B12 Deficiency, A Silent Epidemic – Part 1

This surprised the dickens out of me, I learned how serious vitamin B12 deficiency could be, and yet, many doctors just don't get it. This is just like diabetes as it is hidden and not plainly visible. Granted, I have blogged about vitamin B12 before, but this is done with several weeks of research and from several sources. In addition I have had contact with two doctors that know about the damage vitamin B12 deficiency can cause.

No, vitamin B12 deficiency is not a hidden deficiency, but a deficiency that doctors refuse to recognize and give the priority it deserves. Most doctors just tell patients to eat more meat and replenish their B12 supply. They forget about the intrinsic factor that many of the elderly loose and therefore lose the ability to absorb vitamin B12 from the meat they do consume. Those that are vegetarians and vegans have to take a vitamin B12 supplement because they do not obtain any vitamin B12 from plants.

According to one doctor, vitamin B12 deficiency is described in every medical textbook and the causes and effects are well-established in scientific literature.

First, we need to understand why vitamin B12 deficiency is very common.

The absorption of vitamin B12 is complex and involves several steps, each of which can go wrong. Causes of vitamin B12 malabsorption include:
■ intestinal dysbiosis (An unhealthy change in the normal bacterial ecology of the intestines
■ leaky gut and/or gut inflammation
■ atrophic gastritis or hypochlorhydria (low stomach acid)
■ pernicious anemia (an autoimmune condition)
■ medications (especially PPIs (Proton-pump inhibitors) and other acid- suppressing drugs)
■ alcohol
■ exposure to nitrous oxide (during surgery or recreational use)

This explains why B12 deficiency can occur even in people eating large amounts of B12-containing animal products. In fact, many patients that are vitamin B12 deficient are following a Paleo diet where they eat meat 2-3 times a day.

In general, the following groups are at greatest risk for B12 deficiency:
■ vegetarians and vegans
■ people aged 60 or over
■ people who regularly use PPIs or acid suppressing drugs
■ people on diabetes drugs like metformin
■ people with Crohn’s disease, ulcerative colitis, celiac or IBS (irritable bowel syndrome
■ women with a history of infertility

Vitamin B12 deficiency is far more common than most doctors and the general public realize. Data from the Tufts University Framingham Offspring Study suggest that 40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low normal range – a range at which many experience neurological symptoms. Of these, 9 percent had outright deficiency, and 16 percent exhibited “near deficiency”. Most surprising to the researchers was the fact that low vitamin B12 levels were as common in younger people as they were in the elderly.

Vitamin B12 deficiency has been estimated to affect about 40% of people over 60 years of age. It is entirely possible that at least some of the symptoms we attribute to “normal” aging, such as memory loss, cognitive decline, decreased mobility, etc., are at least in part caused by vitamin B12 deficiency.

What do all of these diseases have in common? This is from another source.

• Alzheimer’s, dementia, cognitive decline and memory loss (collectively referred to as “aging”)
• Multiple sclerosis (MS) and other neurological disorders
• Mental illness (depression, anxiety, bipolar disorder, psychosis)
• Cardiovascular disease
• Learning or developmental disorders in kids
• Autism spectrum disorder
• Autoimmune disease and immune dysregulation
• Cancer
• Male and female infertility
  
  

Answer: they can all mimic or duplicate the signs and symptoms of vitamin B12 deficiency.

Why is vitamin B12 deficiency so under-diagnosed? Vitamin B12 deficiency is often missed for two reasons. First, it’s not routinely tested by most doctors. Second, the low end of the laboratory reference range is too low. This is why most studies underestimate true levels of deficiency. Many B12 deficient people have so-called “normal” levels of B12. Yet it is well-established in the scientific literature that people with B12 levels between 200 pg/ml and 350 pg/ml (It means picograms per milliliter (pg/ml), levels considered “normal” in the U.S., have clear B12 deficiency symptoms. Most healthy people have body stores of about 1200 mcg of vitamin B12.

Table 1. Recommended Dietary Allowance (RDA) for Vitamin B₁₂

Life Stage	Age	Males (mcg/day)	Females (mcg/day)
Infants	0-6 months	0.4 (AI)	0.4 (AI)
Infants	7-12 months	0.5 (AI)	0.5 (AI)
Children	1-3 years	0.9	0.9
Children	4-8 years	1.2	1.2
Children	9-13 years	1.8	1.8
Adolescents	14-18 years	2.4	2.4
Adults	19-50 years	2.4	2.4
Adults	51 years and older	2.4*	2.4*
Pregnancy	all ages	-	2.6
Breast-feeding	all ages	-	2.8
*Vitamin B12 intake should be from supplements or fortified foods due to the age-related increase in food-bound malabsorption.