Can You Have Too Much Vitamin B9?

Negative effects from too high a concentration of vitamins in the body is more commonly observed with the fat-soluble vitamins A and D.   The B vitamins are water-soluble, and the prevailing wisdom is that our bodies don’t store large quantities of them.  Because of this we tend to think that they can’t do any harm: if you take too much the excess is excreted in the urine, and it’s only a waste of money.

This may not always be true in the case of vitamins B9 and B12.  Vitamin B9 is also known as folic acid, and flour in the United States has been fortified with this vitamin since 1998.  This fortification has greatly decreased the incidence of neural tube defects such as spina bifida.  Folic acid fortification has thus been of benefit to women of childbearing age.   Besides the mandatory supplementation of the flour, many cereal manufacturers add folic acid to their products voluntarily.  For older citizens, there is a potential danger in excess vitamin B9 consumption.  Another B vitamin, vitamin B12 or cobalamin, competes with vitamin B9 in some metabolic functions, so an excess of vitamin B9 can lead to a deficiency in vitamin B12.  Vitamin B9 supplementation can mask vitamin B12 deficiency symptoms, as both vitamin B9 and B12 deficiency result in macrocytic anemia, a deficiency in red blood cells and an enlargement in the size of the remaining ones.  Vitamin B9 supplementation can make the red blood cells look normal again, but it does not cure pernicious anemia, which is caused by a vitamin B12 deficiency.  Untreated pernicious anemia can result in severe cognitive and motor impairments and is eventually fatal.

Unfortunately vitamin B12 deficiency is fairly common among the elderly.  A combination of factors leads to this:  lack of vitamin B12 in the diet and increasingly poor absorption of the vitamin with advancing age.  Conditions like stomach ulcers, not producing enough stomach acid, not producing intrinsic factor, and medical interventions like bariatric surgery can all lead to vitamin B12 deficiency.  There is no vitamin B12 supplementation of the US flour supply, and the more common multivitamin supplements do contain vitamin B9, but not vitamin B12.

Get tested for vitamin B12 deficiency using the MMA (methylmalonic acid) urine test.   If the vitamin B12 deficiency is due to failure of vitamin B12 absorption from the small intestine, injections are the most efficient way to get the vitamin into the body. Some liquid vitamin supplements are so concentrated that they can help correct mild deficiencies in spite of sub-optimal absorption. Sublingual and trans-dermal patch vitamin B12 supplements can also be helpful.

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