Vitamins and Minerals

The eight B vitamins that make up the 'B Complex' include:

• Folate or folic acid (vitamin B9)
• Thiamin (vitamin B1)
• Riboflavin (vitamin B2)
• Niacin (vitamin B3)
• Pantothenic acid (vitamin B5)
• Pyridoxine (vitamin B6)
• Biotin (vitamin B7)
• Cobalamin (vitamin B12)

Not enough folate can result in anemia. Folate plays an important role in making new body cells and works with vitamin B12 to make hemoglobin in red blood cells. It may also protect against heart disease.^1,2

Pregnant people who do not get enough folate early in pregnancy have a greater risk of having a baby with neural tube defects, which are birth defects of the brain and spinal cord. One example of a neural tube defect is spina bifida. This is a condition in which the bones of the spinal column do not close completely around the developing nerves of the spinal cord, which may lead to permanent nerve damage. However, taking too much folate may cover up a B12 deficiency. Folate may also interfere with certain medications, so talk with your health care provider before taking folate supplements.^1,2

Vitamin K is important for the body as this vitamin helps the body make several clotting factors. Common sources of vitamin K are green leafy vegetables, though the body creates a small amount in the gut. Continued use of antibiotics can destroy some of the intestinal bacteria that makes vitamin K. If there is not enough vitamin K the blood may not clot properly. People with bleeding disorders may lack vitamin K if they are malnourished, which can result in more bleeding episodes. Talk with your health care provider about if vitamin K supplements are right for you.^1,2

Vitamin C helps make collagen, a tissue that holds muscles, bones, and other tissues together. It also helps keep blood vessels firm, protecting the body from bruising. Vitamin C also helps the body with the following:

• Absorbs the iron and folate you get when eating plant-based foods
• Keeps gums healthy
• Heals cuts and wounds
• Protects against infection
• Acts as an antioxidant

Not enough vitamin C may lead to scurvy, a disease that causes anemia, bleeding gums, bruising, and poor wound healing. Typically, extra amounts of vitamin C, which is a water-soluble vitamin, exit the body via urine. This process can interfere with the results of urine tests for diabetes and diabetes-related kidney disease and severe hyperglycemia. Very large amounts of vitamin C can cause kidney stones or diarrhea. Talk to your health care provider to find out how much vitamin C is the right amount for you.^1,2

Vitamin A supports normal vision and the growth and health of the body's cells and tissues. It works as an antioxidant to fight free radicals (compounds that can cause harm if their levels become too high) in your body. Antioxidants may reduce the risk of certain cancers and some aging related disorders. Vitamin A deficiency may lead to eye problems, dry and scaly skin, reproductive problems, and poor growth. Excess amounts are stored in the body and can be harmful over time. Excess vitamin A can cause headaches, liver damage, bone and joint pain, abnormal bone growth, nerve damage, and birth defects. Talk to your health care provider about how much vitamin A is right for you.^1,2

Vitamin E works as an antioxidant. It may help lessen LDL cholesterol (low-density lipoprotein, or "bad" cholesterol) which can lower the risk of heart disease and stroke. Not having enough vitamin E is uncommon although people that do not take up fats well, such as preterm infants and people with cystic fibrosis, may be at risk. Too much of vitamin E may weaken the action of vitamin K and increase the effect of anticoagulant medication. In people with bleeding disorders, it may worsen their bleeding symptoms. Talk with your health care provider about how much vitamin E is right for you.^1,2

Vitamin D is important for maintaining bone and joint health. Vitamin D helps the body take in calcium. The human body is always breaking down old bone and building new bone. The body uses calcium during the building of this new bone to give it strength and mass. Osteoporosis, which is the thinning of bones, occurs when more old bone is broken down than new bone material is created. Osteoporosis can result in fractures and other serious injuries from falls.^1,2

Vitamin D can be taken into the body through supplements and can be found in foods such as salmon, tuna, sardines, and fortified milks and juices. Vitamin D, known as the "sunshine vitamin," can also be taken in through the skin through sun exposure. As a reminder, be sure to wear sunscreen or sun protection when outside in the sun.^1,2

People with bleeding disorders may be more likely to have poor bone health, possibly due to joint bleeds. During a bleed, blood flows into the joint capsule. Recurring bleeds can lead to the loss of bone cartilage in the target joint.

People who also have HIV may be more likely to have bone loss and fractures because of the use of anti-HIV medications. Too much vitamin D stored in the body can be toxic and could lead to kidney stones or weak bones.

Calcium is one of the most plentiful minerals in the body. Almost all the body’s calcium is stored in the bones. It is important for many functions like building strong bones and teeth, nerve function, muscle contraction and movement, and keeping a normal heart rhythm. Calcium also plays an important role in how the body clots. Calcium ions are involved in platelet activation and complete activation of many coagulation factors like Factor XIII.³

Good sources of calcium include:

• Cheese
• Yogurt
• Milk
• Fortified plant-based milk
• Fortified orange juice
• Some fish
• Leafy greens
• Vegetables (spinach, broccoli, bok choy, kale)
• Almonds

Vitamin D helps your body absorb calcium, so it is important to make sure you are also getting enough vitamin D and it can even be helpful to take both together. Be aware that certain foods and beverages, including sodas and caffeinated drinks, can interfere with the way the body absorbs and uses calcium.³

Calcium is very important during pregnancy and lactation. It is also important for postmenopausal women who can lose a great deal of bone mass due to decreasing estrogen levels. As we get older, calcium absorption also decreases. Decreasing bone mass can lead to osteoporosis, fractures, and falls. Be sure to talk to your health care provider about how much calcium they recommend you take and if you need a supplement.

Iron builds up blood cells, which may be especially helpful after a bleed or injury. Iron also helps blood carry oxygen to the body's muscles. During a bleed, a small amount of iron is lost. You can maintain iron levels by eating naturally iron-rich foods, such as liver, lean red meat, and poultry. Other sources of iron include leafy green vegetables, broccoli, dried beans, grains, and raisins. Combining iron-rich foods with good sources of vitamin C (such as orange juice) can help the body take in iron better. Certain foods can also block the body taking in iron. These include coffee, tea, egg yolks, milk, fiber, and soy protein. It's best to avoid eating these and iron-rich foods at the same time.⁴

Here are some common signs of anemia, or low iron:

• Tiredness
• Weakness
• Tingling and numbness in fingers or toes
• Sensitivity to cold

Talk to your Hemophilia Treatment Center (HTC) or health care provider about ways to monitor and treat iron loss and include iron-rich foods or supplements in your diet. It is possible to take too much iron, so always talk with your health care provider about the best ways to watch your iron levels.⁴

1. Akram, M., Munir, N., Daniyal, M., Egbuna, C., Găman, M.-A., Onyekere, P. F., & Olatunde, A. (2020). Vitamins and Minerals: Types, Sources and their Functions. Functional Foods and Nutraceuticals (pp. 149–172). doi:10.1007/978-3-030-42319-3_9
2. National Institutes of Health (2022). Vitamin and mineral supplement fact sheets. Retrieved from https://ods.od.nih.gov/factsheets/list-VitaminsMinerals/
3. National Institutes of Health (2022, October 6). Calcium. Retrieved from https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
4. National Institutes of Health (2022, April 5). Iron. Retrieved from https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/