Are You At Risk Of Vitamin B12 Deficiency
There are many causes for vitamin B12;deficiency. Surprisingly, two of them are practices often undertaken to improve health: a vegetarian diet and weight-loss surgery.
Plants dont 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 dont eat grains that have been fortified with the vitamin or take a vitamin supplement. People who have weight-loss surgery are also more likely to be low in vitamin B12;because the operation interferes with the bodys ability to extract vitamin B12;from food.
Conditions that interfere with nutrient absorption, such;celiac;or;Crohns disease, can cause B12trouble. So can the use of commonly prescribed heartburn drugs, which reduce acid production in the stomach . The condition is more likely to occur in older people due to the cutback in stomach acid production that often occurs with aging.
How Vitamin B12 And Folate Impact Senior Health
Vitamin B12 plays an important role in many aspects of health, including:
- The formation of red blood cells
- The health of nerve cells in the brain
- The normal function of the brain and nervous system
- The production of energy for the body
Vitamin B12 is primarily abundant in animal-based food sources. During normal digestion, vitamin B12 is released for proper absorption into the bloodstream. Vegans, vegetarians and those who do not consume many animal products , may be at a higher risk for vitamin B12 deficiency.
Folate is another B vitamin, prevalent in beans, cereal, eggs, fruit and leafy green vegetables. It is also known as vitamin B9.
Folate is required for:
- Red blood cell production
- Transforming carbohydrates into energy
Folate has been found in several clinical research studies to promote brain and heart health by controlling an essential amino acid, called homocysteine. High levels of homocysteine in the body have been linked with dementia, memory loss and stroke.
Because B vitamins play such an important role in healthy brain and nerve function and help to repair and synthesize DNA, the experts say that older adults who are at risk for these important nutrient deficiencies should be considered more seriously.
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Pernicious anaemia an acquired autoimmune condition occurs when the body’s immune system attacks the stomach cells, resulting in intrinsic factor not being made, and vitamin B12 being excreted. The nutrient is abundant in animal products, such as meat, fish and dairy. However, if the body is unable to reabsorb vitamin B12, you’ll experience symptoms of a deficiency over time.
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Importance Of Vitamin B12 And Dementia
For years, experts have been trying to figure out the link between vitamin B12 and dementia.
Several studies report that the elderly who have low vitamin B12 levels are at high risk of dementia.
One of the studies with 121 participants uncovered the fact that those with lower vitamin B12 levels had smaller brain volumes according to MRIs and they also performed poorly on cognitive tests.
What About Vegans And Vegetarians
Vegans consume no animal products, but they can definitely take vitamin B12 dietary supplements preferable with water, after eating, to avoid deficiency. This is particularly important for women during pregnancy and while breastfeeding. ; Elderly people may need larger amounts of vitamin B12 than younger people because the body’s ability to absorb vitamin B12 from the diet declines with age. Milk, yogurt and cheese, along with eggs, are the only vegetarian food items that naturally contain significant levels of vitamin B12. ;;;
Plant foods may be fortified with B12. If you are considering taking a B12 supplement, ask your health care provider to help you determine the right dose for you. Some types of soya milk and breakfast cereals are fortified with vitamin B12. Some nutritional yeast products may contain vitamin B12. It is important to read the labels for these foods as not all products and brands have B12 fortification, and the amount of fortification can change with time.
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Evaluating The Epidemiologic Evidence
Even while there is a general impression of strong epidemiologic evidence to support associations between the B-vitamins and cognitive decline, in actuality, the evidence is weak. The impression may be driven by the numerous cross-sectional and case-control studies that relate dietary or biochemical levels of the B-vitamins to cognition or disease status. A primary limitation of these types of studies is that one cannot determine whether the observed association is a cause or effect of the disease. For example, both serum and dietary intake levels of folate have been reported to decline with prolonged institutionalization , and duration of dementia . In addition, studies that use a one-time cognitive assessment cannot separate attained or lifetime cognitive ability from cognitive decline due to age or disease. Confounding bias is highly likely in these types of studies because cognitive ability is related to many factors, including education, socio-economic status, and healthy lifestyle behaviors. Depression may be another source of confounding in these studies, as it is a common condition in persons with dementia , and has been associated with folate deficiency .
