Vitamin B12 Deficiency in the Elderly

"Vitamin B12 deficiency is estimated to affect 10%-15% of people over the age of 60, and the laboratory diagnosis is usually based on low serum vitamin B12 levels or elevated serum methylmalonic acid and homocysteine levels. Although elderly people with low vitamin B12 status frequently lack the classical signs and symptoms of vitamin B12 deficiency, e.g. megaloblastic anemia, precise evaluation and treatment in this population is important. Absorption of crystalline vitamin B12 does not decline with advancing age. However, compared with the younger population, absorption of protein-bound vitamin B12 is decreased in the elderly, owing to a high prevalence of atrophic gastritis in this age group. Atrophic gastritis results in a low acid-pepsin secretion by the gastric mucosa, which in turn results in a reduced release of free vitamin B12 from food proteins. Furthermore, hypochlorhydria in atrophic gastritis results in bacterial overgrowth of the stomach and small intestine, and these bacteria may bind vitamin B12 for their own use. The ability to absorb crystalline vitamin B12 remains intact in older people with atrophic gastritis. The 1998 recommended daily allowance for vitamin B12 is 2.4 micrograms, but elderly people should try to obtain their vitamin B12 from either supplements or fortified foods (e.g. fortified ready-to-eat breakfast cereals) to ensure adequate absorption from the gastrointestinal tract. Because the American food supply is now being fortified with folic acid, concern is increasing about neurologic exacerbation in individuals with marginal vitamin B12 status and high-dose folate intake."

http://www.ncbi.nlm.nih.gov/pubmed/10448529

 The recommended daily allowance (RDA) for B12 for adults of all ages is still 2.4 micrograms (mcg) in 2015. My personal opinion is that the RDA should be revised upward by a large amount.

When high doses of vitamin B12 are given orally, only a small percentage can be absorbed, which may explain the low toxicity. Because of the low toxicity of vitamin B12, no tolerable upper intake level (UL) has been set by the US Food and Nutrition Board.

Because vitamin B12 malabsorption and vitamin B12 deficiency are more common in older adults, the Linus Pauling Institute recommends that adults older than 50 years take 100 to 400 mcg/day of supplemental vitamin B12.

http://lpi.oregonstate.edu/mic/vitamins/vitamin-B12

B Vitamins and Homocysteine and Fracture Risk

“Some studies suggest high blood levels of the amino acid homocysteine may be linked to lower bone density and higher risk of hip fracture in the elderly. Vitamins B6 and B12, as well as folic acid, play a role in changing homocysteine into other amino acids for use by the body, so it is possible that they might play a protective role in osteoporosis. Research is ongoing as to whether supplementation with these B vitamins might reduce fracture risk^4,5.”

4. McLean RR, Jacques PF, Selhub J, et al. (2004) Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med 350:2042-49
 

5. Morris MS, Jacques PF, Selhub J (2005) Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. Bone 37:234-42

http://www.iofbonehealth.org/nutrition

WebMD ranks the effectiveness of vitamin B12 for various uses. The rankings are “effective for,” “likely effective for,” “possibly effective for,” “possibly ineffective for,” and “insufficient evidence for.”

According to webMD, vitamin B12 is likely effective for “high level of homocysteine in the blood (Hyperhomocysteinemia).” “Taking vitamin B12 by mouth, along with folic acid and sometimes pyridoxine (vitamin B6), can lower blood levels of homocysteine.”

 
http://www.webmd.com/vitamins-supplements/ingredientmono-926-vitamin%20b12.aspx?activeingredientid=926&activeingredientname=vitamin%20b12

Treating Sarcopenia

Sarcopenia is, in its most literal sense, the loss of muscle mass, strength and function related to aging.  Most commonly seen in inactive people, sarcopenia also affects those who remain physically active throughout their lives. This indicates although a sedentary lifestyle contributes to this disease, it's not the only factor. In addition, as we age:

• hormone levels change
• protein requirements alter
• motor neurons die
• and we tend to become more sedentary 

 

These factors in combination are thought to cause sarcopenia. The figure shows normal muscle mass on left, muscle wasting on right.

 

There are currently no approved drug treatments for sarcopenia. Research is now focusing on the role of physical activity, nutrition, supplements, and potential future medications that may be used to treat or prevent sarcopenia.

In a review of literature, worsening sarcopenia followed trends in losses of muscle strength as well as impairment of daily functioning. In one study, the prevalence of sarcopenia increased dramatically with age from 4 % of men and 3 % of women aged 70-75 to 16 % of men and 13 % of women aged 85 or older.

More importantly, when sarcopenia is coupled with other diseases associated with aging, its effects can be even more pronounced. Loss of muscle mass and strength is a significant risk factor for disability in the aging population. When patients suffer from both sarcopenia and osteoporosis, the risk of falling and subsequent fracture incidence is higher. Therefore, treating sarcopenia will in turn help to lessen its burden on co-existing diseases.

 Exercise

After a program of resistance training is introduced, research shows that motor neuron firing and protein synthesis (both of which are needed in building muscle mass) increase even in the elderly. These changes indicate it is possible to rebuild muscle strength even at an advanced age.

Aerobic exercise also appears to aid in the fight against sarcopenia.

