Unfortunately, vitamin b12 deficiency is often mistaken for other conditions in the elderly (such as Alzheimer’s and dementia) because the symptoms can be similar.
Vitamin B12 is required
for proper red blood cell formation, neurological function, and DNA synthesis.
Deficiencies of vitamin
B12 are well known to contribute to neurologic dysfunction and chronic pain.
In food, vitamin B12 is
bound to protein but is released during digestion by the activity of
hydrochloric acid and gastric protease in the stomach.
It then combines with ‘intrinsic
factor’, a glycoprotein secreted by the stomach’s parietal cells, for
absorption.
Older people are at an
increased risk for vitamin B12 deficiency for several reasons.
Atrophic gastritis affects
10% to 30% of older adults and decreases secretion of hydrochloric acid in the
stomach, resulting in decreased absorption of vitamin B12.
Pernicious anemia, a
condition that affects 1% to 2% of older adults, is characterized by a lack of ‘intrinsic
factor’; thus, individuals cannot properly absorb B12 in the gastrointestinal
tract.
Pernicious anemia
typically is treated with intramuscular vitamin B12.
Older individuals with gastrointestinal disorders, such as
celiac or Crohn’s disease, or those who have had gastrointestinal surgery, may
also be at risk of vitamin B12 deficiency.
The Institute of Medicine
recommends that adults older than 50 obtain most of their vitamin B12 from
vitamin supplements or fortified foods, though some elderly patients with
atrophic gastritis require doses much higher than the RDA to avoid subclinical
deficiency.
Vitamin B12 injections in
patients with pain who weren’t B12 deficient resulted in reduced pain scores
and less analgesic use in both active treatment arms of a double-blind,
placebo-controlled crossover trial.
A Doctor’s Guide to Vitamin B12 Deficiency in Seniors
By Leslie
Kernisan June 26, 2020
Maintaining
adequate nutrients are vital to seniors’ health.
You may already be
encouraging your parents to eat healthy and take a daily multivitamin, but did
you know that many seniors may still end up developing a
serious deficiency with one particular vitamin?
It’s vitamin B12.
As people grow older,
they become increasingly susceptible to vitamin deficiencies.
Experts estimate that up to 20% of people 50 and older may have a low
intake of vitamin B12.
It’s common, serious,
and worst of all, it’s usually overlooked until it causes significant health
problems.
Vitamin B12
treatments are safe and effective, as long as you catch the problem before
permanent damage occurs.
By learning the
symptoms and risk factors now, you can help your parents detect the signs and
get tested earlier.
Here’s everything you
need to know about vitamin B12 deficiency symptoms in the elderly, including
causes, treatments, and more.
What are the
important benefits of vitamin B12?
Vitamin B12 — also
known as cobalamin — helps the body make red blood cells and
maintain the proper function of nerve cells.
Vitamin B12 benefits
for seniors include:
- Generating cell growth
- Boosting cognition
- Supporting bone health
- Supporting the immune system
How does vitamin B12
deficiency cause harm to seniors?
The most common
health issues in seniors related to low vitamin B12 levels are:
- Anemia
This means a person’s red blood cell count is low. 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, which is yellowing of the skin.
- Neuropathy
This condition occurs when nerves throughout the body aren’t working well. It can cause a variety of symptoms, including tingling, numbness, burning, poor balance, and trouble walking.
- Cognitive impairment
Damaged nerve cells in the brain can result in memory problems, irritability, and even dementia.
What
are the most common symptoms of vitamin B12 deficiency?
The most common signs
of vitamin B12 deficiency in seniors include:
- Fatigue
- Anemia
- Neuropathy
- Memory problems
- Walking difficulties
You may have heard
that vitamin B12 deficiency can cause pernicious anemia. But in fact, it’s
the other way around.
Pernicious anemia is a result of the body’s inability to make what’s called “intrinsic factor.”
The body needs "intrinsic factor" to absorb vitamin B12. Without it, vitamin B12 levels eventually drop.
This often causes anemia, though sometimes symptoms of
nerve and brain problems develop first.
How does the body
obtain and process vitamin B12?
People get vitamin
B12 through foods and supplements. Fish, eggs, milk, poultry, and fortified
cereals have it. Daily multivitamins also have it, as do B12 supplements.
Once vitamin B12 is
consumed, it’s digested and stored in three steps:
1. It’s processed by acids and
enzymes in the stomach and small intestine
2. It’s absorbed by the small intestine
3. It’s stored in the body,
primarily in the liver
The vitamin B12
stored in your body actually meets your needs for a few years.
Although vitamin B12
is essential, only a little bit is needed every day.
Even if a healthy
person stopped consuming vitamin B12, it could take a few years before the body
showed signs of deficiency.
What’s the
recommended dosage of vitamin B12 for seniors?
The recommended daily allowance of
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.
Why are seniors at
risk for vitamin B12 deficiency?
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 in seniors 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 (prescribed for
diabetes), which interferes with vitamin B12 absorption
- Alcoholism, which irritates the
stomach and is sometimes 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 ulcerative colitis or Crohn’s
disease
Why is vitamin B12
deficiency often missed in the elderly?
