December 3, 2011

HEALTH: It Could Be Old Age, Or It Could Be B12.

Her mother couldn’t remember the names of close relatives or what day it was. She thought she was going to work or needed to go downtown, which she never did. And she was often agitated.

A workup at a memory clinic resulted in a diagnosis of early Alzheimer’s disease, and Ms. Katz was prescribed Aricept, which Ms. Atkins said seemed to make matters worse. But the clinic also tested Ms. Katz’s blood level of vitamin B12. It was well below normal, and her doctor thought that could be contributing to her symptoms.

Weekly B12 injections were begun. “Soon afterward, she became less agitated, less confused and her memory was much better,” said Ms. Atkins. “I felt I had my mother back, and she feels a lot better, too.”

Now 87, Ms. Katz still lives alone in Manhattan and feels well enough to refuse outside assistance.

Still, her daughter wondered, “Why aren’t B12 levels checked routinely, particularly in older people?” . . . A severe B12 deficiency results in anemia, which can be picked up by an ordinary blood test. But the less dramatic symptoms of a B12 deficiency may include muscle weakness, fatigue, shakiness, unsteady gait, incontinence, low blood pressure, depression and other mood disorders, and cognitive problems like poor memory.

It’s rare for vitamin levels to be checked in general. My doctor told me he’s started checking Vitamin D levels and is astounded at how low they’re coming in.

UPDATE: Physician/reader Bernard Davidoff writes: “Measuring B12 levels in older people with memory and thought problems is completely routine.” Well, I said “in general.” But shouldn’t we be measuring levels before someone has these kinds of problems?

ANOTHER UPDATE: Another physician reader, Dr. Russell Barr, writes:

I am a physician (internal medicine and geriatrics) who treats many older patients, and orders a lot of vitamin B12 levels.

You comment about making vitamin B12 a routine screening test struck a nerve, as I have considered that as well.

The main problem is that measuring it, although common and nearly routine, is expensive. Several years ago I considered putting together a package of lab tests for wellness exams in the elderly. I was considering a thyroid stimulating hormone level(screen for low thyroid hormone levels), 25-OH vitamin D, and B12. These would be offered to geriatric patients at just a little above my cost, as Medicare does not pay for screening tests (except for limited things like mammograms and flu shots.)

The cheapest I could find for a vitamin B12 level was $75. That is the wholesale price, offered only to doctor’s offices who pay reliably. Tests billed directly to the patient (retail) were double or quadruple that price. My patient population has very few who could afford a $200 package of screening lab tests. Vitamin D is also somewhat expensive.

My compromise was to order B12 levels at just the slightest hint of symptoms, fatigue, tiredness, minimal memory lapses etc. I do perhaps 10-15 levels a month, and maybe 5-10% are low enough to treat. Another 5% are borderline and deserve to be repeated in a year or so.

And reader Charles Hill writes: “My own D.O. noticed that my Vitamin D level was low, and recommended supplements. This hadn’t been a problem for me previously, though I can’t tell whether it’s due to changing metabolism – I’m now 58 years old – or a change in summer activity level due to the ridiculous heat last July and August. I’m assuming that if I had B12 issues, he’d have told me.” Maybe, maybe not.

MORE: A reader emails:

As a patient in his 40’s I’ve experienced B12 deficiency. I’ve had multiple abdominal surgeries over the past 15 years for colon cancer (3 separate times – so OK I’m a bigtime outlier in the data). All the cancer treatment has been done with an excellent team at MD Anderson. Without them there’s no question – I would have been dead long ago. Instead I’m healthy, happy and living a quite normal life.

During the most recent surgery, the end of my small intestine was removed and I really got hit pretty hard by B12 deficiency. Came back from the hospital post op feeling pretty good. But after a week at home I could barely get out of bed. Was hit with fatigue, was disoriented and had a hard time concentrating. Worked out with my primary care doc (who’s also very good) that I’d completely used up my reserves of B12 (mostly stored in the liver) and took quite large B12 supplementation for about 3 months. I still supplement with B12 10,000-15,000 mcg/day (sublingual).

The change after supplementation was dramatic after only a couple days.

B12 wasn’t the only nutrient that I had to start supplementing. There were a couple others. But without question the B12 deficiency hit me hardest.

I’m not an MD, but have begun to seriously wonder if a large portion of what we experience as aging symptoms is more specifically malnutrition that creeps up as our diet and our ability to efficiently process/digest food deteriorates. What percentage of Alzheimer’s could be mitigated with B12 supplementation? I don’t know but fear it could be a pretty high number. The only reason I discovered B12 was the root cause of my symptoms was because it happened very fast after a major change to my GI tract. Not sure anyone’s really looking when the problem creeps up over 10 or more years in a 70-something….

Well, you’ll age regardless, alas. But it’s certainly possible to feel old before your time.

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