Vitamin B12 deficiency in the elderly

Aside from blood disorders, vitamin B12 deficiency has been associated with neuropathy, vertigo, altered gait, depression and cognitive dysfunction. In the UK, an estimated 20% of those aged 65–75 are vitamin B12 deficient. Because untreated B12 deficiency can lead to mild cognitive impairment, which carries a 15% risk of progression to dementia, early detection of deficiency is paramount.

The inability to cleave B12 from food accounts for about 70% of all B12 deficiency in the elderly. Common causes include gastric atrophy, H.pylori bacterial infection, pancreatic insufficiency and the long-term use of proton pump inhibitors, H2 blockers and metformin – common medications in the elderly. While clinical B12 deficiency is typically treated with intramuscular B12 injections, sub clinical (mild) deficiency can be treated with oral supplementation. Subclinical deficiency is a state in which individuals have a normal serum-B12 level but at the lower reference range, have no anaemia but present with neurological symptoms.

While a nutrient-dense diet is important to ensure the recommended nutrient intake of 1.5 µg/day B12 is met, B12 deficiency is rarely due to dietary intake, unless individuals are vegan. Recent studies on oral B12 supplementation acknowledge the link between subclinical B12 deficiency and cognitive impairment or neuropsychiatric disorders. For deficiency arising from low stomach acid, gastritis, PPIs, H2-blockers or metformin, prophylactic supplementation might be considered to prevent irreversible neurological damage. However, it is essential that the cause of B12 deficiency is determined before considering whether oral supplementation is appropriate.

B12 supplements are available in three forms but individuals with a defect anywhere in the B12 metabolic pathway may benefit more from an active form and a liquid or sublingual preparation. Research suggests that a window of opportunity exists for B12 therapy to successfully modulate neurological disorders, being  six to 12 months from the onset of symptoms. Individuals should supplement only as directed by a Registered Nutritional Therapist or health professional.

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