B12 is an essential vitamin that is often overlooked but vital to consider as we age. Adequate B12 levels help to support nerve function, produce red blood cells, and facilitate cell growth and repair. However, many elders are at risk of vitamin B12 deficiency because the body's ability to absorb this vitamin decreases with age.
Why I'm Talking About B12 Deficiency
In my geriatric practice, I frequently encounter patients exhibiting signs and symptoms of vitamin 12 deficiency. Many individuals are unaware of how prevalent this condition is among older adults. As always, this post is intended for educational purposes, so please consult your doctor or healthcare provider before making any dietary changes.
How Vitamin B12 works in the body
Vitamin B12 is essential for:
Red Blood Cell Formation: Supports the production of red blood cells, helping to prevent anemia and ensuring effective oxygen transport in the body.
Cell Growth and Energy Production: Promotes healthy cell growth and maintains energy levels.
Brain and Nerve Function: Protects the nervous system and supports memory function.
Heart Health: Helps regulate homocysteine levels, an amino acid associated with cardiovascular disease.
B12 Deficiency and Aging
As we age, our stomachs produce less acid and less intrinsic factor, a protein necessary for B12 absorption. This means that even if we consume plenty of B12-rich foods, our bodies may not absorb enough.
Symptoms of B12 Deficiency
Deficiency symptoms can be subtle but may include the following:
Fatigue and weakness
Memory problems and cognitive decline
Numbness or tingling in the hands and feet
Balance issues
Mood changes such as depression and irritability
An inflamed tongue (glossitis) and mouth sores.
If B12 deficiency is not treated, it can cause serious neurological complications, so early detection and treatment are essential.
Medications That Lower B12 Levels
Some medications can decrease the absorption of B12. If you take any of the below medications, you may need to get B12 levels checked routinely.
Metformin: Commonly prescribed for diabetes, this medication may reduce B12 levels over time.
Proton Pump Inhibitors (PPIs): Medications like omeprazole (Prilosec) and pantoprazole (Protonix) lower stomach acid, which is necessary for B12 absorption.
H2 Blockers: Drugs such as famotidine (Pepcid) also decrease stomach acid, impacting B12 absorption.
Certain Long-term Antibiotics: These can affect the gut bacteria essential for absorbing B12.
How Much B12 Do You Need?
Adults are advised to have a daily intake of 2.4 mcg of vitamin B12; however, older adults may need higher amounts due to challenges in absorption. A simple blood test can determine B12 levels, and supplementation might be necessary based on individual requirements.
Best Sources of Vitamin B12
Vitamin B12 is primarily found in animal-based foods. If you follow a vegan or vegetarian diet, you may need to obtain B12 from supplements or fortified foods.
Food | Serving Size | B12 Content |
Clams | 3 ounces | 84 mcg (way more than needed!) |
Beef liver | 3 ounces | 70 mcg |
Salmon | 3 ounces | 4.9 mcg |
Tuna | 3 ounces | 2.5 mcg |
Beef | 3 ounces | 1.3 mcg |
Milk | 1 cup | 1.2 mcg |
Yogurt | 6 ounces | 1.3 mcg |
Eggs | 1 large | 0.6 mcg |
Fortified cereals | 1 serving | 1.5-6 mcg |
Why Supplements and Fortified Foods Work Better for Elders
Unlike the natural form of vitamin B12 found in meat, dairy, and eggs, the B12 present in supplements and fortified foods exists in a "free" form that does not require stomach acid for absorption. Many doctors recommend B12 supplements, or even B12 injections, for older adults who have difficulty absorbing this vitamin.
Lifestyle Tips to Support B12 Absorption
Incorporating lifestyle changes can enhance B12 levels and overall well-being:
Eat a balanced diet rich in whole foods, lean proteins, and fortified plant-based alternatives.
Support gut health with fiber-rich foods and probiotics.
Stay active, as regular movement promotes overall metabolic function.
Limit alcohol and smoking, as they can impair nutrient absorption.
Manage stress through mindfulness, yoga, or meditation to support digestive health.
Should You Get Screened for B12 Deficiency?
The U.S. Preventive Services Task Force (USPSTF) does not recommend routine screening for vitamin B12 levels in asymptomatic adults. However, based on my clinical experience, I often check B12 levels because I frequently find deficiencies, even when symptoms are mild.
If you are at high risk—such as older adults, individuals with gastrointestinal disorders, or those following plant-based diets—consult your doctor about screening.
Key Takeaways: How to Optimize B12 for Healthy Aging
Eat B12-rich foods regularly.
Monitor your levels with routine check-ups, especially if you have symptoms.
Supplement, if necessary, mainly if you follow a plant-based diet or have absorption issues.
Address underlying health conditions that may interfere with absorption.
By prioritizing vitamin B12, you can support brain health, energy levels, and overall well-being as you age. If you suspect a deficiency or have concerns about your intake, consult your healthcare provider for personalized guidance.
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