Vitamin B12
deficiency is often missed in seniors for two reasons:
1. The symptoms are
overlooked
The signs of vitamin B12 deficiency are quite common in older adults and can
easily be caused by or attributed to something else.
2. It progresses very
slowly
Many people often go through a long period of being mildly deficient. During
this time, a senior may barely notice their symptoms, or think the symptoms
could be caused by 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 the
aggravating factors.
Unlike many problems
that affect seniors, vitamin B12 deficiency is quite treatable.
First, you need to
make sure it’s detected.
Second, you need to
make sure the treatment plan has raised their vitamin B12 levels and that
they’re kept steady.
When should you check
for vitamin B12 deficiency?
Your parent should
probably be checked for vitamin B12 deficiency if they’re experiencing any of
the common signs or are at risk.
Experts recommend
checking vitamin B12 levels especially if you’ve been concerned about:
- Memory
- Brain function
- Neuropathy
- Walking
- Anemia
To make sure that a
mild vitamin B12 deficiency hasn’t been overlooked, you can have your loved one
proactively tested for low vitamin B12 levels.
If your parent is
suffering from any common risk factors associated with this condition, it’s
best to have them tested as well.
Common risk factors
for developing vitamin B12 deficiency include:
- Following a vegetarian diet
- Having stomach issues
- Having pancreas issues
- Having intestinal issues
- Being on medication to reduce
stomach acid for a long time
How is vitamin B12
deficiency diagnosed?
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.
It’s quite possible
to have clinically low vitamin B12 levels without having anemia.
If a clinician
declines a request for a vitamin B12 check because an older person had a recent
normal blood count, you can share this research article with them
from The New England Journal of
Medicine.
If the vitamin B12
level is borderline, a confirmatory blood test can be ordered. It’s called
methylmalonic acid, and it’s higher than usual when people have vitamin B12
deficiency.
If the blood tests
confirm a vitamin B12 deficiency, the doctor will prescribe vitamin B12
supplementation. The doctor may also recommend additional tests or
investigation to find out why your parent has developed low levels of vitamin
B12.
What are the
treatments with vitamin B12 supplements for seniors?
The initial treatment
for a significant vitamin B12 deficiency involves an intramuscular shot, but
oral vitamins can be given too. The options include:
1. Intramuscular shots of vitamin B12
(1,000 micrograms). This bypasses any absorption problems in the stomach or
intestine.
2. High-dose oral
vitamin B12 supplements (1,000-2,000 micrograms a day) have also
been shown to raise levels, because high doses can usually compensate for the
body’s poor absorption. However, oral treatments likely 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.
Most seniors prefer
oral supplements over regular vitamin B12 injections, which is understandable —
getting shots isn’t fun.
However, taking
supplements orally requires seniors to take their supplement consistently every
single day.
If your parent has
difficulty taking medications regularly, scheduled vitamin B12 shots might be
the better option.
Can high levels of
vitamin B12 become dangerous to seniors?
The good thing about
vitamin B12 treatment is that it’s extremely unlikely to overdose on vitamin
B12. Unlike some other vitamins, vitamin B12 doesn’t cause toxicity when levels
are high.
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. Your family can then 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 functioning 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 to prevent conditions related to vitamin B12
deficiency?
This preventive
approach certainly doesn’t hurt.
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:
The greater the deficiency, the more harm that’s done.
You can help your
parents avoid problems by asking the doctor to check vitamin B12 if they
exhibit a related symptom, or by requesting 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.
https://www.aplaceformom.com/caregiver-resources/articles/vitamin-b12-deficiency
Author
Leslie
Kernisan
Leslie Kernisan,
MD, is a practicing geriatrician who believes that it shouldn't be so hard for
older adults and families to get the right kind of help with health concerns.
For more practical tips — and to get her free, quick guide to checking aging
parents — visit her at BetterHealthWhileAging.net.
Are We Overlooking B-12 Deficiency as a Cause of Dementia?
There is evidence that low B-12 levels occur in 10 percent of older people, and the prevalence increases with age from f5% at age 65 to 20% at age 85. Some of the reasons for this are:
- Development of gastric atrophy as we age, which decreases absorption of normal B-12,
- Medications can compete with absorption (Metformin),
- Dietary deficiency, due to social/economic reasons or heavy vegetarian diet,
- A small number with antibody evidence of pernicious anemia.
Using low B-12 levels as a sole measure of B-12 deficiency will miss 50 percent of cases.
Increased homocysteine levels in the presence of a normal B-12 level—greater than 400— strongly suggests that the elevated homocysteine may be due to folate deficiency. Folate may be in the low range.
There has been a lot of literature in the last few years in regard to the toxicity of elevated homocysteine.
It has been known to increase stroke risks, and levels of 14 or higher increase the risk of Alzheimer's in normal elderly to twice the normal rate.
Increasing homocysteine levels has also been reported to worsen Alzheimer's disease and other dementias.
It has been shown to be a toxic agonist to the NMDA receptors. These receptors are necessary for long-term potentiation in medial temporal lobe neurons necessary to store memory. Homocysteine blocks the NMDA receptor and leads to intracellular calcium with release of proteases and eventually cell death.
Go to https://practicalneurology.com/articles/2009-mar-apr/PN0309_06-php to read this full article
