Did you know that being over 65 years of age is a risk factor for vitamin B12 deficiency?
It’s true. But most mainstream doctors don’t really know how to diagnose it. That’s because they receive very little training on nutrition – generally less than 20 hours of nutrition instruction during their entire time at medical school.
It’s one reason I trained in functional medicine – to learn how food and nutrition affect all systems of the body. And it sure comes in handy when it comes diagnosing vitamin B12 deficiency.
The thing about this type of deficiency is that it mimics disorders that often accompany “old age.”
For example, a very common symptom of B12 deficiency can be neurological problems, like peripheral neuropathy. This happens when you have pain, numbness and tingling in hands or feet. Signs of peripheral neuropathy are common in older people.
Since vitamin B12 deficiency can damage they myelin sheath that protects your nerves, other issues may become apparent. Unsteady movements, tremors, weakness and changes to your gait.
Low levels of vitamin B12 can also cause dementia, mood disturbances and even psychotic episodes.
Now, walk into most doctor’s offices with these complaints and what do they see? An older patient complaining about symptoms of old age.
What do I see? I see a patient who likely has a vitamin B12 deficiency, especially if they also have pale skin or shortness of breath.
But there is a reason why vitamin B12 deficiency commonly strikes older individuals.
Why You’re Not Absorbing Your B12
Our bodies naturally lose the ability to absorb vitamin B12 as we age. So even if you get plenty of it in your diet, you can still become deficient. In fact, you could be low on this nutrient even if you regularly take a B12 supplement or multivitamin.
That’s because the older we get, the less stomach acid we produce. Without stomach acid and certain proteins, vitamin B12 can’t be absorbed into your intestines for delivery to the cells.
This is something most people don’t realize, but physicians really need to take it into consideration when treating older patients. Especially when the patient has symptoms of neuropathy, cognitive problems or difficulty walking.
But aging isn’t the only reason this happens.
Antacid drugs like Prilosec, Nexium and Pepcid destroy hydrochloric acid production and damage intrinsic factor in the stomach. This literally strips your ability to properly absorb vitamin B12. So if you’re constantly taking these heartburn meds, chances are good you’re running low on this vitamin.
The most widely used antidiabetic drug, Metformin, can alter vitamin B12 absorption in as little as four months. About a third of Metformin users develop B12 deficiency. This drug also stimulates bacterial overgrowth that competes with vitamin B12 uptake.
Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and naproxen can impair digestion and cause inflammation of the stomach lining (gastritis). Both of these interfere with the release of vitamin B12 from your food.
Getting Tested is Easy!
It might seem hard to believe, but many doctors are unaware of these links. This creates several obstacles to diagnosis. Initially the B12 deficiency must be recognized; then the connection to reduced stomach acid needs to be established.
If you’re lucky, your physician is familiar with B12 deficiency and symptoms – and commonly tests serum or urine methylmalonic acid to diagnose deficiency. I use this test routinely to diagnose B12 deficiencies in my patients.
If your levels are low, chances are good that your doc will recommend intramuscular injections of vitamin B12. This way the vitamin is absorbed directly into the bloodstream. It bypasses the digestive process altogether.
Then, he (or she) should transition you to a sublingual B12 spray. Using the sublingual version bypasses malabsorption issues.
B12 deficiencies might be more common in people over 65, but it doesn’t mean it has to be a symptom of old age. It’s 100% treatable when you restore your vitamin B12 levels.
SOURCES:
Vitamin B12 Deficiency. BMJ Best Practice. Last updated: Jun 2021
Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010 Sep;85(9):1537-42.
Ammouri W, Harmouche H, Khibri H, et al. Neurological Manifestations of Cobalamin Deficiency. Open Access J Neurol Neurosurg. 2019;12(2).
Cagle, Stephen MD; Song, Steve MD Does long-term use of proton pump inhibitors cause B12 deficiency?, Evidence-Based Practice. 2019 May;22(5):23-24.
Ahmed MA, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. BMC Pharmacol Toxicol. 2016;17(1):44.
van Oijen MG, Laheij RJ, Peters WH, Jansen JB, Verheugt FW; BACH study. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7.
