B12 Deficiency can be Sneaky in Older Adults

By David Blyweiss, M.D., Advanced Natural Wellness

September 29, 2021

Over the years I’ve seen people with B12 deficiency who have been erroneously diagnosed with early onset senile dementia. And when they get injections of the activated form of vitamin B12, methylcobalamin, their alleged senile dementia quickly disappears.

This connection is something that’s generally overlooked by mainstream medicine. But it shouldn’t be.

It’s a known fact that our bodies naturally lose the ability to absorb vitamin B12 as we age. So even if you get plenty of B12 in your diet, you can still become deficient.

That’s because the older we get, the less stomach acid we produce. Without stomach acid and certain proteins, vitamin B12 can’t be absorbed into your intestines for delivery to the cells.

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This is something most people don’t realize, but physicians really need to take into consideration when treating older patients. Especially when they have symptoms of neuropathy, memory problems or difficulty walking.

Aging isn’t the only reason people aren’t absorbing their vitamin B12.

Acid-suppressing drugs like Prilosec, Nexium and Pepcid destroy hydrochloric acid production and literally strip your ability to properly absorb vitamin B12.

Metformin is another medication that alters vitamin B12 absorption. About a third of diabetes patients treated with Metformin develop B12 deficiency. The deficiency typically develops slowly over time, so anyone taking it should have their vitamin B12 level checked regularly. That way you can catch it early.

Oral Contraceptives (even those used only for cyclic/hormonal balancing) can decrease B12 blood levels significantly enough to need consistent B12 supplementation. And without sufficient B12, the toxic amino acid Homocysteine cannot be optimally metabolized away; and as it increases, your risk of dementia, heart disease, stroke, and osteoporosis increases.

Are You B12 Deficient?

Unless you are a vegetarian, you’re probably getting plenty of B12 in the foods you eat. It’s found in beef liver, organ meats, beef, lamb, cheese and eggs. You can also get it from some seafood, such as clams, mussels, sardines and salmon.

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But remember! It’s not just your dietary intake of B12 that counts. The more critical issue is reduced absorption of B12 as you age.

If you can’t absorb it, it doesn’t matter how much B12-rich food is included in your diet. It won’t prevent you from developing deficient or insufficient levels of it in your body. When levels reach that point, it can unleash a cascade of unwanted health concerns.

  • Low vitamin B12 levels can damage the myelin sheath that protects your nerves. This can lead to irreversible nerve damage.
  • It’s associated with high homocysteine levels. High levels of this amino acid can cause inflammation, arterial damage, dementia, Alzheimer’s disease, stroke, heart attack and osteoporosis.
  • A deficiency can also lead to anemia, which means you don’t have enough healthy red blood cells to carry oxygen to your organs and tissue.

The signs of B12 deficiency can easily be overlooked as something else. Some symptoms include tingling or numbness in your extremities, loss of appetite, weight loss, fatigue, palpitations and dementia. And one of the most unusual – but obvious – signs is a glossy tongue with no bumps on it.

Best Way to Restore Vitamin B12 Levels

It might seem hard to believe, but many doctors are unaware of these links. This creates several obstacles to diagnosis. Initially the B12 deficiency must be recognized; then the connection to reduced stomach acid needs to be established.

If you’re lucky, your physician is familiar with B12 deficiency and symptoms – and routinely tests serum or urine methylmalonic acid to diagnose deficiency.

If your levels are low, chances are good he will recommend intramuscular injections of vitamin B12. This way the vitamin is absorbed directly into the bloodstream. It bypasses the digestive process altogether.

Then, he should transition you to a sublingual B12 spray. Using the sublingual version bypasses malabsorption issues.

In the meantime, if you’re taking acid-suppressing proton pump inhibitors to ease digestive issues, I recommended addressing the underlying source of your stomach upset so that you can stop taking them.

Somewhere around half of patients who complain of heartburn don’t actually have excess stomach acid. Instead, they don’t have enough of it. This is especially true among those 60 and older.

A simple home test will help you figure out if that’s what is happening with you. Just take a tablespoon of apple cider vinegar when heartburn strikes. If the pain disappears, that’s a pretty good indication that your body isn’t producing enough hydrochloric acid. My own recommendation for a good general digestive enzyme if you’re over 60, is what I take 2 of before meals, Ortho Digestzyme from OrthoMolecular Labs… their website is Orthomolecularproducts.com.


Cagle, Stephen MD; Song, Steve MD Does long-term use of proton pump inhibitors cause B12 deficiency?, Evidence-Based Practice. 2019 May;22(5):23-24.

Ahmed MA, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. BMC Pharmacol Toxicol. 2016;17(1):44.

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