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A report from the Massachusetts General Hospital and published in the New England Journal of Medicine tells an interesting story. A 62-year-old man over a two-month period developed numbness, a “pins and needles” sensation in his hands, shortness of breath, trouble walking due to severe joint pain, and he began to turn yellow.

Anyone faced with all these problems would think the end is near and start planning to say goodbye to loved ones. In retrospect, his symptoms could have been even worse. He could also have faced paranoia, delusions, memory loss, incontinence, loss of taste and more.

But this man had a pinch of good luck. Tests revealed he had a deficiency of vitamin B-12. He wasn’t going to die. But how did he develop such acute deficiency, and how can you be sure you’re getting enough of this vitamin?

B-12 is an important vitamin. The adult human body needs 2.5 micrograms daily so red blood cells can carry oxygenated blood to the brain, nerves and DNA. Since B-12 cannot be made by the body, it must be obtained from diet or supplements.

What causes a lack of vitamin B-12? Some people simply don’t get enough in their diet. Others, even it they consume sufficient B-12, fail to absorb it. This is why deficiency is especially common among the elderly. One person in five over age 60 and two in five over 80, fail to absorb B-12 from food and they require a supplement. Another reason can be autoimmune disorders that make it difficult to absorb B-12.

As we age, the lining of the stomach gets thinner which decreases the production of hydrochloric acid. Vitamin B-12 is firmly attached to a protein. To pry it loose so it can be absorbed it needs sufficient amounts of hydrochloric acid.

It’s also possible to be low in B-12 if you’re taking medication, such as, Prevacid, Losec, and Nexium, used to treat acid reflux or a stomach ulcer. Even less powerful drugs, like Pepcid, Tagamet, or Zantac, reduce the production of hydrochloric acid.

Intestinal problems such as celiac disease, Crohn’s disease, and excessive alcohol consumption reduce B-12. And with more people using gastric bypass surgery to lose weight, B-12 intake can become be affected.

You can be young and develop a lack of B-12. Plants do not make B-12. So among the growing numbers of young people striving for a strict vegetarian or vegan diet, there is a high risk of B-12 deficiency. Fortified grains can be a source of B-12. Blood work will show if additional B-12 supplementation is needed.

There are many reports lauding the use of B-12 to prevent heart disease, infertility, fatigue, eczema, and a long list of other chronic health problems. But according to Harvard researchers, these reports are all based on faulty evidence.

Alzheimer’s disease is a good example. A deficiency of B-12 can lead to symptoms of Alzheimer’s. But even high doses of 1000 micrograms have had no effect on this disease.

One case of supposed Alzheimer’s disease was cured by B-12 supplementation, but it proved to be the wrong diagnosis. For this patient, memory deficiency problems were quickly cured by B-12. As noted earlier, it’s good to be lucky.

Good sources of dietary B-12 intake include steak, fish, poultry products, and eggs.

Are you wondering why the patient had yellow skin? Red blood cells become fragile with decreased amounts of B-12. Then they release bilirubin, produced by the liver, into circulation resulting in jaundice. If your skin is getting yellow, see your doctor for blood work.

Dr. W. Gifford-Jones is a graduate of the University of Toronto and the Harvard Medical School. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health.

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