Vitamin B12 and Aging
February 20, 2018 | by the National Care Planning Council
For most people, maintaining the proper caloric intake and eating a balanced diet will generally ensure an adequate intake of all of the necessary vitamins and minerals. This is not necessarily true for aging seniors – especially those who are in their 80s or older. Vitamin deficiency in these folks can occur even when maintaining a proper diet. Older seniors often lack the ability to properly absorb certain vitamins from their food. Or they may have reduced ability to synthesize certain vitamins in their bodies. In other cases, they need larger amounts of a certain vitamin because their bodies don't utilize it as well as younger people. Vitamin supplementation with minerals is always recommended for the elderly to avoid this problem.
Despite supplementation, there are two vitamins that still might cause problems – sometimes very severe problems. Some researchers consider a deficiency in these vitamins in the elderly to be a malnutrition epidemic that must be addressed with every elder. These two vitamins are vitamin B12 and vitamin D. In this article we will discuss B12 deficiency. Next week we will discuss vitamin D deficiency
Understanding Vitamin B12
Vitamin B12 is one of four vitamins stored by the liver. Generally the liver can hold up to a 1 to 3 year supply of vitamin B12. Unfortunately, if this vitamin is not replenished through dietary intake, stores will decrease and the blood level of the vitamin will plunge. At a certain point, low circulating B12 in the form of Cobolamine can cause serious problems.
What harm can having too little of a vitamin do? Consider this: Over the course of two months, a 62-year-old man developed numbness and a "pins and needles" sensation in his hands, had trouble walking, experienced severe joint pain, began turning yellow, and became progressively short of breath. The cause was lack of vitamin B12 in his bloodstream, according to a case report from Harvard-affiliated Massachusetts General Hospital published in The New England Journal of Medicine. It could have been worse—a severe vitamin B12 deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence, loss of taste and smell, and more, according to another article in the New England Journal.
The human body needs vitamin B12 to make red blood cells, nerves, DNA, and carry out other functions. The average adult should get 2.4 micrograms a day. Like most vitamins, B12 can't be made by the body. Instead, it must be gotten from food or supplements.
Some people don't consume enough vitamin B12 to meet their needs, while others can't absorb enough, no matter how much they take in. As a result, vitamin B12 deficiency is relatively common, especially among older people. The National Health and Nutrition Examination Survey estimated that 3.2% of adults over age 50 have a seriously low B12 level, and up to 20% may have a borderline deficiency.
Data from the Tufts University Framingham Offspring Study suggest that 40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low normal range – a range at which many experience neurological symptoms. Nine percent had outright deficiency, and 16 percent exhibited "near deficiency." Most surprising to the researchers was the fact that low B12 levels were as common in younger people as they were in the elderly.
Vitamin B12 deficiency has been estimated to create some sort of adverse symptoms for about 40% of people over 60 years of age. It's entirely possible that at least some of the symptoms we attribute to "normal" aging – such as memory loss, cognitive decline, decreased mobility, etc. – are at least in part caused by B12 deficiency. Severe deficiency can actually mimic or exacerbate the following diseases and disorders:
- Alzheimer's, dementia, cognitive decline and memory loss (collectively referred to as "aging")
- Multiple sclerosis (MS) and other neurological disorders
- Mental illness (depression, anxiety, bipolar disorder, psychosis)
- Cardiovascular disease
- Autoimmune disease and immune dysregulation
Dealing with B12 Deficiency
B12 deficiency is often missed for two reasons. First, it's not routinely tested by most physicians. Second, the low end of the laboratory reference range is too low. This is why most studies underestimate true levels of deficiency. Many B12 deficient people have so-called "normal" levels of B12.
