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.
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