B12 is one of the most commonly deficient vitamins, affecting your whole body, from brain to bone. The older you are the more you need. B12 deficiency is extremely common among people over the age of 60 but it appears that even levels in the low–normal range may be harmful.
B12 is vital for keeping your memory sharp
In a study of 61 to 87 year olds, the lower the level of B12 the greater was the brain size shrinkage. Two in five people over age 61 had a level of B12 that was associated with accelerated brain shrinkage and memory decline. None of these subjects were diagnosed as classically B12 deficient. However, the lower your B12 status, the worse is a person’s memory scores. Less B12 means higher homocysteine levels and the higher a person’s homocysteine level the greater is their risk for dementia or Alzheimer’s.
However, low B12 status is rarely properly checked for and there are good grounds for making it a routine test, along with homocysteine, for anyone over the age of 60. This is because its ability to be absorbed becomes worse with age. The usual means of checking is to measure one’s plasma B12 levels, but this is a very crude measure and it is becoming clear that having a level in the low end of the so-called ‘normal’ range is associated with worsening memory.
Testing your B12 status
In fact, in Japan they treat a level below 500ng/l; in the UK, the cut off point is often 150ng/l. Much more accurate is a test called MMA (methylmalonic acid), which is a more reliable marker for B12 deficiency and becomes high if you are deficient. Another alternative is to test HoloTransCobalamin (HoloTC) which, if low, indicates deficiency. An MMA test is more widely available. This chemical only accumulates if you are deficient in B12, or not using it efficiently.
If you want to be sure of your B12 status it is best to get your MMA level tested. This should be below 0.37mol/l. If your homocysteine level is also high it is wise to assume you are not getting enough vitamin B12. My on-line 100% Health check works out your likelihood of being vitamin B12 deficient.
The Osteoporosis Connection
One interesting discovery is the link between homocysteine, low B12 levels and bone and joint health. Over the last five years, there have been more and more studies linking high homocysteine and low B12 levels to increased risk of fractures, osteoporosis and decreased bone mass density, particularly in women. It looks as if homocysteine, rasied by B12 deficiency, actually damages bone by encouraging its breakdown and interfering with the collagen matrix which is what holds bone together. Collagen is made from vitamin C, which is yet another reason why I recommend a daily intake of 1000mg taken twice a day.
High homocysteine levels are linked to most inflammatory diseases, since homocysteine promotes the release of pro-inflammatory agents in the body. Homocysteine levels are frequently found to be much higher in rheumatoid arthritis sufferers as well as those with ankylosing spondylitis, which is an inflammatory arthritic disease of the spine.
Since rheumatoid arthritis is a ‘systemic’ disease, where the whole body’s chemistry is out of balance and many tissues and organs other than the joints are affected, one would suspect that homocysteine plays a leading role in the disease. And it does. Research from the Department of Biochemistry at the University Hospital in Madrid, Spain, examined the homocysteine scores of women with rheumatoid arthritis versus those without. There was a massive difference. The average homocysteine score for those with rheumatoid arthritis was a sky-high 17.3, compared to 7.6 for those without!
B12 and arthritis
Other research groups have found similar differences, especially among rheumatoid arthritis sufferers with a history of thrombosis or abnormal clotting of the blood. Homocysteine is now thought to damage joints and other tissues directly. All of this suggests that reducing homocysteine may well help keep your bones and joints healthy. Yet, disappointingly, very little research has yet been done to test the homocysteine theory on arthritis. An exception occurred in 1994 when forward-thinking researchers from the highly esteemed American College of Nutrition in Clearwater, Florida, gave B12 and folate supplements to 26 people who had been suffering from osteoarthritis of the hands for an average of more than five years, and had been taking non-steroidal anti-inflammatory, pain-relieving drugs (NSAIDs). B12 and folate work together to help reduce high homocysteine levels.
The results showed that people with arthritis who took the vitamins in place of the NSAIDs had less tenderness in their hand joints, and similar improvement in their ability to grip objects, compared with those just taking NSAIDs, but suffered none of the notorious side-effects seen with the use of these drugs.  NSAIDs can cause serious reactions, including premature death from kidney failure, ulcers and bleeding in the digestive tract, and they cost considerably more than B12 and folate supplements.
B12 and chronic fatigue
A common sign of B12 deficiency, known as pernicious anaemia, is chronic fatigue. Other tell-tale signs are brain fogs, breathlessness (sighing and gulping), brittle nails with ridges, pins and needles, swollen or sore tongue, balance problems and unsteadiness. These can be experienced by young and old since some people have innate difficulty absorbing vitamin B12.
How much is enough?
B12 is only found in animal foods, such as meat, fish, eggs and milk. But only increasing the intake of fish and milk is linked to increasing B12 levels. Increasing meat and eggs does not seem to be anything like as effective for improving your B12 status. My advice is to eat more fish and also to supplement at least 10mcg at any age, 50mcg if you are over 50, and 500mcg or more if you have a raised homocysteine level – above 9mmol/l. While none of us ‘need’ 500mcg these high levels become necessary as absorption of B12 declines. This is to do with a lack on production of intrinsic factor in the stomach. One way to improve B12 absorption is to give a special form of B12, either methylcobalamine or glutathionylcobalamine.
The reason for recommending this seemingly very high level, given that the RDA is only 2.5μg, is that only these kind of daily intakes help to correct deficiency. That’s what a group of researchers in Holland found when they investigated how much B12 you need to take in to correct mild B12 deficiency. Only doses of 647 to 1032μg of B12 were associated with correcting deficiency. In their words, ‘the lowest dose of oral B12 required to normalize mild B12 deficiency is more than 250 times greater than the [US] RDA (Recommended Daily Allowance) [2.5μg]’.The RDA in Britain is only 1mcg! So much for a ‘well balanced diet’ giving you all the nutrients you need!
My on-line 100% Health check works out your likelihood of being vitamin B12 deficient. If you do have many symptoms make sure you get tested first. There’s some very good information on the Pernicious Anaemia Society website http://www.pernicious-anaemia-society.org