B12 Deficiency Often Undetected

You need vitamin B12 to form red blood cells, keep your brain sharp, and fuel your energy levels.

Vitamin B12 also regulates the level of the amino acid homocysteine in your body. High homocysteine ups your risk for heart disease, so adequate levels of B12 are important for your cardiovascular health, too. 

With less than the recommended 2.4 mcg daily for adults, the symptoms of low B12 can range from simple fatigue and brain fog to serious changes in vision and balance.  Children need B12, too, between .9 and 1.4 mcg a day, depending on their age.

Most of us can get enough B12 from food sources, which include meat, seafood, milk products, poultry, and eggs. Liver is one of the best sources of B12, but if the thought of a plate of liver and onions makes your stomach curl, or if you’re not much of a meat eater, fortified breakfast cereal (Total, Wheaties, Multigrain Cheerios) will help do the trick.

Mild B12 deficiency may produce no symptoms. But when anemia results from lack of B12, the symptoms may include fatigue, weight loss, rapid heartbeat, pale skin, and easy bruising. Nerve damage caused by lack of B12 may manifest itself as numbness or tingling in fingers and toes, confusion or depression, memory loss, or difficulty walking, among other symptoms.

Deficiency Often Overlooked

In their book, Could It Be B12: An Epidemic of Misdiagnosis (2011, Quill Driver Books), Sally Pacholok and Jeffrey Stuart sound the alarm about the health hazards of vitamin B12 deficiency. They describe it as an often missed, or misdiagnosed condition, writing about patients whose symptoms were mistakenly ascribed to Parkinson’s disease, Alzheimer’s, or multiple sclerosis. In children with developmental or speech delays, an incorrect diagnosis of autism is often given rather than investigating a possible B12 deficiency, they say.

In their view, “normal” B12 ranges in blood testing are too low, and need to be recalibrated. And they dispute the Centers for Disease Control and Prevention statistic that one out of every 31 people older than 50 is B12 deficient. They cite other research from Tufts University, where data analyzed from the Framingham Offspring Study showed that nearly 40 percent of people between 26 and 83 had B12 levels in the “low normal” range.

Poor Absorption

People who get the recommended amount of B12 from their food often fail to absorb it properly. Poor absorption of B12 can be caused by Crohn’s disease or atrophic gastritis, which is inflammation and deterioration of the stomach lining. Excessive alcohol use and some medications, such as those used to treat gastric reflux, may also inhibit the absorption of B12. People who have celiac disease or who have undergone gastric bypass surgery can have trouble absorbing B12 as well.

What should you do if you suspect your B12 level is low? “The first thing is to have a serum B12  test,” says Sally Pacholok. Don’t take B12 supplements before the test, she advises, because that will muddy the results. An emergency room nurse, Pacholok’s interest in B12 deficiency initially stemmed from her personal experience at beginning at age 19.

A pre-employment blood test showed that her red blood cells were unusually large, which can signal either a deficiency in folic acid or in B12. The significance of the finding was overlooked, and then dismissed even when Pacholok pressed the issue of B12 deficiency, which she had researched as part of her nurse’s training.

Pacholok was treated with B12 shots before lasting neurological damage resulted occurred, but many are not so lucky, she says. In her work as an emergency room nurse, she says she regularly sees elderly patients whose fall-related injuries such as a broken hip or other fracture would not have occurred if they had been screened and treated for B12 deficiency.

“B12 deficiency causes numbness in hands and feet, balance and gait problems, forgetfulness, and dizziness,” she says, all of which can contribute to falling. But older patients are often not checked for low B12, she says. What she terms a “knowledge deficit” about B12 deficiency leads to a cavalier attitude of “oh well, you’re older, you should be off balance.”

Treating B12 Deficiency

Mild B12 deficiency can be treated with oral B12 supplments, Pacholok says, but the sublingal (under the tongue) form is best because capsules or other oral forms are often poorly absorbed. A more acute B12 deficiency may require injections of the vitamin.

The cost of treating people for low B12 is minimal, Pacholok notes, compared with treating something serious like a hip fracture to the tune of tens of thousands of dollars. She emphasizes that neurological damage from untreated B12 deficiency cannot be reversed. Yet treatment is often begun too late, she says.

She and her husband, Jeffrey Stuart, the coauthor of the book and an emergency room physician, do their best to raise awareness of the issue among the patients they see, and through their website. They are advocating for increased training for medical professionals. “But we can’t do it alone,” she says. In Michigan where she and Stuart live, they have approached their local, state, and federal legislators to heighten awareness of the impact of B12 deficiency on people’s lives, and the cost to the health care system.

“This isn’t holistic or alternative medicine,” Pacholok points out. “B12 deficiency is a full-blown medical disorder, and it’s mismanaged.”