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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
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
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.
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.
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!
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