Vitamin B12 Deficiency: The Vegetarian Senior's Blind Spot Behind Tingling, Fatigue and Memory Fog

One of the common misconceptions is that parents feel like they eat a balanced diet which could include vegetables, lentils, dairy, and fruits. So, what could be the cause of acute fatigue, tingling sensations in their hands and feet, and increased forgetfulness? It cannot just be a vitamin B12 deficiency.

Among Indian vegetarians, B12 deficiency is a worldwide concern for elderly people which can remain for many years without getting noticed. Symptoms of aging are attributed to stress, insufficient sleep, or just getting old. When B12 deficiency tests are finally done, it turns out that irreversible nerve, mental, and physical damage is already there.

The positive aspect is that B12 deficiency in aging adults is one of the most easily corrected nutritional deficiencies. So let's improve our understanding of the factors that increase risk, detect and identify early signs, and restore B12 levels to its normal range.

The Risks Vegetarians Face

The foods which contain Vitamin B12 in quantities that are nutritionally significant are animal foods (meat, fish, eggs). While dairy has some B12, it is in small quantities. For instance, one glass of milk contains about 1 microgram of B12, whereas an adult over the age of 65 needs approximately 2.4 micrograms per day. Thus, a lacto-vegetarian diet (which is typical in many Indian families) would, to put it mildly, be extremely erratic in its provision of B12.

B12 is not available in any edible form in plant-based foods. This is why a well-balanced vegetarian diet would still cause B12 to lack. Numerous Indian studies show that a significant number of elderly vegetarians are B12 deficient.

Age Makes Absorption More Difficult

Diet is just 1 of the factors involved. Numerous elderly people have B12 in their diet, but their bodies do not absorb it.

The concern is that the elderly produce less stomach acid and an intrinsic factor (a protein) which are critical in releasing B12 from food. Many people over 60 years of age have atrophic gastritis, which is the term given to the gradual thinning of the stomach and is associated with diminished acid production.

Some common medications worsen the problem. Metformin, one of the most common medications taken by seniors in India, is known to interfere with the absorption of B12. The same is true of acid reducing drugs like omeprazole and pantoprazole when taken continuously for a long time. If your parent is on any of these medications, they are more likely to be B12 deficient, irrespective of their diet. That is why many physicians advise B12 testing for patients who have been on metformin for an extended period of time.

B12 deficiency grows over time and its early signs are usually mistaken for other conditions. One of the first symptoms is fatigue. If your parent is voicing concerns about being tired all day and having had a full night's sleep, this is something to consider. If they have pale or yellowish skin, a sore, smooth and red tongue, mouth sores, and other symptoms, these may be ignored or not noticed.

What Happens Without Treatment

A lack of B12 means the myelin sheath that encases and protects the nerves cannot be maintained. When the sheath goes inadequate for long periods the result is permanent nerve damage and the resultant peripheral neuropathy. Poor coordination due to nerve damage increases falls and fractures in the elderly and takes away their independence.

A deficient state also leads to the formation of large and abnormal red blood cells which is a type of anaemia (megaloblastic anaemia). Patients' weakness and fatigue are exacerbated by anaemia. Advanced deficiency states can cause a degree of cognitive impairment that is sufficient to be diagnosed as dementia.

Once nerve damage occurs, and especially when it is detected late, the damage is usually irreversible. Which is why families need to be mindful of the time.

Obtaining a Diagnosis is Pretty Straightforward

In India, it is possible to get a diagnosis of vitamin B12 deficiency with a blood test to check serum B12 levels. This can be done at any diagnostic laboratory for a small fee. A B12 deficiency is diagnosed when serum levels are 200 pg/mL or less. Levels of B12 in the range of 200–300 pg/mL are borderline, and patients can experience symptoms in this range. So, doctors will usually request additional tests to check for higher levels of homocysteine or methylmalonic acid.

