How to Avoid Harm from Vitamin B12 Deficiency in Seniors
Do you have senior parents? Are you worried about their health and nutrition? Learn from Leslie Kernisan, MD, who shares an article about why vitamin B12 deficiency is so common — and serious — in older adults, and how you can help detect and treat this often overlooked health problem.
A Vitamin B12 Deficiency
You know that vitamins and nutrition are important for a senior’s health. So you’ve been encouraging your parents to eat right and take a daily multivitamin.
But did you know that even among seniors who do this, many still end up developing a serious deficiency in one particular vitamin?
It’s Vitamin B12.
Experts estimate that up to 20% of people aged 50 and over may be low in vitamin B12, with this deficiency becoming more common as people get older. It’s common, serious, and worst of all, commonly overlooked until it causes significant health problems.
But if you know the symptoms and risk factors, you can help your parents get a vitamin B12 deficiency detected. Treatment is safe and effective, as long as you catch the problem before permanent damage occurs. Here’s what to know.
How Vitamin B12 Deficiency Harms a Senior’s Health
In the body, vitamin B12 — also known as cobalamin — is especially vital to making red blood cells, and maintaining proper function of nerve cells. When vitamin B12 levels are low, a person can develop health problems related to red blood cells and nerve cells not working well.
The most common problems related to low vitamin B12 levels include:
- Anemia. This means low red blood cell count. Red blood cells carry oxygen in the blood, so anemia can cause fatigue or shortness of breath. The breakdown of faulty red blood cells can also cause jaundice.
- Neuropathy. This means nerves in the body not working well. This can cause a variety of symptoms, including tingling, numbness, burning, poor balance and walking difficulties.
- Cognitive impairment. This means that nerve cells in the brain are not working well. This can cause memory problems, irritability, and even dementia.
You may have heard that vitamin B12 deficiency can cause pernicious anemia. But in fact, the term “pernicious anemia” means a vitamin B12 deficiency that’s caused by the loss of a body’s ability to make “intrinsic factor.” The body needs intrinsic factor to absorb vitamin B12; without it, vitamin B12 levels eventually drop. This often causes anemia, but sometimes symptoms of nerve and brain problems occur first.
Why Low Vitamin B12 Levels Are Common in Older Adults
To understand how low vitamin B12 levels happen in aging adults, it’s good to start by learning how the body usually obtains and processes this vitamin.
In nature, vitamin B12 is available to humans only in meat and dairy products. However in modern times, you can easily get it via a supplement or multivitamin. The recommended daily allowance for vitamin B12 for adults is 2.4 micrograms. Experts have estimated that a Western diet contains 5-7 micrograms of vitamin B12, and a multivitamin often contains 12-25 micrograms.
Once you ingest vitamin B12, it is processed by acids and enzymes in the stomach and small intestine. The processed vitamin B12 is then absorbed by the small intestine, and it’s stored in the body, especially in the liver.
This stash can actually meet the body’s needs for a few years; although vitamin B12 is essential, only a tiny bit is needed every day. So if a healthy person stops taking in vitamin B12, it often takes a few years before the body runs out of stored B12 and develops symptoms.
So why does vitamin B12 particularly affect older adults?
As people get older, their ability to absorb vitamin B12 tends to decrease. This is because seniors often develop problems with the acids and stomach enzymes needed to process the vitamin.
Common risk factors for low vitamin B12 levels in older adults include:
- Low levels of stomach acid, which can be due to weakening of the stomach lining, or to medications that reduce stomach acid
- Medications such as metformin (used for diabetes), which interferes with vitamin B12 absorption
- Alcoholism, which irritates the stomach and sometimes is linked to a poor diet
- Surgeries that remove parts (or all) of the stomach or small intestine
- Any problem that causes poor absorption in the stomach or small intestine, such as Crohn’s disease
Why Vitamin B12 Deficiency is Often Missed in Seniors
Vitamin B12 deficiency is often missed because the symptoms — fatigue, anemia, neuropathy, memory problems, or walking difficulties — are quite common in older adults, and can easily be caused by something else.
Also, vitamin B12 deficiency tends to come on very slowly, so people often go through a long period of being mildly deficient. During this time, a senior might have barely noticeable symptoms, or the symptoms might be attributed to another chronic health condition.
Still, a mild deficiency will almost always get worse over time. And even when a senior has many other causes for fatigue or problems with mobility, it’s good to fix whatever aggravating factors — such as a vitamin deficiency — can be fixed.
