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The Unknown and Hidden Scourge of Senior Citizens

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B12 Deficiency: Still America's #1 Missed Diagnosis

Doctors rarely consider Vitamin B12 deficiency even though B12 deficiency is common and is the #1 most missed diagnosis. At least 6% of the general population has B12 deficiency. That is almost as common as heart disease. However heart disease, blood pressure and cholesterol levels are constantly monitored and treated, yet when was the last time you had your B12 level tested? The average doctor will see 1 or 2 cases of B12 deficiency every day. However I have talked to doctors who tell me they only see 1 or 2 people a year that the doctor thinks need their B12 level tested. Because these doctors are missing 99% of the B12 cases, most cases of B12 deficiency are never diagnosed.

Vitamin B12 Deficiency Increases With Age

B12 deficiency effects slightly more than 1 person out of 20 for the general population, but goes all the way up to 1 out of 5 for people over 60. Because B12 deficiency can be corrected, If treated appropriately, it represents one of the most important opportunities for senior citizens to improve their health and reduce their suffering.

B12 Deficiency Symptoms are Often

Wrongly Attributed to Normal Aging

Vitamin B12 deficiency symptoms are often considered normal signs of aging. How many seniors do you know that complain of numb feet? Numb, tingling or burning feet are classical symptom of B12 deficiency. Seniors may be ignored by their doctor when they complain of headaches, or insomnia or tiredness, all of which may be due to B12 deficiency. Mental confusion and dementia are classical signs of severe B12 deficiency, yet I have encountered patients in nursing homes due to dementia that have not had their B12 level tested. B12 deficiency is known as “The Great Masquerader" because it causes so many symptoms in so many different parts of the body.

Here are potential B12 deficiency symptoms you should not ignore.

  • Feeling tired all the time

  • Numbness, or tingling (pins and needles) in feet or hands

  • Burning feet

  • Headaches

  • Depression, irritability or anxiety

  • Forgetting things, or easily confused

  • Heart palpitations or shortness of breath

  • A smooth tongue

  • Constipation, diarrhea, nausea, loss of appetite, or gas

  • Muscle weakness

  • Insomnia or other sleep problems

  • Balance problems when walking

  • Experiencing a change in the way you feel and behave

B12 Deficiency is Rarely Due to Dietary Deficiency

If you eat meat, eggs and cheese you probably have enough B12 in your diet. But absorbing the B12 is the issue. To absorb B12 you need high levels of acid in your stomach, and Intrinsic Factor which is also produced by your stomach. Unfortunately as people age production of both acid and Intrinsic Factor decline which is why so many seniors end up with B12 deficiency. People with a history of heavy drinking are also predisposed to inadequate B12 absorption. Other GI problems, such as celiac disease, SIBO, IBD, and bypass surgery for weight loss are also important contributing factors. Thus most B12 deficiency is an absorption issue, but vegans are the exception. A vegan diet actually is B12 deficient and requires supplementation. Please note: if Vitamin B12 deficiency is due to inadequate absorption, taking oral B12 supplements will NOT correct the deficiency.

The Normal Range for Vitamin B12 is NOT Known

A serum vitamin B12 level between 160 pg/mL and 900 pg/mL is considered normal by many labs. Other labs use 200 pg/ml to 900 pg/ml as the normal range. However many experts suggest a minimum level of 350 pg/mL for optimal health. And there are many documented cases of people with levels as high as 400 or 500 that responded to B12 therapy. We really don't know where the cutoff should be for normal.

Methylmalonic Acid Should be Tested to

Diagnose B12 Deficiency

The best way to see if a patient has adequate B12 is to test the methylmalonic acid level. Low B12, causes your methylmalonic acid level to climb. Most experts consider the methylmalonic acid level to be the best indicator of the actual B12 level, especially if your B12 level is below 600. Basically 200 to 900 is the normal range and if your B12 level is in the bottom half of that normal range, IE below 600, you look at the methylmalonic acid level. If methylmalonic acid is high, you are B12 deficient. You can test the methylmalonic acid level with blood or urine. In most cases B12 and methylmalonic acid should be ordered at the same time. Between the two tests you can know for sure if you have a B12 problem.

If You Need B12, You Probably Need a B12 Shot

Because almost all B12 deficiency is due to malabsorption, you can't treat B12 deficiency with oral B12. If you don't absorb B12 from meat and eggs you won't absorb it from a pill. There are sublingual B12 products on the market, but they don't work any better than regular pills. Thus if you need to increase your B12 level, you need B12 shots.

I'll tell you 2 things about B12 shots.

  1. They're pretty cheap. We used to do them for $15 in the olden days, and even now you shouldn't have to pay more than $30 or $35. And they are usually covered by insurance.

  2. And they really work! If you are B12 deficient, a B12 shot will make a BIG difference. More energy, better sleep, better mood, less aches, pains, numbness and tingling.

You Don't Need to Suffer!

If you have a B12 deficiency, you might suffer needlessly for years before you are correctly diagnosed, if ever. If you have ANY doubt, ASK to have your B12 level tested, including a methylmalonic acid test.

Take care and BE HEALTHY!

CW Jasper

April 2023

© 2023· Content is Property Created by CW Jasper


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Spencer Beck
Spencer Beck
Apr 28, 2023
Rated 5 out of 5 stars.

Great article, is there a potential was of addressing the absorption problem and increase the methylmalonic acid?

Doctor Jasper
Doctor Jasper
May 03, 2023
Replying to

Good gastrointestinal health might preserve B12 absorption, but once you lose it, B12 shots are about your only realistic option. If you don't want to lose your ability to absorb B12 avoid heavy drinking, don't get bypass surgery to lose weight, avoid old age, don't develop any chronic GI diseases, etc


Gerald Hacker
Gerald Hacker
Apr 27, 2023

Dr. Jasper, if a person is taking omeprazole to treat GERD, will this impact their absorption of B12 because the omeprazole reduces stomach acid?

Gerald Hacker
Gerald Hacker
Apr 29, 2023
Replying to

Thank you! That's good to know.


2 Questions: How often are the shots needed for someone who is deficient?

What about sublingual B12? Doesn't at least some of that bypass the GI absorption problem?

Doctor Jasper
Doctor Jasper
Apr 26, 2023
Replying to

Hi Bart, nice to hear from you! I guess I should have addressed this a little better in the article, because I have already fielded one phone call and now your comment on this issue of sublingual products in the 2 hours since I sent the article out. OK, in a marketing sense you can make the claim that sublingual pills bypass the absorption issue in the gut. But the increased absorption is not enough to be clinically relevant for anybody with a true deficiency. Some doctors use injections to get the B12 levels up to normal and then try to phase over to sublingual pills to maintain it. That may work, I'm not sure, but I don't think any…

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