"Oh, I am just getting on in years." You might hear yourself say that when you sit listless on the sofa in the afternoon, or when your fingers have been tingling more often lately. Sometimes that is true. But these complaints can also point to a vitamin B12 deficiency, and in older adults this is more common than many people think.
We think it is a shame that a B12 deficiency is so easily dismissed as old age, because it is one of the few causes of fatigue you can simply have measured. Below you can read why the risk increases with the years and when testing is wise.
What does vitamin B12 do in your body?
Vitamin B12 is needed to make red blood cells and for a healthy nervous system. Your body cannot make this vitamin itself and gets B12 from animal products such as meat, fish, eggs, and dairy. According to the Voedingscentrum, B12 occurs almost exclusively in animal foods, which is why a supplement is wise for anyone eating a vegan diet.
With a deficiency, blood and nerves eventually work less well. That is why both your energy and the feeling in your hands and feet are affected by a low B12 level.
Why are older adults at greater risk of a deficiency?
In older adults it is usually not about eating too little, but about reduced absorption. Over the years the stomach often makes less stomach acid. As a result, B12 is harder to release from food and the body absorbs less of it. The deficiency then develops slowly, even with a good diet.
| Cause with age | What happens |
|---|---|
| Less stomach acid | B12 is harder to release from food |
| Inflammation of the stomach lining | The lining absorbs B12 less well |
| One-sided diet | Less meat, fish, eggs, or dairy |
| Certain medicines | Can further lower absorption |
What symptoms does a B12 deficiency cause?
The first complaints are often fatigue, a pale colour, and shortness of breath on exertion. There may also be tingling or a numb feeling in the hands and feet, because the nerves suffer from the deficiency. Sometimes there are memory or concentration problems too. A low B12 is also a possible cause of anaemia. Because these complaints come on gradually, they are often noticed late, which is why measuring can be clarifying.
Which medicines raise the risk?
Two commonly used medicines deserve attention. Long-term use of metformin, a medicine for type 2 diabetes, can raise the chance of a B12 deficiency. Stomach acid inhibitors can also reduce B12 absorption. If you use one of these long-term, it can be useful to have your B12 checked now and then. Never stop your medicines on your own initiative, but discuss your questions with your GP.
Are you getting enough B12 from your diet?
For most people who eat meat, fish, eggs, or dairy, intake from food is usually sufficient. In older adults the problem more often lies in absorption than in intake. Still, it is worth looking at your eating pattern. If you have been eating less meat or fish in recent years, for example because cooking takes more effort or taste changes, intake can unintentionally drop.
If you eat (partly) plant-based, B12 deserves extra attention, because the Voedingscentrum notes that this vitamin occurs almost exclusively in animal products. A supplement or fortified products can then help. If in doubt, discuss with your GP whether a supplement is wise for you, rather than dosing high on your own.
How is a deficiency treated?
If a deficiency is found, it is often well treatable, usually with tablets or, with a serious absorption problem, with injections. Which form suits you depends on the cause and severity, and your GP decides that. It is good to know that recovery of the blood count is usually fairly quick, while nerve complaints such as tingling can improve more slowly. That is why measuring early helps: the sooner a deficiency is noticed, the greater the chance of full recovery.
When is measuring worthwhile, and how do you do it?
If you recognise persistent fatigue, tingling, or shortness of breath, a measurement can be clarifying. Thuisarts.nl advises discussing vague but persistent complaints rather than waving them away. You can have your vitamin B12 and iron measured with the Vitamin and Iron Panel from Levenswijs, without a referral. If you only want to look at the single value, read more about vitamin B12 or about ferritin, the value that reflects your iron stores.
If you would like the bigger picture, read about blood values after 60 or see which preventive blood tests make sense.
One last practical tip: note down your complaints before having a test, for example since when you have been tired and how bad the tingling is. That way you can better judge over time whether an approach helps, and you have concrete information when you talk to your GP.
Our advice: do not attribute persistent fatigue or tingling to ageing too quickly. Have your B12 measured calmly and always discuss an abnormal result with your GP. A low B12 is often well manageable, and that can give you back a good amount of energy.
Frequently asked questions
Why am I more likely to get a B12 deficiency with age?
With the years the stomach often makes less stomach acid, so B12 is released less easily from food. A one-sided diet and certain medicines can also play a part. The deficiency then develops gradually.
What symptoms fit a low vitamin B12?
Common complaints are fatigue, a pale colour, shortness of breath and tingling in the hands and feet. These come slowly and are not specific. A blood test gives clarity, but does not provide a diagnosis.
Do metformin or acid reducers raise my risk?
Long-term use of metformin and of acid-reducing medicines can lower the absorption of B12. If you use these long term, occasional measuring can be worthwhile. Never stop your medicines yourself, but discuss it with your GP.
Do I need a referral to have my B12 measured?
No. At Levenswijs you can have your vitamin B12 measured without a referral. The result is reviewed by a doctor registered in the Dutch BIG register. For treatment, your GP remains your point of contact.
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