Nutrition

Adequate nutrition plays a major role in treating sarcopenia. Research has shown older adults may need more protein per kilogram than their younger counterparts to maintain proper levels that reinforce muscle mass. Protein intake of 1.0-1.2 g/kg of body weight per day is probably optimum for older adults. This theory, coupled with the fact that older adults tend to take in fewer calories in general, may lead to pronounced protein deficiency as well as deficiency of other important nutrients. Therefore, maintaining adequate protein intake as well as adequate caloric intake is an important facet of the treatment of this disease.

Diets rich in acid producing foods (meat and cereal grains) and low in non-acid producing foods (fruits and vegetables) have been shown to have negative effects on muscle mass. As mentioned above, protein is important, but a diet high in meat and cereal grains should be balanced with a diet high in fruits and vegetable (nonacid-producing foods) in order to be effective in treating sarcopenia.

Supplements

There is some evidence to support that creatine supplements can also aid in muscle development for older adults that are following a resistance training program.

Maintaining appropriate blood levels of vitamin D may also aid in maintaining muscle strength and physical performance.

http://www.iofbonehealth.org/what-sarcopenia

http://www.iofbonehealth.org/preventing-sarcopenia

My Daily Supplements

I have written about my supplements in previous posts but have made several changes since then. The following list is an update of all my supplements. I have alphabetized them by brand name. I take one of each daily unless otherwise noted. The Ca/Mg (#3) and strontium (#5) are primarily for bone health. The multivitamin (#6) is for general health, as are most of the other supplements. The probiotic (#9) is for digestive health. I take lecithin (#1) as an aid in preventing cholesterol buildup in the arteries and to combat heart disease. I take a large dose (5000 mcg) of methylcobalamin (#10) (vitamin B12) daily because taking a statin drug to reduce cholesterol also reduces vitamin B12. My husband takes B12 to keep from getting the canker sores that once plagued him. Methylcobalamin is more effective than cyanocobalamin; he tried both.

No one should copy my supplement protocol because each person’s needs are unique to him or her. I hope publishing this list will give others a place to start in forming their own protocol.  

  

  1. Bluebonnet Lecithin, 1365 mg in one softgel (I take two softgels daily.)

  2. Country Life Citrus Bioflavonoids, 1000 mg

  3. Country Life, Gluten Free, Calcium Magnesium Complex (500 mg Ca, 250 mg Mg per tablet)

  4. Doctor’s Best Lutein, 20 mg lutein esters yielding 10 mg minimum free lutein, 2 mg zeaxanthin

  5. Doctor’s Best Strontium Bone Maker, 2194 mg strontium citrate, 680 mg elemental strontium in two capsules (two capsules daily)

  6. Nature Made Multi for Him, No Iron (Not a typo. My husband and I both take this multivitamin.)

  7. Nature Made Vitamin C, 500 mg

  8. Nature’s Bounty Vitamin E, 100 % Natural, 400 IU

  9. Nature’s Way Primadophilus bifidus (This is a probiotic.)

10. Solgar Sublingual Methylcobalamin, 5000 mcg

11. Twin Labs Zinc, 50 mg

Notes on My Supplements

I always keep a couple of bottles of Nature’s Bounty Ginger Root capsules, 550 mg, in my refrigerator and take them for nausea and upset stomach as needed. If I don’t have fresh ginger and need ginger for a recipe, I just open a few, usually three, capsules and use the ginger powder for cooking.

I don’t take a separate vitamin D supplement because my multivitamin contains 1000 IU. I also try to get some sun each week. Some people may need more vitamin D if a 25(OH)D test shows they have a deficiency or insufficiency of this vitamin.

I do not take vitamin K2. Many people take this vitamin for bone and cardiac health. There is some debate about which form (MK4 or MK7) and what dosage of this vitamin one should take. The Japanese studies used 45 mg MK4, and patients are prescribed this dosage by physicians in Japan. The MK7 is taken in microgram dosages. Some people experience sleeplessness when taking MK7. No RDA/RDI has been established for vitamin K2 of either form. Studies in the US and Europe have not confirmed the efficacy of vitamin K2 for bone or cardiac health.

Notes on My Multivitamin

Nature Made has a Multi for Her, Multi for Him, Multi for Her 50+, and Multi for Him 50+. All the formulations are similar except the Multi for Her, which I will not take because it contains iron. Supplemental iron is not needed by men and postmenopausal women unless they have been diagnosed with iron deficiency anemia. Excessive iron can lead to iron toxicity. I have taken the other three formulations at one time or another, depending on what was available. 

What I like about the Nature Made multivitamins is that they are USP-verified, and that is rare to find. It gives me assurance that the multis contain the vitamins and minerals in the dosages specified and have no impurities.  Nature Made Vitamin C is also USP-verified, as are many of that brand’s other vitamins.

My Supplement History

On 8/5/2010, I posted all my supplements on my blog.  http://strontiumforbones.blogspot.com/2010/08/my-daily-supplements.html

On 09/30/2011, I posted about the three supplements I was taking specifically for bone health.

http://strontiumforbones.blogspot.com/2011/09/supplements-for-bone-health.html

On 03/2/2012, I posted an update on my calcium/magnesium supplement.

http://strontiumforbones.blogspot.com/2012/03/update-on-my-calcium-and-magnesium.html

COMB Study

You might also be interested in the protocol used in the COMB study.

http://strontiumforbones.blogspot.com/2012/02/combination-of-micronutrients-for-bone.html