NUTRITION HOTLINE: Vitamin Deficiencies

Q. I have anorexia nervosa. Should I be taking a multivitamin?

A. Yes, taking a multivitamin is a good idea for people with anorexia nervosa. Studies have found that deficiencies in vitamin A, folate, vitamin B-12, riboflavin, thiamin, niacin, and vitamins B-6, E, C, and D can have profound effects.

Vitamin A (the retinol form) is necessary for normal growth and reproduction, and for healthy vision, skin, bones, and immune function. It is found in animal products including meat, poultry, fish, and dairy. Many people with anorexia nervosa have decreased bone density and stunted growth, making adequate Vitamin A intake important. (Retinol can cause liver damage in high doses. Do not exceed 100% of the RDA.)

Folate and vitamin B-12 are essential for the development of red and white blood cells in bone marrow and for normal production of brain neurotransmitters. Deficiency results in what is called macrocytic anemia (red blood cells have a larger than normal volume), which causes fatigue, weakness, light-headedness, and memory problems. Folate and possibly B-12 deficiency can also cause depression, a condition found in a high percentage of people with eating disorders. Lack of vitamin B-12 can also cause permanent nerve damage. One study found that 50% of patients with anorexia nervosa were folate deficient. Food sources include orange juice, beans, green leafy vegetables, and fortified grains. Only animal products contain vitamin B-12, so vegans always need a supplement.

Riboflavin is essential for the metabolism of all nutrients, and is found in grains, dairy products, meat, and poultry. Symptoms of riboflavin deficiency consist of vision and skin problems, cheilosis (cracked lips), and angular stomatitis (cracks in the corners of the mouth). Thiamin is essential for carbohydrate metabolism and nerve function, and is found in grains and starchy vegetables. People who are deficient will have decreased appetite, fatigue and constipation, and in severe cases, beriberi, a condition that causes weight loss, cardiac, and neurological problems including mental confusion. Niacin deficiency (pellagra) has also been reported in some cases of anorexia nervosa. Symptoms include a rash in areas of the skin exposed to sunlight, glossitis (a red, smooth, inflamed tongue), and angular stomatitis, weakness, dementia, diarrhea, and in prolonged cases, death. Niacin is found in meats, fish, poultry, dairy products and grains.

Vitamin B-6 is necessary for metabolism of all nutrients, and for the production of brain neurotransmitters including serotonin and norepinephrine. It is found in many foods such as meats, grains, poultry, nuts, and vegetables. Deficiency results in weakness, anemia, cheilosis, angular stomatitis, nerve problems, and decreased immune function. (Vitamin B-6 is toxic in that it causes nerve damage in high doses. Do not exceed 100 mg per day.)

Antioxidant deficiencies, including vitamins C and E, are also common in individuals with anorexia nervosa. Scurvy (vitamin C deficiency) has been reported in the literature. Symptoms include weakness, fatigue, and bleeding in the skin and gums. Vitamin C maintains collagen and bones, the immune system, and brain neurotransmitters. Fruits and vegetables are good sources. Vitamin E is involved in the immune system and prevents damage to all cells in the body. It is found primarily in nuts, eggs, and oils.

Vitamin D deficiency contributes to decreased bone density in anorexia nervosa, and a minimum of 1,000 IU per day in supplements is recommended (It is difficult to get that amount in food).