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Why is Vitamin B12 deficiency a concern for older people?

I have for some time noticed a Facebook friend complaining about the difficulty she’s experiencing getting her Vitamin B12 injections.

I rather assumed this must be for a specific condition that she lives with, and let it pass me by.

But now I’ve discovered that Vitamin B12 is actually really important, as it’s one of those that we start to lack as we get older.

So we thought we’d take a look at what Vitamin B12 does, and who’s at risk of not getting enough.

What’s the problem?

Lack of Vitamin B12 can cause tiredness, cognitive issues, muscle weakness and impaired balance, amongst other symptoms.

Vitamin B12 has been found to be important in quite a few important processes, such as:

  • Producing red blood cells: Deficiency can lead to a type of anaemia that affects the way oxygen is carried.
  • Neurological function: Vitamin B12 helps to support the nervous system and is involved in the production of myelin, which is a protective sheath around nerves. Vitamin B12 deficiency can lead to symptoms such as numbness or tingling in the hands and feet, difficulty walking, memory problems, and cognitive decline. Severe deficiency can cause irreversible nerve damage.
  • DNA synthesis: Vitamin B12 is required for the synthesis of DNA, the genetic material in cells. Deficiency can affect cell division and renewal, leading to abnormal cell growth and potentially increasing the risk of certain cancers.
  • Healthy hearts: Vitamin B12 deficiency has been associated with an increased risk of cardiovascular disease, possibly due to elevated levels of homocysteine, an amino acid that can damage blood vessels when present in high concentrations.

Who’s at risk?

 Older people, those with Type 2 diabetes and long-term vegans may be particularly prone to Vitamin B12 deficiency.

Why is Vitamin B12 deficiency more likely to be a problem for older people?

Our bodies change in how they function as we get older. In some cases that can mean we don’t get enough Vitamin B12. That might be because of:

  • Decreased absorption: As we age, we produce less stomach acid. This acid is important for absorbing Vitamin B12 through the food we eat.
  • Digestive disorders: Conditions such as atrophic gastritis, celiac disease, Crohn’s disease, or surgical removal of parts of the stomach or intestine can interfere with the absorption of Vitamin B12.
  • Medications: Certain medications commonly used by older adults, such as proton pump inhibitors (PPIs) and H2-receptor antagonists (H2 blockers) for acid reflux or ulcers, can reduce stomach acid production, which may further the absorption of Vitamin B12.
  • Diet: If we change our diets and reduce our intake Vitamin B12-rich foods, such as meat, fish, dairy products, and fortified cereals, this too can contribute to deficiency.
  • Alcohol: We do hear that some people are drinking more heavily in middle age and into their senior years than when they were young. One of the many issues with this is that excessive alcohol consumption can impair the absorption of Vitamin B12 and also lead to damage to the lining of the stomach and intestines, further exacerbating the issue.

Why might Type 2 diabetes have an effect on Vitamin B12 levels?

Type 2 diabetes seems to be yet one more bane of getting older.

People with Type 2 diabetes are at an increased risk of vitamin B12 deficiency due to several factors, including:

  • Metformin use: Metformin is a commonly prescribed medication for Type 2 diabetes that works by improving insulin sensitivity and lowering blood glucose levels. However, it has also been linked to reduced levels of Vitamin B12 absorption.
  • Dietary: Patients with Type 2 diabetes may be advised to follow a low-carbohydrate diet, which could further reduce their consumption of these foods.
  • Peripheral neuropathy: Peripheral neuropathy is a common complication of diabetes that affects the nerves in the extremities, leading to symptoms such as numbness, tingling, and pain. It’s been found that Vitamin B12 deficiency can exacerbate peripheral neuropathy symptoms or contribute to nerve damage, as vitamin B12 is essential for nerve function and the maintenance of the nervous system.
  • Gastroparesis: Gastroparesis is a condition that affects the normal movement of the muscles in the stomach, leading to delayed emptying of food into the small intestine. Gastroparesis can impair the absorption of Vitamin B12, contributing to deficiency. People with Type 2 diabetes are at an increased risk of developing gastroparesis due to damage to the nerves that control stomach function.
  • Kidney disease: People with Type 2 diabetes are at an increased risk of developing kidney disease, which can impair the kidneys’ ability to reabsorb Vitamin B12 and other nutrients from the urine, leading to increased excretion of Vitamin B12.

Are vegans at greater risk?

Vegans are at an increased risk of Vitamin B12 deficiency because Vitamin B12 is primarily found in animal-derived foods. The factors affecting vegans include:

  • Dietary exclusion: Vegans exclude all animal products from their diet, including meat, fish, dairy, eggs, and other animal-derived foods. Vegans may not obtain Vitamin B12 through their food choices unless they consume fortified foods or supplements. Foods like fortified plant-based milk, breakfast cereals, nutritional yeast, and meat substitutes may be fortified with Vitamin B12, but relying solely on these sources may still not provide an adequate intake for some individuals.
  • Poor absorption: Even if vegans consume fortified foods or supplements containing Vitamin B12, absorption can still be an issue. Vitamin B12 absorption requires adequate stomach acid and intrinsic factor, a protein produced by the stomach lining. Some individuals may have impaired absorption due to factors like age, gastrointestinal disorders, or medications.
  • Long-term stores depletion: The liver stores Vitamin B12, and people who have been following a vegan diet for an extended period may gradually deplete their Vitamin B12 stores over time. Initially, symptoms of deficiency may not be apparent, but over time, they can develop as stores become depleted.

To mitigate the risk of Vitamin B12 deficiency, vegans could consider the following strategies:

  • monitor Vitamin B12 levels through blood tests, especially if following a strict vegan diet for an extended period
  • consume fortified foods regularly, such as fortified plant-based milk, breakfast cereals, and nutritional yeast
  • take a daily or weekly Vitamin B12 supplement, as recommended by a healthcare professional
  • seek guidance from a registered dietitian or healthcare professional for personalised recommendations on meeting nutrient needs while following a vegan diet.

What are the solutions for those with Vitamin B12 deficiency?

Vitamin B12 is important to our health and we can start to lose the ability to absorb it as we grow older or change our lifestyles.

There are a range of possibilities for improving our levels of Vitamin B12, from modifying our diets and taking supplements to receiving injections.

And that is where this article began – with the difficulty many patients are experiencing in being provided with the injections they need.


This article is for information only. We are not healthcare professionals but we try to summarise the conversations around important topics and signpost where to go for greater expertise.

Please talk to a healthcare professional if you are at all concerned about your health or that of an older family member.


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