Unlike many problems that affect seniors, vitamin B12 deficiency is quite treatable. You just need to make sure it’s detected, and then make sure the treatment plan has raised the vitamin B12 levels and kept them steady.
Who Should Be Checked for Vitamin B12 Deficiency
Your parent should probably be checked for Vitamin B12 deficiency if he or she is experiencing any of the health problems that can be caused by low levels of this vitamin.
I especially recommend checking vitamin B12 levels if you’ve been concerned about memory, brain function, neuropathy, walking or anemia.
To make sure you aren’t missing a mild vitamin B12 deficiency, you can also proactively check for low vitamin B12 levels if your parent is suffering from any of the common risk factors associated with this condition.
For instance, you can proactively request a vitamin B12 check if your parent is vegetarian, or if she has suffered from problems related to the stomach, pancreas, or intestine. It’s also reasonable to check a level if your older parent has been on medication to reduce stomach acid for a long time.
How Vitamin B12 Deficiency is Diagnosed and Treated
The first step in checking for deficiency is a blood test to check the serum level of vitamin B12.
Because folate deficiency can cause a similar type of anemia (megaloblastic anemia, which means a low red blood cell count with overly-large cells), doctors often test the blood for both folate and vitamin B12. However, folate deficiency is much less common.
You should know that it’s quite possible to have clinically important low vitamin B12 levels without having anemia. If a clinician pooh-poohs a request for a vitamin B12 check because an older person had a recent normal blood count, you can share this research article with her.
If the vitamin B12 level is borderline, a confirmatory blood test can be ordered. It’s called methylmalonic acid, and it is higher than usual when people have vitamin B12 deficiency.
If the blood tests confirm a vitamin B12 deficiency, the doctors will prescribe vitamin B12 supplementation to get the body’s levels back up. The doctor may also recommend additional tests or investigation to find out just why your parent has developed low vitamin B12.
The typical initial treatment for a significant vitamin B12 deficiency involves intramuscular shots of vitamin B12 – 1000 micrograms. This bypasses any absorption problems in the stomach or intestine.
High-dose oral vitamin B12 supplements (1000-2000 micrograms per day) have also been shown to raise levels, because high doses can usually compensate for the body’s poor absorption. However, oral treatments probably take longer to work than intramuscular shots. So they’re not ideal for initially correcting a deficiency, although they’re sometimes used to maintain vitamin B12 levels.
I’ve found that most seniors prefer oral supplements over regular vitamin B12 injections, which is understandable; I don’t like getting shots either. However, this requires seniors to consistently take their supplement every single day. If your parent has difficulty taking medications regularly, scheduled vitamin B12 shots are often the better option.
The good thing about vitamin B12 treatment is that it’s basically impossible to overdose. Unlike some other vitamins, vitamin B12 doesn’t cause toxicity when levels are high.
So if your parent is being treated for vitamin B12 deficiency, you don’t need to worry that the doctors will overshoot. You just need to make sure a follow-up test has confirmed better vitamin B12 levels, and then your family will work with the doctors to find the right maintenance dose to prevent future vitamin B12 deficiency.
Are There Other Benefits To Taking Vitamin B12 Supplements?
Since we know vitamin B12 is necessary for proper function of red blood cells and brain cells, you might be wondering if your parent should take higher doses of vitamin B12 as part of a healthy aging approach.
It certainly won’t hurt, since vitamin B12 doesn’t cause problems at higher blood levels the way some vitamins do.
But once an older person has a good level of vitamin B12 in the body, it’s not clear that additional vitamin B12 will reduce the risk of problems like cancer or dementia. To date, much of the research on the benefits of extra vitamin B12 has been inconclusive.
However, research has definitely confirmed that a deficiency in this essential vitamin is harmful to the body and the brain, with worse deficiencies generally causing greater harm.
So to help your parents make the most of this vitamin, focus on detecting and treating vitamin B12 deficiency. Remember, this common problem is frequently overlooked.
You can help your parents avoid problems by asking the doctor to check vitamin B12 if they exhibit a related symptom, or by asking for a proactive check if your parent has any risk factors.
Our aging parents have enough health problems to deal with. Let’s protect them from the ones that are easily detectable and treatable.
Has your parent or senior loved one been treated for a vitamin B12 deficiency? What was the experience like? Share your stories with us in the comments below.
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