It’s Never Too Early for B12…Fortification

by Amy Scheuerman

It’s Never Too Early for B12…Fortification

B12 is often thought of as an issue for the elderly, but here at Friedman we know better.  Policies made today can effect our tomorrow.  While some of these decisions, like eating right and exercising, are obvious, others such as changing government policy are less so.  However, with the Dietary Guidelines for Americans up for revision in the coming months, now is the time to look at some of the recommendations that will be made and how they will effect us as we grow older.

The older you are the more likely a vitamin B12 deficiency becomes.  By the time you reach age 65 there’s a one in four chance that you will have a B12 deficiency.  This is a scary statistic since low B12 is highly associated with the development of dementia.  In fact, some of the cutting edge research on B12 and its relationship with cognitive function is being done right here at the Jean Meyer Human Nutrition Research Center.

B12 Diet and Digestion

Our bodies and brains require B12 to function, but they do not produce it and must get it through diet. Vitamin B12 is found in meat, milk and eggs. Older adults are at a high risk of developing B12 deficiency due to the fact that this population tends to eat less meat, and because they have more trouble digesting proteins.

The B12 found in meat and animal products is bound to the proteins in those foods.  Before B12 can be absorbed by the body it must be broken apart from these proteins.  This process happens in the stomach when the protein begins to be broken down by stomach acid.

Unfortunately, as people age the amount of stomach acid they produce decreases.  This decrease in the amount of stomach acid affects almost 20% of people in their fifties and almost 70% of people in their eighties.  Since stomach acid is needed to break B12 apart from proteins in order for the B12 to be available to the body, the older you are the more at risk you become for B12 deficiency.

B12 deficiency is very prevalent…and can have major consequences.

B12 and Cognition

“Twenty-five percent of the elderly population suffers from B12 deficiency, and although causation cannot be shown there is a high correlation between deficiency and cognitive decline,” says Dr. Jacob Selhub, Senior Scientist at the Jean Meyer Human Nutrition Research Center at the Tufts University Friedman School of Nutrition Science and Policy. Basically, not getting enough B12 may push underlying factors (such as genetics, or stress levels) into overdrive, causing mental decline or dementia in people with a predisposition.

Why is this well documented B12 deficiency in older adults not noticed and treated more often? The reason may be hidden in our daily bread.

Folic Acid Fortification and B12 Deficiency

In January of 1998 the FDA began mandatory folic acid fortification of cereal grain products sold in the United States.  The reason for this policy was to prevent neural tube defects, a specific type of birth defect.  Since most people eat bread products fortifying them with folic acid seemed like a good way to prevent birth defects.

However, the fortification of grains with folic acid presents risks to the elderly.  Dr Ralph Green, MD, Chair of Pathology and Laboratory Medicine at the UC Davis Medical Center, was one of the first researchers to recognize potential risks.  Speaking at the American Association for Clinical Chemistry meeting in July of 2003, he pointed out that higher levels of folic acid intake prevent the anemia produced by B12 deficiencies.

Anemia, a condition where there are not enough red blood cells or those cells are malformed and cannot do their job, is the major symptom associated with B12 deficiency.  If a person consumes a lot of folic acid this symptom of vitamin B12 deficiency can be hidden–but the underlying problem isn’t solved.

Dementia and cognitive impairment are some of the worse side effects of a B12 deficiency, but there are others that may occur depending on how severe the deficiency is.  Women with low B12 levels are twice as likely to suffer from clinical depression as women with normal levels.  Sleepless nights are another possible side effect of a mild deficiency.  In the worst cases B12 deficiency can mimic Alzheimer’s Disease and progress in the same way, resulting in complete loss of memory and death.

What’s the Solution?

Hopefully someday the USDA and FDA will realize that folic acid fortification without B12 fortification is bad news for the elderly and begin B12 fortification.  However, this won’t happen unless educated people lobby for it.

If someone you care about is over the age of 65, encourage them to get tested for low B12 or high folic acid levels.  A general practitioner should be able to order the tests.  There is no evidence that increasing B12 improves cognition or prevents mental decline in people who do not have low B12 levels.  Therefore increasing the amount of B12 in someone’s system will only help if you are already low or if your folic acid levels are very high.

Since protein bound B12 is less accessible to the elderly, upping the amount of meat or meat products in someone’s diet may not help.  Instead, the best advice is to take a crystalline B12 supplement.  Unlike protein bound B12, absorption of unbound crystalline vitamin B12 actually begins in the mouth where it can be absorbed through the mucus membranes.  You can easily find a crystalline B12 supplement at a drugstore, the grocery store, or a health and nutrition store such as GNC.

“For those who do have evidence of deficiency (or borderline deficiency), there is no harm in taking oral B12, and I would recommend this for my own patients,” says Dr. Christopher H. van  Dyck, Director of the Alzheimer’s Disease Research Unit at the Yale University School of Medicine.

Mental decline and aging are difficult things to face personally or in loved ones, but eating a healthy diet, interacting with friends, and having a healthy level of B12 can all help.  Encourage the FDA to start B12 fortification of cereals as soon as possible.

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