As we age we lose our ability to properly absorb B12.  There is something called Intrinsic Factor which is needed for B12 to be properly absorbed.  Therefore if we take oral supplements of B12 that we swallow they aren't doing us much good either because the intrinsic factor is not available to absorb what is in a vitamin pill.    That is why many physicians use B12 injections.   In my office I use sublingual B12 that is absorbed through the capillaries under the tongue directly into the blood stream.   Anyone that is severely B12 deficient should use injections to get there levels up.   But really anyone over 60 might want to get a complete blood count (CBC) to determine if they might be B12 deficient.   If you see your (Mean Corpuscular Volume) MCV greater than around a 95 and your Hematocrit (HCT) and Red Blood Cell Count (RBC) on the low end of normal you may be B12 insufficient.   (A blood test for B12 directly is not a good measurement of B12 status.  Better measurements are Methylmalonic Acid (MMA) and Homocysteine which is a measure of folate status.)

It is known that low folate also contributes to cognitive decline. That is because B12 and folate work together - they are both methylators.   They support DNA replication - so if either are inadequate we make larger than normal red blood cell sizes and see an increase in MCV.   This is a first marker of inadequate B12 status.

The symptoms of low B12 or folate have extraordinary breadth.   There are a multitude of potential symptoms and causes.     One medically induced cause is acid blocking medication.  (If you are on an acid blocking medication give me a call so we can correct the underlying cause and get you off of it!)   

Here are other symptoms of B12 deficiency:

• Mental confusions
• Memory Issues
• Headaches
• Depression
• Fatigue
• Pins and Needles
• Weight Loss
• Constipation
• Shortness of Breath
• Sore Tongue
• White spots on forearm
• Insomnia
• Rapid Heartbeat
• Vertigo

A study that was just released showed improvement in cognitive function in 900 adults aged 60â??74 y with elevated psychological distress by supplementing with folic acid and B12 over the course of 2 years.   They used small amounts of B12 (only 100 micrograms) and I wonder if larger amounts were used such as what one would get in a B12 shot if even more improvement would have been realized.   I typically use 5mg dosages or 50 times the study in my office and hear great benefits of well being.  They also used folic acid, the synthetic form that up to 40% of people have cannot metabolize properly because of a genetic trait.   Therefore it is important to use a natural form of folate. The  better supplement companies are now switching to natural folate because of synthetic folic acid's potential cancer risk.

Look for a sublingual B12 that ideally has 'methylcobalamin' and/or 'adenosylcobalamin' and natural folate.   If you see the words "Folate(folic acid)" that means it is synthetic.  You want the label to say something like "Folinic Acid" or "Folate" or "Tetrahydrafolate" or "5MTHF" or something of the like, just not folic acid.   Whole food supplement companies such as RightFoods or New Chapter say something like "Folate (from Spinach)", then you know it is whole foods.

A B12/folate sublingual supplement is an inexpensive way to support our health as we get older.   If you suspect you may be getting low get some blood work and compare to previous years blood work.  Again a CBC is the better screening tool rather than a B12 test.

Please let me know if you have any questions.

Yours In Health,

George Mandler

Licensed Acupuncturist

Licensed Dietitian/ Nutritionist