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.
Two slices of regular deli ham with 11 percent fat weighing 2 ounces contains 102 calories. Use extra lean ham with 5 percent fat and consume just 74 calories. A 1-ounce slice of American cheese adds 94 calories to the sandwich. Opt for cheddar and you'll take in 114 calories. A slice of Swiss is 105 calories.