B12 Deficiencies Signal Trouble

Not long ago, Johns Hopkins Medical School researchers found that men infected with the HIV virus took an average of four years longer to develop Acquired Immune Deficiency Syndrome (AIDS) if their blood vitamin B12 levels were normal. Of 310 homosexual men who tested positive for the human immunodeficiency virus (HIV), those with normal B12 took an average of eight years to progress to symptomatic AIDS, while those with low B12 took only four.

This doesn't prove that supplementing with high doses of B12 will slow the onset of AIDS. It may indicate that low B12 levels mark other factors that cause disease progression. Nonetheless, the study is the latest showing vitamin B12's important role in maintaining health--and in the case of AIDS, a role more important than previously thought.

Much of the credit for renewed interest in vitamin B12 should go to John Lindenbaum, M.D., of the Columbia University College of Physicians and Surgeons in New York. Lindenbaum and his research team studied vitamin B12 activity in more than 500 people over age 65. He found that at least 15 percent had evidence of low B12 function as measured by a sensitive test called the Methyl Malonic Acid (MMA) test. MMA is a biochemical that requires vitamin B12 for the next step of its metabolism. If B12 is suboptimal, MMA levels rise. The test enables practitioners to detect subtle deficiencies even when vitamin B12 blood levels are still within the normal range.

Serious Deficiencies Vitamin B12 deficiency is a common yet often misdiagnosed problem. That's because its typical symptoms such as numbness, tingling, unsteadiness, fatigue, memory loss and depression are easily attributed to anxiety or "old age"--two "conditions" without clearcut remedies. If left untreated, B12 deficiency may result in nervous system abnormalities or pernicious anemia, a potentially fatal blood disease.

Vitamin B12 deficiency is especially common among the elderly because many older people don't produce enough stomach acid to liberate B12 from foods. If B12 remains bound, the body can't absorb it. Other people at high risk for B12 deficiency include those taking acid-blocking drugs such as Prilosec®; vegetarians whose diets exclude animal foods--the main source of B12; and people with stomach or intestinal diseases.

Treating deficiencies is relatively simple and rarely requires vitamin B12 injections or sublingual preparations. Because the B12 in vitamin pills is not tightly bound, it can still be absorbed even with low stomach acid. The few people who do need injections generally have a serious gastrointestinal tract problem such as pernicious anemia or Crohn's disease that prevents proper B12 absorption.

Richard N. Podell, M.D., is clinical professor of family medicine at the UMDNJ-Robert Wood Johnson Medical School in New Brunswick, N.J. He is the author of Patient Power: How to Protect Yourself Against Medical Error (Fireside, 1996).

REFERENCES
Healton, E., Savage, D., et al. "Neurologic aspects of cobalamin deficiency," Medicine, 70: 229-45, 1991.

Lindenbaum, J., Healton, E., et al. "Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis," N Engl J Med, 318: 1720-28, 1988.

Lindenbaum, J., Rosenberg, I., et al. "Cobalamin deficiency in elderly people," Am J Clin Nutr, 60: 2-11, 1994.

Tang, A., et al., J of Human Nutr, February, 1996

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