Vitamin B 12 (cobalamin) deficiency is a common cause of megaloblastic anemia, a variety of neuropsychiatric symptoms, and elevated serum homocysteine levels, especially in older persons. There are a number of risk factors for vitamin B 12 deficiency, including prolonged use of metformin and proton pump inhibitors.n asymptomatic patients with low-normal levels of vitamin B 12 (200 to 350 pg per mL [147.56 to 258.23 pmol per L]), elevated levels of the precursor compounds homocysteine and methylmalonic acid may prompt a decision to supplement patients with vitamin B 12. 5.
A ham sandwich made with two slices of whole wheat bread, two slices of ham and one leaf of iceberg lettuce contains 220 calories.
An egg and cheese sandwich provides nearly 400 calories and 20 grams of fat and a peanut butter and jelly sandwich provides about 350 calories (although you can make a healthier peanut butter and jelly sandwich).