Vitamin B12 deficiency – still a serious threat

Even if an individual eats a well-balanced diet, a vitamin B₁₂ deficiency can occur and cause serious damage before a lack of this nutrient is even suspected. It’s estimated that some 6% of the population under age 60 has a lack of vitamin B₁₂, and about 20% of people 60 and older. Of those 85 and older, 23% are deficient. Deficiency can impact everyone, from an embryo to the very old, in some of the following ways:

• It can cause infertility, miscarriage, and premature birth
• Like a folate deficiency, a lack of B₁₂ can lead to spinal abnormalities
• Babies lacking B₁₂ may have problems with sucking and with swallowing
• Adults with a B₁₂ deficit may experience numbness and tingling of the hands and feet, weakness, fatigue, decreased appetite, constipation, and weight loss
• A type of anemia called macrocytic anemia can develop but this doesn’t always occur
• Neurological and psychological problems may be present even when the blood B₁₂ level is normal or only slightly below normal.
• Problems with memory and reasoning – because of this, it is often confused with dementia, especially in older individuals – a group at high risk of having a B₁₂ deficiency
• Difficulty walking and with balance or fine motor tasks like using silverware or scissors

Who is at risk for a B₁₂ deficiency?

Anyone over age 50 is more prone to atrophic gastritis with a decrease in gastric acid and thus less able to release B₁₂ from animal protein – a very common cause of deficiency

Strict vegetarians (vegans) – because the main source of B₁₂ is meat, eggs, dairy products and other sources of animal protein

Those with celiac disease, Crohn’s disease, and those who had weight loss surgery

Individuals who are H. pylori positive (this is specialized testing usually done when someone develops an ulcer since the bacteria cause ulcers too) – the bacteria devour B₁₂ in the gut

Some medications can interfere with B₁₂ absorption – proton pump inhibitors, H-2 receptor blockers (both of these are used to prevent and treat ulcers and GERD), the type 2 diabetes drug metformin (Glucophage), some antibiotics and certain medication to prevent seizures

The best test for a vitamin B₁₂ deficiency isn’t a B₁₂ level. Either a total homocysteine or MMA level may be superior. These chemicals accumulate when there is insufficient B₁₂, so elevated levels indicate a deficiency.

Crystalline vitamin B₁₂ is a synthetic form of the vitamin. It is in the free form so it doesn’t require the usual high level of stomach acid for it to be made available for absorption. This makes it effective for prevention and treatment of a vitamin B₁₂ deficiency.

 

References

114. O’Leary, et al “Vitamin B₁₂ status, dietary protein intake and proton pump inhibitors use in geriatric rehabilitation subjects.” Nutrition and Dietetics, 2011: 68, 109-114.

Mary Cadogan, “Functional Implications of Vitamin B₁₂ Deficiency,” Journal of Gerontological Nursing, Vol. 36, no. 6, 2010.

Samantha Nash, “Vitamin B₁₂ deficiency,” British Journal of Midwifery, Nov. 2016, Vol. 24, #11