Vitamin B12 Deficiency Optic Neuropathy
Vitamin B12 deficiency is the underlying cause of several syndromes of nutritional optic neuropathy. The optic neuropathy may be the initial manifestation in a patient when no other neurological signs of vitamin B12 deficiency, such peripheral neuropathy and dementia, are evident. Males comprise 80% of affected patients.6
Vitamin B12 deficiency and its complications are more often seen in pernicious anemia, an autoimmune disorder resulting from antiparietal cell antibodies and anti-intrinsic factor antibodies that inhibit the production of intrinsic factor, which is required for absorption of vitamin B12 in the ileum. Pernicious anemia most often occurs in middle-aged and elderly white people. Optic neuropathy may be the initial feature of pernicious anemia, preceding the development of megaloblastic anemia and even lower cervical and upper thoracic posterior column demyelination and leukoencephalopathy. Patients with pernicious anemia and no visual symptoms may have abnormal visual evoked potentials , suggestive of subclinical optic nerve lesions, optic chiasm lesions, or both.1
H. Qiu, … M. Chen, in, 2017
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Vitamin Deficiency May Reduce Brain Volume
Doctors in India, including that of the Department of Neurology, King George Medical University wrote in the journal;Magnetic resonance imaging;:;We conclude that brain networks associated with cognition control are altered in patients with vitamin B12 deficiency,;which partially recover following six weeks of replacement therapy. The reason for this studys appearance in an MRI journal was that this research team was able to demonstrate by;resting;state;functional;MRI a;clinical neuropsychological evaluation in;patients with brain networks that appeared to be restoring.
MRI documented brain atrophy was also noted in a 2011 study from researchers at Rush University. The study published in the journal;Neurology; reported that vitamin B12 deficiency could be responsible for reduced brain volume.
However, a July 2020 study suggests that their results did not reveal significant associations between biochemical markers and cognitive function, global or regional brain volume, cortical thickness or cortical surface area, neither in controls nor in Alzheimers disease patients. However again, The present results do not exclude such effects of B12 and folate supplementation in individuals with vitamin deficiency. The topic is confused.
How Do We Know We Are Deficient
The symptoms are often not very specific, so vitamin B12 deficiency can go unnoticed for a long period of time. It is also easily mistaken for other conditions, and therefore remains misdiagnosed. That is where the danger lies. By the time the condition gets detected, there might be some irreversible damage done already. A careful interview and a blood test is required. You are considered to be B12 deficient if your concentration of vitamin is less than 150 pmol/L.;
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Symptoms Of A Vitamin B12 Deficiency: Nerve Damage And Memory Disorders
Since vitamin B12 is stored in the liver for a long period, a deficiency in this vitamin develops gradually, over a longer amount of time. The symptoms of deficiency are varied, due to the different functions of the vitamin, and can be dismissed for a long time as a sign of aging. A vitamin B12 deficiency is frequently only identified when the most typical symptom of a vitamin B12 deficiency hyperchromic anemia develops. Hyperchromic anemia is a special form of anemia which develops due to the insufficient proliferation of red blood cells. However, when it becomes noticeable, it is often too late for early diagnosis and treatment. This is because, the neurological damage triggered by the vitamin B12 deficiency may develop much earlier without being noticed and, if it remains untreated for too long, it may be irreversible. The problem: Associating the nonspecific neurological symptoms such as gait unsteadiness, confusion and memory disorders with a possible vitamin B12 deficiency still happens far too rarely and as a result, they remain untreated for a long time. A vitamin B12 deficiency is closely linked to the risk of developing dementia which associates a low vitamin B12 level with memory disorders and early-stage Alzheimers dementia. This is shown in a recent study that establishes a connection between a vitamin B12 level and mild cognitive impairment.
What If The Person Wont Go For Investigations And Tests
The person may be feeling frightened of getting a diagnosis and may think that they will lose their independence or have to go into care. In some cases, they may not understand that there are concerns about their memory or behaviour and deny they have a problem.
It is important to reassure the person that their symptoms may be due to another potentially treatable condition. This could mean they become more willing to visit the GP. If the person simply refuses to go to the GP, you can contact the surgery to explain the situation, either by phone, letter or email. The GP may be able to provide a home visit to speak to the person about their symptoms.
The GP may not be prepared to discuss confidential information with you, but they should welcome relevant information about the persons current health and concerns.
For more advice on encouraging someone who is reluctant to visit their GP, please watch our video, here.
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Vitamin B12 And Dementia: Is There A Link
The bodys inability to correctly absorb B12, a vitamin found in animal products like meat, cheese, eggs and milk, has been linked to neurological disorders. Depression, dementia and mental impairment are often associated with vitamin B12;and folate deficiency, especially in the elderly,according to doctors who have studied the vitamins. Now a new study by;The Irish Longitudinal Study on Aging at Trinity College in Dublin has found that an alarming number of older adults over 50 are deficient in both vitamin B12 and folate, another B vitamin.
The study found that one in eight participants were deficient in B12 and one in seven were deficient in folate. Researchers noticed that deficiency rates increased in older age groups. In people ages 50 to 60, deficient folate was 14 percent; in those ages 80 and above, it was 23 percent.
As people age, their ability to absorb B12 declines. Stomach acids that are required for absorption decline with age, and people who take drugs to help with stomach acid or ulcers are more at risk for developing a B12 deficiency.
