Diabetes could compound the risk of falls in elderly people, a Singapore study has shown, but a healthy diet could alleviate the problem.
A polyclinic doctor has found a link between folic acid deficiency and muscle weakness in diabetics aged 65 and above.
Dr Andrew Wee Kien Han, a consultant at SingHealth Polyclinics, also found that patients given vitamin B12 supplements - a common practice by doctors - could end up being deficient in folic acid.
Both are B vitamins and having too much of one could mask a deficiency in the other.
From 2012 to 2014, Dr Wee studied 56 patients at Marine Parade Polyclinic, half of them women, of different races aged 65 or above and who had had diabetes for at least a year.
Besides examining their health records and giving them questionnaires about their daily activities, he got them to make simple movements, and used instruments to measure their leg and hand strength. He found that women with folic acid deficiency had about 25 per cent lower leg strength and hand strength on average than those with normal folic acid levels.
For men, though, the main predictor of muscle weakness is a substance called homocysteine, which needs both folic acid and vitamin B12 to convert it into useful chemicals that the nervous system needs.
Men with too much homocysteine had about 30 per cent lower average leg and hand strength, compared to those with normal levels of homocysteine.
Solving the problem may not be as simple as giving B12 supplements, as vitamin B12 might be related to folic acid breakdown, the study suggested.
The research, published in Nutrition Journal last October, has been downloaded more than 850 times.
Dr Wee hopes for clinical trials to test whether increasing folic acid intake can actually reverse muscle weakening. He also plans to investigate whether diabetes medicine and treatment itself may be causing the vitamin deficiencies.
Meanwhile, there is a simple way to tackle the problem. "You want more folic acid, just take more fresh fruit and vegetables," said Dr Wee.
Dr Lee Chung Horn, a diabetes specialist at Gleneagles Medical Centre, said a larger study of more patients would help in understanding the situation better. "Nutritional deficiencies are common in elderly persons and doctors should be attentive to discovering and treating these deficiencies," added Dr Lee.