The People's Perspective on Medicine

Is Your Confusion Due to a Vitamin Deficiency?

Older people may be less efficient at absorbing vitamin B12. A vitamin deficiency could cause cognitive difficulties that go away with supplementation.
Vitamin B-12 Dietary Supplement Pills Spilt From Container

As we grow older, our mental lapses bother us more and more. Could losing the car keys be the first sign of Alzheimer’s disease? Is forgetting the PIN for the ATM an early warning flag for dementia? One reader with such worries found that a vitamin deficiency led to forgetfulness, confusion and concern.

What Vitamin Deficiency Affects Brain Function?

Q. I am 65 and recently thought I was getting dementia. It never occurred to me I could be suffering from a vitamin deficiency.

If it hadn’t been for a relative who is a hospital lab director, lord knows what would have happened. My short-term memory was bad (I couldn’t remember whether I had just brushed my teeth without feeling my toothbrush), and I had a moment of confusion that terrified me: I couldn’t understand the numbers on my digital clock one night.

My balance had deteriorated so that I was unsteady if I closed my eyes to keep the shampoo out of them in the shower. This made no sense to me, as I am a ballroom dancer.

My relative explained that people over 50 sometimes have difficulty absorbing vitamin B12 through the gut. Finally, she suggested a sublingual tablet that goes directly into the bloodstream. I got some at the drugstore and within only a few days my mental confusion and other symptoms started to go away.

It’s been several months and I feel like myself again. Vitamin B12 deficiency is greatly under-diagnosed, especially in older persons.

Older People May Lack Vitamin B12:

A. You’re right that vitamin B12 (cobalamin) deficiency is more common among older people. In addition, it can cause neurological difficulties (Kumar, Handbook of Clinical Neurology, 2014). Sadly, doctors may not always suspect a vitamin deficiency as the cause of cognitive problems. As a result, people concerned about dementia should always be tested to see if they might have low levels of this critical vitamin.

Doctors used to treat patients for vitamin B12 deficiency with monthly injections. More recently, studies have shown that high-dose vitamin B12 pills or sublingual tablets are also effective (Ankar & Bhimji, StatPearls, June 20, 2017).

Others Who May Suffer from a Vitamin Deficiency:

In addition to the elderly, people who have had bariatric surgery to lose weight are susceptible to vitamin deficiency, including cobalamin deficiency (Via & Mechanick, Current Obesity Reports, online July 17, 2017). Those taking the diabetes drug metformin or PPI acid-suppressing medications may also become depleted. Consequently, if you take one of these drugs, you should ask your doctor for periodic monitoring (Kancherla et al, Journal of the American Geriatrics Society, May 2017).

Rate this article
4.6- 38 ratings

Today's Newsletter Reading List

    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
    Drug and Nutrient Interactions

    Download the guide to which drugs increase nutrient requirements -- and which, like Synthroid or tetracycline, are inactivated by common supplements like iron or calcium.

    Drug and Nutrient Interactions
    Join over 150,000 Subscribers at The People's Pharmacy

    We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.

    Showing 16 comments
    Add your comment

    What is recommended amounts of sub-lingual B-12 daily? Husband is 96 yrs.. takes several prescriptions. Heart, BP, Cholesterol. Don’t want to overdose, but do believe he would benefit from this vitamin.

    If he is low in vitamin B12, a sublingual dose of 1000 mcg (that’s micrograms) aka 1 mg is a high but entirely tolerable dose. Do ask his doctor for a recommendation. If your husband is already deficient, he may need to start at 2,000 mcg

    Another wonderful and accurate article! I’m a retired neuropsychiatrist and treated hundreds of early dementia patients successfully with vitamins and supplements, including B12. However, as a graduate of the University of Wisconsin medical school in ’72, I had the good fortune of having Robert Schilling as a mentor. He was a world expert on B12 and I still recall the oral absorption route, which is easily disrupted by other meds, gut pathology, antacids, etc. So, IM is often worth a try. NEVER trust blood tests over clinical assessment, as blood only contains a tiny fraction of any chemical and may not be an accurate reflection of tissue levels. Folate is necessary to supplement along with B12. Anything can be overdone and eventually has some toxicity. Thanks for your good work!

    Has anyone found a sublingual B12 that does not contain an artificial sweetener (sucralose, sorbitol, etc) or maltodextrin (or other MSG like) ingredients? I am a 50 year old, female who was told at my last annual physical that my B12 level was low. I’ve been taking a B12 capsule but realize that the sublingual B12 is probably better however I can not tolerate artificial sweeteners or many flavor enhancers.

    I found out that our primary physician doesn’t make hospital calls. What? Change primary care docs fast. Medicine should be his/her concern in hospital not just in “the office.” We had a really awful hospital stay.

    I found that my body would not convert cyanocobalamin to methylcobalamin. My understanding is that Methyl is what our body uses. It’s just that most people’s bodies do convert. That is probably why doctors never mess with methyl. Methyl may only come from a compounding pharmacy. I wish I knew if a body can get too much B12. My doctor told me to quit using it as mine went off the scale upward. I thought all the B vitamins were water soluable and it would be impossible to get too much. I did what my doctor said, and quit. It is all so confusing. I would love to hear other opinions, especially those of People’s Pharmacy.

    I’m 90 and take many vitamins and no meds. One time I heard a doctor, possibly on the People’s Pharmacy, expounding on the benefits of B-12, so I was popping sublingual B-12 every time I felt a little tired. One day I became dizzy, and the doctor did a blood test. My B-12 was way off the charts. It seems that too much B-12 can cause you to lose potassium, and that was my problem. Just shows that too much of a good thing can be dangerous. I seem to have a tendency to do this. I still take B-12, but in moderation.

