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.
You may even add a few veggies for crunch and flavor. While it doesn't sound like those simple ingredients would provide too many calories, they can quickly add up. A typical ham and cheese sandwich provides nearly 16 grams of fat. 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).