How’s Your Vitamin B12?

by Dr. Max Hammond
“Hello, Mrs. Porter?”
“This is Elizabeth Logan, Dr. Martin’s PA. I want to review your lab findings with you.”
“Why, what’s wrong?” Margaret Porter, “Marcie” to her friends, at 83 didn’t need one more thing to worry about, today of all days. “Elizabeth, I feel fine. I told you that when I was in for my Medicare physical.”
“And I am sure you are, Mrs. Porter.” Elizabeth tried to be reassuring. “Don’t be alarmed. I just want to go over a few things with you.”
“Okay.” Marcie didn’t sound reassured. “I got so worried when the office called. I’m planning my husband’s birthday party for tonight. Do I have to come in?”
“Oh, no. Just review these things with you.” Elizabeth took a deep breath. “One of your lab values came back a little low. Your vitamin B12 levels. They should be above 244 (pg/ml) and your levels are about 145.”
“Oh, my, is that dangerous, being that low? And what is B12 and what is it used for?”
“Okay, let’s start at the beginning. B12 is a vitamin that your body needs to make red blood cells and to make the covering on your nerves. And, yes, it can be dangerous if it causes pernicious anemia or a malfunction of your nerves or brain. So, we do need to correct it.” Elisabeth pushed on. “But let me ask you a few questions first. Okay?”
“Of course, sweetie. Go ahead. Ask away.”
“Okay. First, Marcie, do you have any numbness or tingling in your hands or feet or difficulty walking? Are you having any difficult with tiredness, sluggishness, or memory?”
“No, dearie. My memory is a sharp as ever. I’m just a little house afire when I get going. And I get around just fine. Don, my husband, is the one with the walker. It’s his birthday today, you know.”
“Your history says that you have not had any abdominal surgery, correct?”
“Yes, dear, no surgery. Why do you ask?”
“People who have had stomach surgery or diseases of the bowel, like ulcers or Crohn’s disease can be missing one of the enzymes made by the stomach (intrinsic factor) or a part of the bowel (ileum) where B12 is absorbed into the blood stream.”
And some medicines can interfere with this process. I know you don’t take metformin or blood pressure medicines. Did you stop the medicine you were taking to lower your stomach acid?” Elizabeth was hoping Marcie was understanding all of the information coming so fast.
“Yes, dearie, don’t you remember? We stopped that when we were working on my osteoporosis. You said it was bad for my calcium levels.”
“Very good. Thank you. Yes, you need the stomach acid to get enough calcium and the vitamin B12, as well, into your body.” Elizabeth thought Marcie seemed to be as sharp as she claimed.
“So, why do I have a low B12 level, Elizabeth? Don’t I get enough B12 in my food?” Marcie asked.
“Actually, B12 isn’t manufactured by humans, animals, or plants. It comes from bacteria that grow in the dirt. The animals eat the B12 in the dirt and pass it on to those who eat meat. But you are a vegetarian, aren’t you, Marcie?”
“Have been all my life, lacto-ovo-vegetarian, dearie. And never a problem until now.”
“Well, Marcie, many foods – like dairy and eggs have some very small amounts of B12. And some foods are fortified with B12. You can look on the food labels to see if what you eat has B12. Or you might be taking a multivitamin that has B12 in it. But you seem to have gotten along quite well so far, probably because the liver can store up to five years-worth of B12 before starting to run low.”
“Yes, I’m taking my vitamins every day.” Marcie sounded puzzled. “So, what’s my problem, Elizabeth?”
“I suspect – with your age – your gut is not absorbing the B12 as well as it used to. Twenty percent of people over 60 have this same problem.”
Elizabeth laughed. “Oh, that old bugaboo, huh? My age. Okay. What do we do?
“Since you don’t have any symptoms, I think we can start with a 500 mcg tablet of B12 from the drug store or Walmart – that you chew, don’t swallow it – taken four times a week. Then we can measure your B12 levels in about 3 months and see if the levels are coming up. If not, then we can get more aggressive and start looking for other reasons why your B12 levels are low. How does that sound to you?”
“That sounds great, dearie, so long as it doesn’t interfere with Don’s birthday party.”
“Yes, dear, I’m sure it won’t. And give Mr. Porter a birthday hug for me.”

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