Did you ever think being deficient in one small vitamin could do so much damage? Unfortunately, B12 deficiency and borderline deficiency are relatively common — especially among older adults. Cardiac patients need to be especially aware.
Vitamin B12 is a water-soluble vitamin and plays a key role in cell metabolism, the formation of red blood cells, nerves, DNA, and the normal functioning of your brain and nervous system. A severe B12 deficiency can lead to:
- Nerve damage
- Memory loss
- Loss of taste and smell
- Deep depression
- Paranoia and delusions
- Severe neurologic problems
- Blood diseases
Who’s at Risk?
If you don’t consume enough B12 (through supplementation or the foods you eat) or can’t absorb this vitamin no matter how much you take in, you are at risk of developing a B12 deficiency. Ask your doctor to check your B12 level (blood test) if you:
- Use commonly prescribed heartburn drugs* that reduce stomach acid, such as a proton-pump inhibitor (e.g., Nexium, Prilosec or Prevacid) or a H2 blocker (e.g., Pepcid, Tagamet or Zantac). Stomach acid is needed to absorb B12.
- Are over 50 years old — You produce less hydrochloric acid in your stomach as you age. Known as “atrophic gastritis“, this condition affects 10-30% of older adults.
- Take metformin (a diabetes drug). This drug can interfere with your body’s ability to absorb B12.
- Are a strict vegetarian/vegan — Plants don’t make B12.
- Have had stomach stapling or other gastrointestinal surgery which removes certain parts of your stomach or small intestine.
- Have a condition that interferes with the absorption of food (e.g., celiac disease or Crohn’s disease).
Cardiac patients often take medications, such as calcium channel blockers (CCBs) or beta blockers, that weaken the muscle that closes off the esophagus (the lower esophageal sphincter) causing heartburn and other GERD symptoms. It is not uncommon to take a heartburn drug if taking these heart medications that treat high blood pressure, angina, abnormal heart rhythms, and cardiomyopathy.
If you’ve been taking antacids for some time, consider asking your doctor whether you still need to be on an acid-reducer or if your dose can be reduced. Also ask if you should be screened for B12 deficiency.
Calcium Channel Blockers, such as:
- Amlodipine (Norvasc)
- Diltiazem (Cardizem LA, Tiazac)
- Isradipine (DynaCirc CR)
- Nicardipine (Cardene SR)
- Nifedipine (Procardia, Procardia XL, Adalat CC)
- Nisoldipine (Sular)
- Verapamil (Calan, Verelan, Covera-HS)
Beta blockers, such as:
- Atenolol (Tenormin)
- Bisoprolol (Zebeta)
- Carvedilol (Coreg)
- Metoprolol (Lopressor, Toprol XL)
- Nadolol (Corgard)
- Propranolol (Inderal)
Symptoms of B12 Deficiency
A B12 deficiency can sneak up slowly, but can also appear and intensify quickly. Since there are a multitude of symptoms, the condition is often overlooked and diagnosed as something else. Early detection and treatment are critical. Consult your physician for a blood test to confirm a B12 deficiency, so you can begin treatment immediately. Symptoms include:
- Nerve problems, such as numbness or tingling (“pins and needles” sensation) in the hands, legs, or feet
- Problems with balance (difficulty walking or staggering)
- Confusion or dementia
- Cognitive difficulties (difficulty thinking, concentrating and reasoning)
- Diarrhea or constipation
- Swollen, red tongue or bleeding gums
- Yellowed skin (jaundice) or pale skin
- Shortness of breath, mostly during exercise
- Tiredness/fatigue or light-headedness when standing up or with exertion
- Paranoia or hallucinations
Food Sources of Vitamin B12
Good sources include fortified foods and animal/dairy products, such as:
- Clams, 3 oz. – 34.2 mcg (over 14 times the average daily intake)
- Sirloin steak, 6 oz. – 5 mcg
- Salmon, 3 oz. – 4.9 mcg
- Trout, 3 oz. – 4.2 mcg
- Yogurt, 8 oz. – 1.4 mcg
- Milk, 8 oz. – 1 mcg
- Swiss cheese, 1 oz. – 0.9 mcg
- Egg – 0.6 mcg
- Breads, cereals, or other grains fortified with vitamin B-12
Vitamin B-12 can be supplemented by liquid, transdermal patch, nasal patch, injection or oral supplements.
Fit Tip: Consult with your physician regarding B12 supplementation if you are at risk for a deficiency. Eat fortified foods if you are over age 50 or a strict vegetarian/vegan. The Daily Value (DV) for vitamin B-12 is 6.0 mcg per day. (Daily Values are established to meet the needs of all healthy adults and are based on a 2,000 to 2,500-calorie diet).
Since 10% to 30% of older people do not absorb vitamin B-12 efficiently from food, consider eating foods fortified with B-12 to meet the RDA or take a vitamin B-12 supplement if you’re over 50 years old. Older people may need 25-100 mcg per day to maintain vitamin B-12 levels.