Want a Bargain on Vitamin B12?

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I was surprised and disappointed to see this add in my email's inbox this morning. Really? If you need a quick pick-me-up, come on in for a B12 shot? I realize this is not dramatically different than the many supplements on sale at your local grocery or pharmacy, but somehow the invasive nature of a shot takes it to a higher level for me. Not to mention that B 12 shots are actually a PRESCRIBED medication...
So, it begs the question, who really NEEDS B12 shots? The obvious answer is those people who are severely deficient in B12. Why DO people get B 12 shots? As always, the answer is not exactly straight-forward. Many people get them because, well, they ask for one! There is a myth out there, quite popular with the entertainment industry, that getting a B 12 injection gives you a "shot" of energy. This idea has been around for many decades, and there are patients who absolutely swear it works. Additionally, many people believe if they are really stressed and run down- say at finals time in college- then a B 12 shot seems to keep them from getting sick. Is this true?
There are not any current evidence-based medical studies that support this theory. There is one recent study that showed high intake of Vitamin B12 (and of B6) is protective against depression in older adults living within the community. (Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time.)
What we primarily use B 12 shots for, however, is the obvious- true B 12 deficiency. Why do people get this? A few get it as a side effect from bariatric surgery (a stomach bypass), but most get B 12 deficiency from making antibodies to B 12 receptors in your stomach. When this happens, you can no longer ABSORB Vitamin B12 from your diet, so the only ways to get B 12 is from a shot or from a medicine that can be absorbed under your tongue, or more recently, a prescription medicine you squirt in your nose (in the same manner as allergy nose sprays.) When you bypass the stomach receptors, the B12 can then enter your body effectively. Who is prone to getting B 12 deficiency? Anyone with other auto-immune diseases, where the body starts making antibodies to other organs or receptors. This includes adult onset diabetes, vitiligo, thyroid disease and other diseases in the rheumatic family such as lupus.
How about symptoms of B 12 deficiency? There may be none. In severe cases, the patient develops anemia. Often, we see nonspecific symptoms such as brittle fingernails, fatigue, and forgetfulness.
If you have a family history of true B 12 deficiency, that is also a risk factor.
The good news is that B12 is easily replaced, and though it will take a few months to get tanked back up, you should completely recover with time as long as you are consistent about your method of B 12 replacement. Additionally, extra B12 should not be harmful to anyone, as it is a water soluble vitamin (which means you may have lovely, expensive, bright yellow/green urine if you over-replace, but no other worries!)
BOTTOM LINE: B 12 replacement is only really necessary if your levels are low- check with your doctor if you are concerned!

Alzheimer's Disease- Why So Hard to Diagnose?

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.