The next time a parent goes to the doctor's office, ask for a B12 test, as well as a test for hemoglobin, blood glucose, and thyroid function. These conditions have symptom overlap, and all the questions can be answered with a single vial of blood.

How to Restore Healthy B12 Levels

Making a plan for restoring vitamin B12 levels would need the help of a medical professional as plans are personalised on the basis of the severity of the deficiency.

For mild B12 deficiencies, include dairy products, yogurt, cottage cheese, and cheese. You can also include foods like breakfast cereals, some plant-based milks, and nutritional yeast. This diet can help younger vegetarians with mild deficiencies, but older adults with a confirmed deficiency will not find this diet work for them.

For treatment of deficiencies, some practitioners recommend oral supplements in the form of tablets, which most seniors can take. For newer deficiencies, high-dose oral B12 (1,000 to 1,500 micrograms) is suggested as about 1% of the dose is absorbed passively through the intestines, even if there is an absent intrinsic factor.

For a B12 deficiency, weekly intramuscular B12 injections are prescribed for the first month, and then one every month for maintenance. Many adults report a quick improvement in energy levels; however, those who have nerve issues take a longer time to show improvement.

Do not take a self-prescribing medication that is considered B12. Since it is water soluble, the excess is excreted. However, a healthcare professional should be consulted regarding the dose, a corresponding folate deficiency, and to rule out other causes of the symptoms.

Protecting Your Parent During Recovery

During the healing process, nerves heal slowly, and your parent may experience tingling in their arms and legs. They can also face problems with balance that can take weeks or even months to get better. It is important to implement protective measures in the home to prevent falling during this period.

If your parent has difficulty moving around, walking aids would be needed. Seniors who feel unbalanced because of neuropathy benefit greatly from using walking sticks that have four legs as they provide better weight distribution. AGEasy sells walking sticks that are height adjustable, have soft grips, and come with anti-slip tips. For seniors who tire easily there are also walking/rest models. These can be purchased at ageasy.co.in.

To make the bathroom safer, remember that most falls happen to seniors on wet floors in the bathroom. Seniors have an increased risk of slipping if they have foot numbness. AGEasy bathroom equipment features grab bars that are mountable beside the toilet seat and shower benches. Anti-slip mats and shower chairs are also available to lower the risk of falling.

In addition to the above measures, safety nets should be used. Fall-detection watches that remind seniors of their medications are a clever way as well. Most treatment plans fail due to non-adherence to prescribed medications, especially in a senior population.

Dizziness and fatigue can be caused by a variety of issues, and seniors on home monitors are able to have their blood pressure tracked which can provide important information to their physician. This is especially true for older adults with limited mobility, to ensure that they remain safe during their recovery. If the symptoms are B12 related, the home monitor can also provide valuable information to the physician to confirm if that is the case.

When to See a Doctor

Please make an appointment with your parent's doctor as soon as possible if they experience any of the following: numbness or tingling in the hands or feet, fatigue for more than two weeks and of an inexplicable cause, difficulty in maintaining balance, or loss of memory. If your parent suddenly becomes confused, have difficulty walking, or experience changes in their vision, take them to an urgent care facility immediately.

While B12 deficiency is always treatable, only a doctor can assess similar symptoms which could be caused by diabetic neuropathy, thyroid problems, other types of anemia, early-stage dementia, etc.

Bottom Line

A healthy vegetarian diet is a good choice for all ages, however, for older adults, it creates one irrefutable problem, which is a deficiency of vitamin B12. Unfortunately, B12 deficiency is something families often incorrectly attribute to regular old age. The ramifications of this can be severe and as time passes, the problem gets worse. The good news is, it's an easy fix.

Families just need to get a blood test done to measure a parent's B12 levels and obtain a doctor's recommendations regarding vitamin B12 supplementation. If your parent is 60 or older, vegetarian, and has never been screened for vitamin B12 deficiency, that is a priority task for the family.

This article is not intended to offer individualized medicine. Please consult your doctor for diagnosis and treatment.