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In This Episode:
Dr. K explains what all older adults and family caregivers should know about the surprisingly common problem of vitamin B12 deficiency. She covers:
- Common symptoms of low vitamin B12, such as anemia (low red blood cell count), neuropathy (nerve problems), and cognitive impairment
- The role of vitamin B12 in the body
- What causes pernicious anemia, which is a type of vitamin B12 deficiency
- Which medications interfere with vitamin B12 absorption and can cause low levels
- Other risk factors for having low vitamin B12
- How to test for vitamin B12 deficiency, including when to test for methylmalonic acid
- How this vitamin deficiency can be treated
Related episode:
011 – Vitamin D: The “Healthy Aging” Dose & FAQs
Related Resources:
- How to Avoid Harm from Vitamin B12 Deficiency
- Vitamin B12 as Protection for the Aging Brain
- National Institutes of Health Vitamin B12 Fact Sheet
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Prue Jones says
I am the opposite as have extremely high levels of Vitamin B12. Many of the deficiency symptoms you describe I have so I am wondering if I am deficient. I am a 64 year old woman in good health. I do have chronic Lyme disease which was discovered and treated successfully with a year of antibiotics and herbals. Could the antibiotics have caused absorption issues perhaps?
I appreciate your thoughts on this.
Nicole Didyk, MD says
Sorry to hear about your Lyme disease and I’m glad your treatment was successful.
Antibiotics can definitely affect absorption of vitamins and other substances (including medications) in the gut. If you’re off the antibiotics now, I would talk to your doctor about whether you need to look into your B12 levels more closely.
Diane says
My Dad has had multiple iron transfusions over the past 5 or 6 years..and many test but the doctors have not found where he is losing blood. I recently went to have some test done, I went to a doctor that uses natural things to try and fix the problem. Ok, so Anemia runs in our family , my hemoglobin was 6.6 .The doctor told me I needed and iron transfusion and wants to do one if my levels don’t come up next month. But He put me on vitamins with iron , testosterone pellet injection and D3 supplements, magnesium…and fish oil..but he made a statement that I have Been thinking over in my mind about, he said that the d3 and testosterone being low could be why I’m anemic, that these were the “vehicles “ so to speak to carry oxygen to the heart…. so he hopes my levels are up when I come back..so my question is , have you heard of this? And could this be my dads problem? Because this doctors does blood work but never puts him on any vitamins or supplements?
Leslie Kernisan, MD MPH says
Hm, I’m not sure what type of anemia you have running your family, but a hemoglobin of 6.6 is quite markedly low. So I would recommend asking the doctors to clarify what they think the cause of your anemia is. Low D3 and testosterone sound like a very unusual cause of a hemoglobin 6.6.
Older adults tend to have different causes of anemia than younger people, so even if there is “anemia in the family”, I wouldn’t assume you and he have the same cause. It sounds like perhaps they think he is actually losing blood but aren’t sure where. This doesn’t mean that your anemia is due to blood loss (although it might be).
The “vehicles” carrying oxygen to the heart are functioning red blood cells and adequately open blood vessels. Red blood cells do need certain nutrients in order to be made and to function.
I explain common causes of anemia in this article: Anemia in the Older Adult: 10 Common Causes & What to Ask. I recommend asking your health providers many more questions about what they think is going on and what their plan is. Good luck!
WERNER L. KIST says
I have many symptoms of Vitamin b-12 deficiency but do not show vitamin b-12 deficiency when tested. I suspect that I was vitamin b-12 deficient for over 10 years. I had my levels checked during this time but the vitamin b-12 tests were not accurate because being a vegetarian I ate a lot of salads and my folate was off the charts. It has come tp my understanding that a high folate level can hide a vitamin b-12 deficiency – which at the time was not known. Although I complained about pain in the my feet and less control on my urination, the primary physician didn’t link it to anything. It was years later that on a blood test I discovered that I had a homocystiene level of 17. When I brought this to the attention of my primary physician, he gave me a MMA test and confirmed that I had a vitamin b-12 deficiency. I could have had this for over 10 years! We supplemented the vitamin b-12 with oral supplements of 2500 mcg. per day. My level of vitamin b-12 came back up and with in 3 months, my levels of vitamin b-12 were declared normal again. This happened near the age of 60. At the age of 63 while doing some yoga positions, I apparently bruised my spinal column and have lost the sense of temperature and sharpness in my left leg – Brown-Sequard syndrome. I had MRI’s done but there was no physical impingement on my spinal cord. The symptoms over time have gotten worse as I can no longer run, or walk a long distance without exhaustion. Although I have googled the effects of vitamin b-12 deficiency, there is little information of whether vitamin b-12 deficiency has defered effects and what the long term effects might be of a long term vitamin b-12 deficiency. I still supplement with vitamin b-12 and the latest tests don’t show any deficiency – my folate is still off the charts – my rbc count is low but my iron levels are at the high end. I have gone to a number of physicians but to no avail – any ideas?
Leslie Kernisan, MD MPH says
It sounds like you are having some neurological symptoms and also fatigue with walking long distances, and you’re trying to find out what might be causing this. Vitamin B12 deficiency can cause neurological symptoms and if the deficiency goes on a long time, they may not completely reverse once vitamin B12 levels are restored to normal.
In your case it sounds like your symptoms started a few years after your vitamin B12 level was treated. I am not a neurologist or a specialist in vitamin B12, so I can’t say how possible it is that your current symptoms are related to your prior deficiency.
In general, neurology sounds like the right specialty for evaluation of your symptoms. If you have seen already seen a neurologist, you could consider getting a second opinion from another one (perhaps one at an academic medical center). Major medical centers also offer second opinion services, such as this one at UCSF: https://www.ucsfhealth.org/secondopinion/#.
Good luck!
gary lucas says
I just now listened to your podcast on B12. Even though I was reporting severe neuropathy to multiple physicians (toes to elbows) my complaints were minimally investigated and routinely dismissed. Because I rarely challenge the opinions of physicians, it took years before I was seen by a Neurologist who prescribed injections. Even with his report, I found no support for the injections from my hospital group who are the largest in my State, and several more years went by without treatment. Ultimately with guidance from the Pernicious Anemia Facebook Group, I fought for and received multiple injections per month, got my serum levels above one thousand, and after five years of multiple injections per month, my last Neurological exam reported that the nerves in my hands and feet and cognitive impairment — which was so severe I assumed it was brain damage was almost totally restored. I relate my experience because, for one, the expense of self injection of B12 is not covered by insurance and has gone up from $2 to $25 per vile, the symptoms of B12 deficit are extreme, and several physicians misguided me and have presumably misguided others. Please let me say, I’ve enjoyed your Geriatric podcasts and intend to keep listening.
Leslie Kernisan, MD MPH says
Wow, what a story. I’m glad you ultimately found the treatment you needed. Wonderful that you were able to get support and encouragement from a community of other patients. And fantastic that so many of your symptoms resolved! I don’t often hear success stories like that, but that may be because most of my patients are older (hence other causes for cognitive impairment) and perhaps have milder vitamin B12 deficiency than you had.
That price increase for vitamin B12 injections is quite concerning. Have you already tried oral vitamin B12 for maintenance? Even in people with pernicious anemia, research suggests that high daily doses can maintain vitamin B12 levels. Here is a recent article summarizing this approach:
Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia
Good luck and thank you for your kind words regarding the podcast!