Dr. Laura: Is it aging or low B12?

B12 deficiency has been estimated to affect about 40% of people over 60 years of age, and about 40% of the general population are on the lower end of normal.

Vitamin B12 deficiency can look like the signs and symptoms of diseases that are commonly associated with aging such as Alzheimer’s, dementia, cognitive disorders, multiple sclerosis, Parkinson’s, and other neurological problems; depression and anxiety; cardiovascular disease; cancer; and low libido. If someone you love has these symptoms, best to get there B12 levels checked and supplement if help reduce the symptoms.

Supplementing with an active form of B12 can help reduce inflammation, which has improved symptoms of arthritis and eczema.

Vitamin B12 works with folate to make DNA, red blood cells and the insulating sheath around the nerves to help with nerve signalling. This is why when I inject B12, I always include folate with it.

Causes/Risks of B12 deficiency

  • Vegan/vegetarianism
  • Intestinal malabsorption due to low stomach acid
  • Celiac disease
  • Crohn’s disease
  • Pernicious anemia (an autoimmune condition affecting our ability to absorb B12)
  •  Atrophic gastritis (usually H. pylori infection in the elderly)
  • Long term use of Proton Pump Inhibitors (PPI’s)
  • People on Metformin therapy

If someone you know or love fall into any of these categories, best they get tested even if they don’t have symptoms, as deficiency can start before the symptoms show up.

Symptoms of B12 Deficiency

  • not much if  it’s mild
  • weakness
  • fatigue
  • strange sensations
  • numbness, or tingling in hands, legs, or feet
  • difficulty walking such as staggering or balance problems
  • anemia
  • a swollen, inflamed tongue
  • yellow skin
  • jaundice
  • difficulty thinking and reasoning
  • memory loss
  • paranoia or hallucinations

Testing for B12

It is easy to run a B12 test, however there are other blood and urine markers that can provide a more complete picture, such as methylmalonic acid (MMA) and homocysteine. Homocysteine may be more sensitive and accurate for detecting the early stages of B12 deficiency. When I run tests, I look at things from a functional medicine perspective and this may involve the more complete profile.

If there is an absorption issue suspected, we need to identify and correct that, if possible. Further testing and treatment may be required to do that.

The results of the tests are also interpreted differently when you come to see me. I look at things from a functional range – your optimum level of performance- not the point at which you have disease. The conventional medical system in North America regard a low B12 to be below 200 pg/mL. This is the point where irreversible neurological damage can happen. I prefer to go at the guidelines set out by Europe and Japan – somewhere over 550 pg/mL.

Supplementing

Best to get B12 from animal based sources – strongest providers are the organ meats (liver, kidney) and seafood like oysters and clams. To get ahead quickly or to supplement a vegan or vegetarian diet, you will need activated B12, so hydroxy or methyl based cobalamin are the best. If there is intestinal absorption issues, then you’ll need a pill to dissolve under the tongue or an injection to provide the boost. What I carry in the clinic is an activated form of B12/B complex so it absorbs easily and we see good results on the before and after blood work, or we can go for the injection – usually weekly for a month and then once a month for a few months. Then we re-test.

 

Dr. Laura M. Brown ND is a Naturopathic Doctor with a Functional Medicine approach. She is a Certified Gluten Practitioner, A HeartMath Certified Practitioner and is engaged in ongoing education with the Kresser Institute of Functional Medicine.