Vitamin B12 and Senility

Diabetic patients with diabetic neuropathy may be suffering from neuropathy not because the high blood sugar has damaged the nerves but instead because the elevated blood sugar levels have impaired the absorption of vitamin B12 in the gastrointestinal tract. Vitamin B12 is vital if you want to have healthy peripheral and autonomic nerves, and if you want to have enough red blood cells around to circulate oxygen throughout the tissues of the body.

If you have a normal digestive tract and also suffer from diabetes, you can get vitamin B12 through dietary measures.  This includes fish, dairy products, beef, pork, and poultry.  If you don’t eat enough of these types of foods, you may be suffering from a vitamin B12 deficiency.  You can also have vitamin B12 deficiency if you lack in intrinsic factor, which is a molecule made in the parietal cells of the stomach that is crucial for the absorption of vitamin B12.

You can eat all of the vitamin B12 you want but, if you have gastrointestinal problems, it may not be able to be properly absorbed by the intestines.  Certain medications, such as Zantac, Prilosec, Prevacid, and Pepcid AC, along with other medications used to treat gastritis or gastroesophageal reflux disease (GERD) can interfere with the secretion of intrinsic factor, which decreases the absorption of vitamin B12.  Infections of the stomach can also affect B12 absorption.

Metformin, which is a typical medication used to treat type 2 diabetes and insulin resistance, can also affect vitamin B12 absorption.  The disease of diabetes itself may contribute to B12 deficiency.  In a study published in 2009, about 22 percent of individuals with diabetes mellitus also had deficiencies in vitamin B12.  Since vitamin B12 is vital to the health of nerve cells, a deficiency of this vitamin can lead to diabetic neuropathy.

Common Signs and Symptoms of Vitamin B12 Deficiency

You may have few symptoms of vitamin B12 deficiency if the disease is in its early stages.  If your vitamin B12 level is just below normal, you may have no symptoms whatsoever of vitamin B12 deficiency.  Early symptoms involving a deficiency of vitamin B12 include the following:

• Constipation
• Loss of weight
• Decreased appetite
• Muscle weakness
• Fatigue

These symptoms can be due to many things so you may not suspect that the cause of your symptoms is due to vitamin B12 deficiency.

Complications of Vitamin B12 Deficiency

Extremely low levels of vitamin B12 can be dangerous and can be linked to severe complications.  For example, you can develop pernicious anemia from a lack of B12.  When you are anemic, you don’t have many red blood cells and there are fewer cells to pass oxygen to the peripheral tissues of the body.  About one-fifth of all people with a vitamin B12 deficiency have pernicious anemia.

Typical symptoms you’ll experience if you have pernicious anemia include the following:

• Headache
• Dizziness
• Paleness of the skin
• Chest pain
• Tiredness
• Loss of taste
• Loss of smelling ability
• Shortness of breath
• Irregular heart rate

In diabetics, vitamin B12 deficiency can affect the nerves, leading to paresthesias.  Paresthesia means that there is a tingling, burning, or itchy sensation of the skin structures, particularly on the feet, legs, hands, and arms.  The sensation may progress to numbness of the affected area or a feeling of prickliness of the skin.

Low vitamin B12 levels can be linked to elevated levels of homocysteine, which is an amino acid that is linked to stroke and heart disease.  In its most severe stages, vitamin B12 deficiency can result in difficulty walking, depression, memory loss, decreased mobility, and even dementia, particularly in the older diabetic patient.

The Difference between B12 Neuropathy and Diabetic Neuropathy

Diabetes that is left unchecked with high blood sugar levels often leads to nerve damage and peripheral neuropathy—the result of elevate blood sugars lasting a long period of time.  Typical symptoms of diabetic neuropathy include weakness, numbness, and burning pain in the feet and hands.  This type of diabetic neuropathy is known as peripheral neuropathy.  Diabetic neuropathy can also result in autonomic nerve damage, which affects the GI tract.

Interestingly, diabetes isn’t the only cause of peripheral neuropathy.  Having B12 deficiency for a long period of time can also result in nerve damage.  The symptoms you experience in neuropathy from B12 deficiency are identical to those symptoms you’ll find in diabetic neuropathy.

Treatment of B12 Deficiency

If you have peripheral neuropathy or evidence of pernicious anemia, you should seek medical attention as soon as possible.  The symptoms may not be all that obvious, especially in the early stages of the disease.  They can mimic other diseases, making the diagnosis of vitamin B12 deficiency difficult to do.

You can have a blood test, which can give you the level of vitamin B12 in the body.  If you are diabetic, you may wish to have a vitamin B12 level drawn as high blood sugar levels can impair B12 absorption so that you can have neuropathy from two different causes.  The doctor will also check your hemoglobin A1c level, which is a measure of how effective you have been in controlling your blood sugar levels.

If you have diabetes and also have low vitamin B12 levels, the doctor may recommend vitamin B12 supplementation along with advice for keeping your blood sugars in good control.  You will need to take in vitamin B12 through your diet as part of a healthy lifestyle that includes plenty of sleep and regular exercise.  Your doctor may recommend that you eat more fish, eggs, red meat, poultry, and dairy products.  High levels of vitamin B12 can especially be found when eating beef liver or clams.

You can’t get vitamin B12 through a vegetarian or vegan diet. Instead of meat products, you can eat nutritional yeast, cereal, bread, or tofu, which often have vitamin B12 as a supplement. Be sure to read the nutritional label, which will tell you if vitamin B12 has been added to the vegan product.  If your B12 deficiency is serious or if you don’t make enough intrinsic factor, you can receive vitamin B12 injections that don’t rely on intestinal absorption of the vitamin.

After you have been taking vitamin B12 supplements for a few months, you will want to have your B12 level checked again to make sure you are absorbing the vitamin properly.  You should also be working on keeping your blood sugars in good standing.

Vitamin B12 Supplementation and Diabetic Neuropathy

Even if you have normal vitamin B12 levels along with your diabetic neuropathy, taking B12 supplements can decrease the symptoms of diabetic neuropathy.  Several research studies have been done using vitamin B12 in participants with diabetic neuropathy.  In many of the research studies, the B12 supplementation actually reduced diabetic neuropathy symptoms, and decreased the burning pain and numbness seen in the disease.

References:

• Diabetes and B12: What you need to know. http://www.healthline.com/health/diabetes/b12-what-you-need-to-know#Causes1. Accessed 5/11/16.
• Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan. 2005 Jun; 14(2):48-54.