Misdiagnosed Depression and Alzheimer’s
by Carole Jackson, Bottom Line Health
It may seem like an extreme form of wishful thinking to suggest that symptoms believed to signal the onset of Alzheimerâs disease could instead be due to a lack of one particular vitamin — and yet studies over the years have been telling us just that. Some people 50 and older who are suffering from memory problems, confusion, irritability, depression and/or paranoia could see those symptoms dramatically diminish simply by taking vitamin B-12.
Frighteningly, recent research shows that up to 30% of adults may be B-12 deficient — making them vulnerable to misdiagnosis of Alzheimerâs. I spoke to Irwin Rosenberg, MD, senior scientist and director of the Nutrition and Neurocognition Laboratory at Tufts University in Boston, about who is at risk and how to protect yourself. He told me that for years, doctors had believed that B-12 deficiency showed itself most significantly as the cause of anemia (pernicious anemia), but they now realize the lack of B-12 may even more dramatically be causing neurological symptoms, some of which are similar to Alzheimerâs.
Others at Risk…
Age is not the only risk factor for having a B-12 deficiency — other at-risk groups include vegetarians (dietary B-12 comes predominantly from meat and dairy products) and people who have celiac disease, Crohnâs disease or other nutrient malabsorption problems. Evidence accumulating over the past few decades shows that regular use of certain medications also can contribute to vitamin B-12 deficiency. These include antacids, in particular proton pump inhibitors (PPIs) such as esomeprazole (Nexium), lansoprazole (Prevacid) and many others which reduce stomach acid levels, making it difficult for B-12 to be fully absorbed. The diabetes drug metformin (Glucophage) also can reduce B-12 levels.
A common symptom of vitamin B-12 deficiency is neuropathy, a tingly and prickly sensation, sometimes felt in the hands and feet and occasionally in the arms and legs as well. Dr. Rosenberg told me that people with B-12 deficiency also tend to have problems maintaining proper gait and balance. Dr. Rosenberg recommends testing B-12 levels for a few groups of people, including those on PPIs for more than a few months… people having memory problems and/or often feeling confused — and this can include people of any age… those with neuropathy in the feet and/or legs… and those who have unexplained anemia.
As mentioned above, deficiencies of B-12 in older adults are nearly always a direct result of too little stomach acid, which is essential for absorption of B-12. This explains why powerful antacids trigger B-12 deficiency. Another problem is that sometimes, especially in older people, the stomach isnât making enough of a protein called intrinsic factor (IF) that is needed to break down B-12 effectively. There is no way to increase IF, says Dr. Rosenberg, and so the solution is to administer B-12 in large enough quantities to override the difficulty with absorption. Traditionally this has been done with injections of B-12, but more recently doctors have found that oral supplementation with high amounts of B-12 that dissolves under the tongue also is successful and certainly easier than regular injections. Dr. Rosenberg adds that there is no reason to be concerned about “balancing” B vitamins as was once thought — B-12 is water soluble and the body can excrete what it doesnât need.
What You Can Do
Adults can easily get the recommended daily amount of 2.4 micrograms (mcg) of B-12 from dietary sources, which includes all animal products. For example, just three ounces of steamed clams supplies 34.2 mcg and three ounces of salmon provides the necessary 2.4 mcg. However, this amount will not address the problems associated with aging and medications. Once again, the issue goes back to absorption — if you donât have enough stomach acid and/or IF to use the B-12 you ingest, it is almost irrelevant how much animal protein you eat. This is why the Institute of Medicine says that for people over age 50 and for vegetarians, the best way to ensure meeting your bodyâs B-12 needs is to take a supplement or seek out foods fortified with it. Reason: The body can more easily absorb the form of B-12 used for supplementation and fortification even in people who have low levels of stomach acid. Caution: B-12 tests are sometimes insufficiently sensitive, especially for vegans. If your test indicates levels are fine in spite of symptoms, Dr. Rosenberg recommends having your doctor order a different test that will evaluate whether your B-12 system is intact. There is no need to suffer from any kind of B-12 deficiency symptoms, let alone risk misdiagnosis of Alzheimerâs, when the solution is so close at hand!
Irwin Rosenberg, MD, senior scientist and director of the Nutrition and Neurocognition Laboratory at Tufts University, Boston.