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.



  1. 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


Medications that can increase the risk of Pneumonia

Medications that can increase the chance of getting Pneumonia

While colds usually spread easily from person to person, the germs that cause pneumonia often are found in a dormant state in people and the lung infection doesn’t develop until the immune system is weakened and/or stomach contents backs up into the throat and into the airway. Germs in that fluid can thus get into the air sacs and start an infection there. As with any foreign invader, the pathogens (germs) are detected by the body and the inflammatory process starts. Part of inflammation includes the production of an exudate, a fluid with white blood cells and debris. This exudate fills some of the air sacs and decreases the surface area where oxygen can be absorbed and carbon dioxide eliminated. The lack of oxygen makes people feel weak and short of breath. If severe, it can kill the person.

The pneumonia vaccines can decrease the chances of getting severe, invasive (spreads throughout the body) pneumonia, but it doesn’t always prevent it. In “Use of Opioids or Benzodiazepines and risk of pneumonia in Older Adults:  A Population-based Case-Controlled Study” by S. Dublin, et al (Journal of the American Gerontological Society, 2011; 59: 1899-1907) over 90% of the people who gotten pneumonia had received the vaccine. Although the vaccine can help protect, clearly much more must be done to decrease pneumonia risk.

Because some medications increase the risk of pneumonia, this under-rated topic was selected by this author. It came to my attention after listening to “Pneumonia Diagnosis” by Willian Sonnenberg (FP Audio Digest 452, January, 2017, by the American Academy of Family Physicians). The drug classes implicated:

  • Proton Pump Inhibitors, medications used to treat ulcers and GERD (gastroesophageal reflux disease), increase stomach content pH so fewer germs that cause pneumonia are killed. These drugs have only been implicated in strep pneumoniae as a cause of pneumonia
  • Drugs with anticholinergic effects – some of those for urge incontinence, older antihistamines, and certain tricyclic antidepressants (TCAs) can increase pneumonia risk
  • Inhaled corticosteroids (used for asthma and COPD) may increase the risk up to 69%
  • Benzodiazepines, used for anxiety and sleep, could also increase pneumonia risk
  • In the Dublin article, the research didn’t confirm the link with benzodiazepines and pneumonia but did find that some opioids can make pneumonia more likely to develop.
  • Morphine, codeine and fentanyl were found to suppress some aspects of the immune and inflammatory response. This effect was particularly strong the first few weeks of use.
  • Use of benzodiazepines were associated with an increased chance of infection in the critically ill, increase the chance of community acquired pneumonia and increase the 30-day mortality following pneumonia per an on-line pharmacology journal ( for January, 2013 based on an article on such in the medical journal Thorax).


This article is not intended to replace your health care provider. The intent is to make important information about medications available.