By Jeanette Kimszal, RDN, NLC
Did you know September is B12 awareness month? Feeling tired or lethargic? You could be suffering from a deficiency.
An estimated 15 to 25% of older adults have a B12 deficiency and do not know it. This is because they were never tested or diagnosed.
B12 is a water soluble vitamin and can be found in Brewer’s yeast and sea vegetables. However, the best source is from beef, organ meats, fish, eggs, and dairy.
Water soluble vitamins are excreted in the urine and need to be replenished every day. One thing that is different about B12 is that it is stored in the liver until it is ready to be used.
This means that it can be months or years before the depletion sets in. The down side of this is that if someone cannot absorb the stored nutrient they still will be at risk for deficiency.
This is especially true for older adults. As we age our stomach produces less acid which in turn can result in a decline of how much B12 is absorbed. Older adults who are vegetarians, vegans, have a history of alcoholism, or suffer digestive issues like gluten intolerance, celiac disease, Crohn’s, acid reflux, or IBS are especially at risk.
B12 is needed for many body processes, one of the most integral being energy production. It is also responsible for creating red and white blood cells. B12 helps moves iron through the bloodstream. B12 improves immunity, heart, and brain function. It also helps with digestion and absorption of foods. So if you are deficient your cells will get less oxygen and produce less energy in turn leading to problems with digestion, forgetfulness and make you feel lethargic, sad, weak, tired, and possibly anemic.
The biggest problem with B12 deficiency is that a lot of the signs and symptoms are mistaken for other diseases or thought to be “just a part of getting old.” Symptoms include depression, anxiety, a feeling of tired or weakness, paresthesias, dementia, mental illness, tremor, difficulty ambulating and frequent falls. It is also misdiagnosed as Alzheimer’s disease, depression, diabetic neuropathy, vertigo, and mini-strokes. Sometimes it imitates diseases like multiple sclerosis, chronic fatigue syndrome, and psychosis.
A blood test will determine your B12 status. Levels under 450 picogram/mL indicate there is a deficiency. A normal B12 does not always show the whole picture. Testing MMA and homocysteine levels can give you more information if your B12 is normal. Elevated MMA (above 0.4 micromoles/Liter) and homocysteine (above 6 micromoles/Liter) also show a deficiency.
If you do not eat a diet rich in B12 you need to start taking B12. If you are eating a diet rich in B12 foods but are still suffering from any of these symptoms you may be lacking adequate stomach acid and should look into supplementation. I recommend a liquid or intramuscular form of this vitamin so it goes directly into the bloodstream. You also want to make sure you are getting the most active form of the vitamin so it will work properly. This includes adenosylcobalamin, methylcobalalmin, or hydroxycobalamin.
Often older adults spend more time indoors than their younger counterparts making getting Vitamin D naturally a bit more challenging. Adequate levels of Vitamin D are important for bone health, immunity, and weight management. The best way to get vitamin D is from the sun. Spending just 10 minutes outside in the morning before 10 am will give you what you need. For those winter months where we never see the sun it is important to supplement. Be sure to take a liquid supplement of D3 for the most active form.
Similar to B12, Iron is important for metabolism regulation. If you do not have enough, iron pills can be hard on the stomach and may not be adequately absorbed if there is not enough stomach acid present. An alternative is to take liver pills or collagen protein supplements. This will also give you added calcium to help your bones.
Lastly water consumption continues to be important as you age. Older adults often lose their thirst mechanism and do not feel thirst as much as they used to. Be sure to get enough water. Typical consumption for hydration is 60 to 80 ounces a day.
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