Vitamin B12 deficiency is common among adults over 50 due to reduced stomach acid needed for absorption. Ignoring symptoms can lead to irreversible nerve damage, cognitive problems, and anemia. Early red flags include extreme fatigue, numbness in extremities, memory loss, and a swollen tongue.

What is vitamin B12?

Vitamin B12 is an important nutrient that helps the body maintain healthy nerve cells and red blood cells, and also helps the body make DNA.

The body does not produce vitamin B12 on its own, so it must be obtained from foods and drinks rich in it. Vitamin B12 is primarily found in animal products, such as fish, meat, dairy products, and eggs. It is also found in fortified foods (foods with added vitamins and minerals), such as cereals, bread, plant-based milk, and nutritional yeast.

Adults need about 2.4 micrograms (mcg) of vitamin B12 daily; pregnant or breastfeeding women need more. Infants and children's needs vary by age, according to the health website Cleveland Clinic.

What is vitamin B12 deficiency?

Vitamin B12 deficiency, sometimes called cobalamin deficiency, occurs when the body does not get enough of this vitamin or does not absorb it sufficiently from food. Vitamin B12 is an important nutrient that helps the body produce red blood cells and DNA, the genetic material in all body cells. It is essential for body functions. If left untreated, vitamin B12 deficiency can cause physical, neurological, and psychological problems.

Complications of vitamin B12 deficiency

Memory impairment related to vitamin deficiency can mimic early stages of dementia, making early diagnosis crucial. Here are the most notable signs that appear after age 50:

Peripheral neuropathy:

Numbness and tingling like "pins and needles" in the hands and feet, along with muscle weakness and balance problems.

Cognitive decline:

Memory problems, difficulty concentrating, severe mood swings, and in some cases, memory loss.

Chronic fatigue:

Persistent exhaustion due to the body's inability to produce enough red blood cells to carry oxygen.

Changes in the tongue and mouth:

Inflammation of the tongue, making it red and smooth, or painful sores and dryness at the corners of the mouth.

Pale skin:

Slight yellowing of the skin or pallor of the whites of the eyes due to the breakdown of red blood cells.

Causes of vitamin B12 deficiency

Vitamin B12 deficiency occurs if you do not consume enough of it or if your body does not absorb it properly. Conditions that may lead to vitamin B12 deficiency include:

Vitamin B12 deficiency in the diet: People who do not eat enough foods rich in vitamin B12, or do not eat fortified foods, may develop a deficiency.

Gastritis: Gastritis is inflammation of the stomach lining, a common cause of vitamin B12 deficiency. It may cause deficiency due to a lack of hydrochloric acid in the stomach, which is necessary for absorbing vitamin B12.

Pernicious anemia: People with pernicious anemia do not produce intrinsic factor, which is essential for absorbing vitamin B12. Consequently, they suffer from vitamin B12 deficiency.

Digestive tract diseases: Diseases affecting the digestive tract, such as Crohn's disease and celiac disease, can prevent the body from fully absorbing vitamin B12.

Surgery: People who have undergone gastrointestinal surgery, such as gastric bypass surgery, may have difficulty absorbing vitamin B12.

MTHFR deficiency: A genetic mutation (change) that makes it difficult to metabolize vitamin B12 properly. The body needs higher doses of vitamin B12 to function well, and sometimes special supplements of methylated vitamin B12.

Risk factors

You are more likely to develop vitamin B12 deficiency if you have one or more of the following risk factors:

Age over 75: People over 75 are more prone to vitamin B12 deficiency because their bodies often cannot fully absorb it.

Digestive disorders: Digestive disorders can make it difficult for the body to absorb vitamin B12.

Following a vegan diet: Vitamin B12 is naturally found only in animal products, such as meat and dairy. Therefore, people on a vegan diet are more at risk of deficiency if they do not take supplements.

Taking certain medications: Some medications may lower vitamin B12 levels in the body, including metformin, proton pump inhibitors, H2 receptor antagonists, and birth control pills.

Having Sjögren's syndrome: People with Sjögren's syndrome are more likely to have vitamin B12 deficiency.

How is vitamin B12 deficiency diagnosed?

Diagnosing vitamin B12 deficiency can be difficult, as symptoms may not appear or may mimic other nutrient deficiencies. Healthcare providers usually perform blood tests to check for vitamin B12 deficiency in people at risk.

Specific tests that help diagnose vitamin B12 deficiency are: complete blood count (CBC) and a vitamin B12 blood test.

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