Vitamin B12 deficiency is thought to be a silent epidemic, especially among people at midlife and older, which means there's a good chance that you or someone you love suffers from it.
Ask yourself this: Do you (or your spouse, or a parent) experience neurological problems, like numbness or tingling in limbs, balance problems, dizziness, forgetfulness, memory loss or dementia? Have you been diagnosed with depression, or another psychiatric disorder? What if these seemingly serious health problems are simply the result of a b12 deficiency? And what if your doctor is prescribing you potent drugs—for dementia, or depression, say—when your issues could be more effectively and safely treated with vitamin b12? If that were the case you would certainly want to know about it, which is why Sally Pacholok, an ER nurse and co-author of the book Could it Be B12? An Epidemic of Misdiagnoses says that people experiencing one of these symptoms should demand that their doctors test their b12 levels.
"I've been an ER nurse for 25 years and every day I see people coming in with signs and symptoms or risk factors for b12 deficiency, but patients often go undiagnosed or misdiagnosed," says Pacholok. "Studies have shown that 16% of the US population has a b12 deficiency, but that's probably an underestimate, because they define deficient as less than 200 serum b12, but we know that people can have signs and symptoms up to 400."
As a result, she says, people are being given treatments they don't need, and in some cases even being confined to nursing homes, when proper b12 supplementation could solve the problem.
Why is this epidemic so underdiagnosed? Doctors usually only look for b12 deficiency in vegetarians, because B12 is found exclusively in animal products, but even hardcore carnivores can be deficient. "Unlike other vitamins B12 is difficult for your body to absorb," says Pacholok. "There are several steps required for proper absorption and a road block at any point can cause a deficiency." Here are a few of the reasons you could be deficient:
You're 55+. Once you hit midlife your stomach slows down its production of hydrochloric acid, which is required for b12 absorption.
You take drugs for digestive issues. Proton pump inhibitors (PPIs), which "doctors prescribe like candy" for conditions such as heartburn, points out Pacholok, reduce stomach acid even more, which can result in a b12 deficiency over time.
You have an autoimmune (or other digestive) disorder. "People with diseases like Crohn's, celiac and IBS can become b12 deficient because the linings of their small intestines are compromised, which inhibits b12 absorption."
You've had radiation treatments. "If you've had radiation of the pelvic area for prostate, colon, ovarian or another pelvic cancer, it will damage the lining of the small intestine, hindering absorption."
So anybody meeting any of the risk factors above, or experiencing any of the warning symptoms, should go to the doctor and demand a b12 test. "The test is cheap and easy and covered by Medicare and most insurance, so there's no reason not to," says Pacholok. If your doctor tells you your results are "normal" ask for the actual numbers, since what the US calls normal—200 pg/mL (picograms per milliliter)—can result in symptoms, and older adults with levels up to 500 pg/mL can still experience symptoms.
If you find that you're deficient, supplements can help, but only if you get the right kind. "Because absorption is difficult through the digestive tract, injections are often the best way to supplement b12," says Pacholok, who adds that the injections are easy to do at home and often only necessary 2-3 times per month (ask your doctor for details). If you want to buy b12 over the counter, look for sublingual pills, which you slip under your tongue until they dissolve, allowing them to mostly bypass your digestive system and be absorbed straight into your body.
You can learn more about the symptoms, causes and treatment of b12 deficiency at the website www.b12awareness.org.
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