It is well-established in the scientific literature that people with B12 levels between 200 pg/mL and 350 pg/mL – levels considered "normal" in the U.S. – have clear B12 deficiency symptoms. Experts who specialize in the diagnosis and treatment of B12 deficiency, suggest treating all patients that are symptomatic and have B12 levels less than 450 pg/mL. They also recommend treating patients with normal B12, but elevated urinary methylmalonic acid (MMA), homocysteine and/or holotranscobalamin. These markers are a reliable measure of B12 deficiency even if blood levels of B12 seem normal.
In Japan and Europe, the lower limit for B12 is between 500-550 pg/mL, the level associated with psychological and behavioral manifestations such as cognitive decline, dementia and memory loss. Some experts have speculated that the acceptance of higher levels as normal in Japan and the willingness to treat levels considered "normal" explain the low rates of Alzheimer's and dementia in that country.
Plants don't make vitamin B12. The only foods that deliver it are meat, eggs, poultry, dairy products, and other foods from animals. Strict vegetarians and vegans are at high risk for developing a B12 deficiency if they don't eat grains that have been fortified with the vitamin or take a vitamin supplement. People who have stomach stapling or other forms of weight-loss surgery are also more likely to be low in vitamin B12 because the altered condition of the stomach interferes with the body's ability to extract vitamin B12 from food.
Conditions that interfere with food absorption, such celiac or Crohn's disease, can cause B12 trouble. So can the use of commonly prescribed heartburn drugs, which reduce acid production in the stomach (acid is needed to absorb vitamin B12). These include drugs like Prevacid, Zantac or Nexium. This also includes use of antacid tablets such as Tums which cut down the production of acid. Just think of all of the people who take medication or over-the-counter drugs for acid reflux and are running the risk of vitamin B12 deficiency. Deficiency is also more likely to occur in older people due to the cutback in stomach acid production that often occurs with aging.
People with pernicious anemia have an autoimmune disorder that prevents the stomach from making intrinsic factor needed to absorb vitamin B12. Doctors usually treat pernicious anemia with vitamin B12 shots, although very high oral doses of vitamin B12 might also be effective.
Vitamin B12 deficiency can be slow to develop, causing symptoms to appear gradually and intensify over time. It can also come on relatively quickly. Given the array of symptoms it can cause, the condition can be overlooked or confused with something else. Symptoms may include:
- strange sensations, numbness, or tingling in the hands, legs, or feet
- difficulty walking (staggering, balance problems)
- a swollen, inflamed tongue
- yellowed skin (jaundice)
- difficulty thinking and reasoning (cognitive difficulties), or memory loss
- paranoia or hallucinations
Vitamin B12 is not toxic to the systems of healthy individuals, even when taken in large dosages, the Linus Pauling Institute reports. For these reasons, there is no established upper limit for vitamin B12 intake. Any excess vitamin B12 in the body is either stored in the liver or washed out through the kidneys. This is because, unlike most vitamins, it is water-soluble. Because of these properties, the best way to prevent low B12 levels as well as to treat existing low levels is to take huge doses of the vitamin. Research on megadoses has found that even with malabsorption problems or pernicious anemia, individuals can absorb enough to maintain healthy blood levels.
Supplementation can take three forms. Oral pills, injections or lozenges that are placed under the tongue (sublingual) which dissolve into the saliva glands and are subsequently taken up by the bloodstream. The most foolproof way to ensure adequate supplementation is through the sublingual pills. This is because B12 enters directly into the bloodstream and does not encounter absorption problems in the gut. The best form of sublingual supplementation is through a form of vitamin B12 called methylcobalamin. Because vitamin B12 and folate (folic acid) and iron work together in the body, the sublingual supplementation using methylcobalamin should also contain folic acid. Iron supplementation should take the form of vitamin pills. The sublingual methylcobalamin form of supplementation is usually not available in drugstores but can be ordered on the Internet through various sources.
Injections are also foolproof because they are absorbed into the bloodstream as well. On the other hand injections can only be had through a visit to the doctor. Most people don't want to put up with the cost and hassle of getting a monthly injection in their butt.