    Wondering whether the 65 yr old letter writer had their B-12 level checked and what the lab director thinks of the “normal” ranges listed on the test results? Even though my lab values are normal, I also benefit from a supplement.

    I would like to know what the optimum amount of vitamin B12 is? I suddenly find labs don’t even concur on deficiency amounts. I just had my vitamin D checked – one doctor’s lab said I was deficient at 32, my other doctor said only under 10 is deficient. After much research I now find maintain D above 60 is optimum to reduce cancer by 75%! After reading the comments on B12 sublingual, how much should I have?? I am very forgetful now too but do not want to take too much. And is the sublingual OTC as good as injections?

    My middle-school-age grandson had an ongoing fairly severe headache for a number of months. His schoolwork and social life plummeted. They tried everything and went to numerous doctors and he was eventually put on oxycodone. We were not happy with this, but at least he could function and not be in constant pain. Finally a neurologist measured his vitamin D level and it was extremely low. Once he was put on vitamin D, the headaches disappeared. This is a kid who spent a lot of time outdoors, not always wearing sunblock. For some, that mechanism doesn’t work. I know it’s not related to B-12, but is an example of how numerous doctors overlooked checking vitamin levels.

    In my earlier comment, I failed to note that common vitamin supplements and b vitamin fortified foods pose a danger to MTHFR individuals because these “clog up” the body’s receptors and prevents the body from using methylated b vitamins from foods such as dark green leafy vegetables or from methylated b vitamin supplements.

    The issue of b-vitamin deficiencies is much more complicated than commonly thought. This is particularly true of b12 and folate. There is a very common genetic mutation referred to as MTHFR (methyltetrahydrofolate reductase) that prevents the body from carrying out a process known as methylation. The human body cannot use b vitamins in the forms found in common supplements until they are methylated. Methylated b vitamin supplements are available but are quite expensive. Common tests for vitamin deficiencies do not distinguish between methylated and non-methylated b vitamins in the blood although more sophisticated tests do exist but are rarely used. MTHFR is associated with two genes but the greatest health impact concerns gene C677T. MTHFR can be either heterozygous (one bad copy of the gene) resulting in partial blocking of methylation or homozygous (two bad copies of the gene) resulting in almost total blockage of methylation. Unfortunately, few physicians (even neurologists) seem to be aware of this extremely common genetic mutation which is a known cause of almost all autoimmune diseases. This defect also dramatically raises homocystine levels which is a major factor in causing heart disease.

    No suggestions of foods to consume with vitamin B-12?
    My list: Nori, seaweed, shellfish, sardines, trout, wild caught salmon, grass fed beef, grass fed beef liver, free range or organic eggs, feta cheese, cottage cheese, nutritional yeast.
    Eating would be more pleasurable than taking a pill, I would assume?
    Thank you for reading.
    Kind regards,
    J. Helms

    I used to take many herbs and vitamins. They were very expensive.. but, being a smoker and an alcoholic, I knew I needed to take care of myself as much as possible; especially since I am a multi-tour combat Vietnam Vet who suffers PTSD and was exposed to Agent Orange (Dioxin) poisoning. The alcohol and tobacco addictions were also due to wartime traumata, as well. I avoided the VA for many years; but eventually, after my first heart attack, I found that VA was my only option.

    Of course, they loaded me up with many many PILLS. Heart medications (and stents), blood-thinners, water pills, “statin” drugs, high blood-pressure pills, thyroid, pills for reflux, Metformin, insulin, inhalers for COPD and allergy pills … then, the myriad assortments of depression, anxiety and sleep medications for mental problems!

    The doctors told me that I should discontinue all vitamins and herbs because they “interfere” with the drugs.. and they were “a waste of money”. I did discontinue them; as they increased in popularity, they were increasing in cost to a point I could not afford them! I did stop drinking with help from AA; and I am still fighting the battle against tobacco.. trying to give it up.

    These chemical-based drugs pushed to VA by “Big Pharma” did save my life; but, the side-effects (and possibly, interactions) caused havoc in my daily living. Omeprazole, probably caused the crippling R. Arthritis in my hands and a form of rash related to the arthritis on my scalp; 12 years of diarrhea due to Metformin use and God only knows what the Statin drugs have caused.

    Recently, I was diagnosed with “anemia” due to 4 pints of blood-loss resulting in lowered iron stores and hemoglobin… by an outside doctor. I had been complaining of extreme weakness for over a year at VA. The VA took the SAME blood-tests as the outside doctor. He found it on my first visit… they were looking for an allergy to gluten or dairy… for a YEAR! RX: an iron supplement x 60 days! It is cheap and effective! I’m just so curious if there might be more effective treatments for MANY of these ailments in the forms of herbs, diet and vitamin therapies?

    Just because VA is “cheaper health care” doesn’t mean it is “better”, or even “equal to” an old-style doctor with common sense! Rather than being critical, he told me that taking Milk Thistle for all those years probably cured my Hepatitis that I had when returning from the war in 1972. I am now looking for a more holistic approach to treatment, although I “know” I will need “some” of the “Big Pharma Meds” (Moderation in all things?)

    I stopped using table sugar 6 months ago. Too my surprise I lost 30 pounds and my puffy stomach went down. I substitute Agave and honey to sweeten my tea.

    How much is “high dose”? I’m sure it varies by person, but there must be a typical level of need. Can a deficiency be determined by a blood test?

    * Be nice, and don't over share. View comment policy^