No one’s surprised when Grandpa Joe gets more and more forgetful. We just assume that getting older is accompanied by memory loss, as well as other problems such as a tendency to fall or a failing heart.
What’s often overlooked: The possibility of a critical vitamin deficiency. Many of the so-called age-related diseases actually are caused by a deficiency of vitamin B-12.
Studies have shown that B-12 deficiency occurs in 15% to 25% of people 65 and older—in the US, that’s at least 6 million seniors. The Centers for Disease Control and Prevention has reported that one in every 31 adults age 51 and older is deficient in B-12.
Troubling: Few doctors routinely test for B-12 even when patients have signs and symptoms that are clearly consistent with a deficiency. And even when doctors suspect a B-12 deficiency, they often rely on a complete blood cell count (CBC) versus specific B-12 testing. This is problematic because untreated B-12 deficiency can cause permanent brain and/or nervous system injury.
A deficiency of B-12 causes demyelination, or damage to our nerves and brain. Nerves have an insulating coating known as the myelin sheath, and B-12 deficiency damages this sheath—in a manner somewhat similar to the fraying of an electrical wire—making it harder for nerve cells to carry messages. This causes balance and gait disorders, which frequently cause falls and fall-related trauma (such as hip fractures). B-12 deficiency also causes brain atrophy (shrinkage) and a resulting decline in memory and cognitive functioning. I estimate that at least 20% of patients with a diagnosis of dementia or Alzheimer’s disease actually are suffering from a B-12 deficiency.
B-12 also is crucial to the function of osteoblasts (bone-forming cells). Thus, people with B-12 deficiency are at greater risk for osteoporosis and nonfall–related fractures.
In addition, researchers have discovered that B-12 is just as important as another B vitamin, folate, for lowering our level of homocysteine, a toxic amino acid that can cause blood clots, heart attacks and strokes when elevated.
Most physicians get little training in nutrition. And it’s easy for doctors to mistake a B-12 deficiency for other disorders that share the same signs and symptoms. In addition to dementia and Alzheimer’s, it is common for B-12 deficiency to be misdiagnosed as depression, mental illness, vertigo, chronic fatigue syndrome, multiple sclerosis, fibromyalgia and diabetic neuropathy.
When diagnosing a B-12 deficiency, most doctors look for macrocytic anemia, a condition in which red blood cells are abnormally large and hemoglobin counts are low. But you don’t have to have macrocytic anemia to be B-12 deficient. Sometimes blood test results may appear normal even when there is a B-12 deficiency. For example, when people take supplements that contain folic acid, the folic acid can “mask” such a deficiency.
WHO’S AT RISK?
A B-12 deficiency can occur at any age, but older adults are at greater risk.
Reasons: You need adequate amounts of hydrochloric acid in the stomach to break down and absorb B-12. Nearly one-third of those age 50 and older don’t produce enough stomach acid.
Also, a stomach protein called intrinsic factor is needed for B-12 absorption. The body’s production of intrinsic factor may decline with age—or stop altogether in people with an autoimmune disease called pernicious anemia.
Also at risk: Vegetarians or vegans who eat little or no animal foods…heavy drinkers…people with eating disorders…patients who have had stomach surgery (including gastric bypass for weight loss)…those with intestinal diseases, such as Crohn’s and celiac disease…patients who take the diabetic drug metformin (Glucophage)…and certain women who are breast-feeding.
TESTS AND TREATMENTS
Your B-12 level should be tested annually, just as you have your cholesterol and glucose screened annually.
Best tests: The serum B-12 test measures the amount of B-12 in the blood. It costs less than $100 and is covered by insurance. Another useful test for a B-12 deficiency is the urinary methylmalonic acid test (uMMA).
There still is controversy about what level of serum (blood) B-12 is needed. A serum B-12 of less than 200 picograms per milliliter (pg/mL) is considered a deficiency. However, it has been well-documented in medical literature that symptomatic patients with serum B-12 between 200 pg/mL and 400 pg/mL actually are B-12 deficient. A level of at least 450 pg/mL is the minimum required. For brain and nerve health a serum B-12 level of at least 1,000 pg/mL needs to be maintained. It is very difficult to get enough B-12 from your diet.
If you test low…
Start with injections. B-12 injections assure proper absorption. Unlike oral forms of B-12, the injections bypass the stomach and small intestine, where malabsorption and transport problems occur.
B-12–deficient patients should be given a series of injections—1,000 micrograms (mcg) every day for seven days—followed by weekly injections for two months. Maintenance therapy typically is an injection every two weeks.
Injections actually are the cheapest treatment, once the patient or family member is taught by a health-care provider to self-administer them properly. A 30-milliliter multidose vial of a form of vitamin B-12 called hydroxocobalamin costs an average of $36 and typically is enough to treat a patient for one year. Microfine needles make the injections almost painless.
Ask your doctor about B-12 lozenges. After an initial series of injections, some people can switch to B-12 lozenges. A typical dose is 2,000 mcg daily of methylcobalamin, another form of B-12. That sounds like a lot, especially because the recommended daily allowance (RDA) for B-12 is 2.4 mcg daily (2.6 mcg and 2.8 mcg during pregnancy and lactation, respectively)—but only about 1% of oral B-12 is absorbed.
Beware of acid-suppressing drugs. Millions of Americans depend on medications such as omeprazole (Prilosec) and ranitidine (Zantac) to reduce stomach acid. These drugs are prescribed for patients who have ulcers, heartburn or GERD. People who take them long-term have a high risk of developing a B-12 deficiency.
My advice: If you are on acid-suppressing medications long-term, your B-12 level must be monitored and your doctor should place you on high-dose B-12 lozenges or injections
Source: Sally M. Pacholok, RN, BSN, an emergency nurse, Trauma Nursing Core Course provider and a member of the Emergency Nurses Association who has worked in health care for 32 years. She started the public education Web site B12Awareness.org . Based in Detroit, she is author, with Jeffrey J. Stuart, DO, of Could It Be B12? An Epidemic of Misdiagnoses (Quill Driver).