshellipand-the-diseases-they-cause

   

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