Past studies have shown that the consequences of low B12 levels are possibly dire: In one study from 2008, researchers from the University of Oxford in Britain found that low B12 was associated with brain shrinkage. Those with low levels of the vitamin lost twice as much brain volume as those with high levels over a five-year period.
This study was published in the British Journal of Nutrition.
How Vitamin B12 Deficiency Harms 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 malfunctioning.;
The most common problems related to low vitamin B12 levels include:
- Anemia. This means the 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.
- Neuropathy. This means that nerves in the body are 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 specific vitamin B12 deficiency caused by the loss of; a bodys; 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.
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Frequently Sought As A Cause Of Dementia B
Ronald Devere, MD
LC is a 68-year-old female who came to my Memory Disorders Clinic accompanied by her elderly parents. She was unable to provide a proper history due to her confusion. Her parents relate that she had an eightmonth history of progressive memory loss, increasing obsessive behaviors . She was becoming increasingly agitated and unable to comprehend simple conversation. Her pertinent history revealed a bipolar disorder over the past 40 years requiring hospitalization for shock treatment and long-term psychiatric follow-up. The only medication she was taking at the time that I saw her was Risperdal 2mg in the morning, thyroid medication, and estrogen. One week before coming to see me she had been driving from her home to her psychiatric follow-up clinic and was found by the police walking on the highway not knowing where she was. She was admitted to a nearby hospital.
She saw me one week later. Her personal history revealed she had a Bachelor’s degree in music, taught piano, and was an accomplished pianist. Over the last five years this interest had waned. She did not smoke or drink. Her family history revealed other members with long histories of psychiatric disorders but no history of dementia.
The patient and her parents returned a month later so I could review the test results with them and determine a course of action.
Importance Of Vitamin B12
Before getting deeper into the connection between vitamin B12 and dementia, it is prudent to learn the importance of the vitamin in the human body.
In the brain, vitamin B12 enables a process known as memory formation where brain cells make new connections.
The vitamin is also an essential part of myelin, a coating that protects a majority of the brain cells. Other important roles that the vitamin plays in the body include:
- Formation of red blood cells
- DNA synthesis
- Production of energy
- The normal function of the nervous system and the brain
Learning these roles of the vitamin explains why a deficiency can lead to memory loss or dementia.
With this in mind, check out some of the reasons why low vitamin B12 mostly affects older persons.
Note: another name for vitamin B12 is Cobalamin.
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Neural Tube Defects And Folic Acid
As with a vitamin B12 deficiency, a lack of folate can also affect an unborn baby’s growth and development in the womb .
This increases the risk of neural tube defects, such as spina bifida, developing in the unborn baby.
It’s recommended that all women who could get pregnant should take a daily supplement of folic acid.
You should take a 400 microgram supplement of folic acid every day before you get pregnant, and up until you’re 12 weeks pregnant.
Page last reviewed: 23 May 2019 Next review due: 23 May 2022
Breastfeeding By A B12 Deficient Mother
Vitamin B12 deficiency is very common in infants born to vegan or vegetarian mothers. A study has shown that the prevalence of the deficiency among infants is about 45%.13
Both unborn and newborn babies have a special need for vitamin B12 and if the mother is a vegetarian or a vegan, this need may not be met either through her diet for the unborn or through her breast milk for the newborn. As a consequence, vitamin B12 deficiency may develop in a breastfed infant within 36 months of age, severely affecting the babys growth.14
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Low Vitamin B12 Level In Elderly May Spur Dementia
26 September 2011
Low vitamin B12 levels may be to blame for some cases of poor memory and cognitive decline in the elderly, a new study suggests.
The analysis of 121 people found that those with lower vitamin B12 levels scored worse on cognitive tests, and had smaller brain volumes as revealed by MRI scans. Shrinking brain volume has been linked to dementia in other studies.
“Every single marker of low vitamin B12 was correlated with low brain volume,” said study researcher Christine Tangney, a clinical nutritionist at Rush University in Chicago.
Vitamin B12 is found in meat, fish, eggs and dairy products. Deficiency in vitamin B12 is common in those who adhere to a vegan diet and in third-world countries. However, a growing body of evidence suggests that elderly people in developed counties are also at risk of B12 deficiency. The new results, published tomorrow in the journal Neurology, suggest that doctors should test vitamin B12 levels when treating anyone with signs of dementia, the researchers said.
Vitamin B12 in the body
“As folks get older, their guts change in their ability to absorb vitamin B12,” Tangney told MyHealthNewsDaily. “For many people, the reason is that their stomach acid production is reduced.” You need acid to break down the bonds between vitamin B12 and proteins, so older people may need more vitamin B12 as they age, and may be more likely to be deficient in the vitamin, she said.
More work needed