Confusion surrounds B-12 deficiency

Tired and run down? No appetite? Trouble walking? Depressed or irritable? Do your hands or feet tingle?

Symptoms like these describe dozens of different disorders. Yet many people are not tested for one possible cause: a deficiency of B-12, a vitamin essential to health that is found in meat and dairy products.

Those vulnerable to potentially serious complications from B-12 deficiency are senior citizens, strict vegetarians or vegans, bariatric and other stomach-surgery patients, and people who take certain diabetes, heartburn and ulcer medicines.

Others particularly at risk are people who lack a protein that helps absorb the vitamin. This occurs in those with some autoimmune disorders and pernicious anemia, a blood disorder.

But there’s controversy about the wisdom of routine testing because of costs and concerns that doctors might find people with low levels of the vitamin who don’t warrant therapy.

Nine out of 10 people with low B-12 levels actually are healthy and don’t need intervention, says Dr. Ralph Carmel, a leading B-12 expert who is widely published on the topic and who has treated thousands of patients with the problem.

The trouble is distinguishing those with real problems from others with lower levels that “have no clinical implications,” says Carmel, director of research in the Department of Medicine at New York Methodist Hospital, in Brooklyn. Once a true B-12 deficiency is established, doctors need to treat patients promptly and aggressively because if the problem goes untreated, “it can be disastrous,” he says. “If it goes untreated for too long, the damage doesn’t go away.”

A recently published book, “Could It Be B-12? An Epidemic of Misdiagnoses” (Quill Driver Books, $12.95) by Sally Pacholok and Dr. Jeffrey Stuart, argues that B-12 deficiency frequently is underdiagnosed.

“I’ve worked in the same hospital for 23 years, and I see so many people with signs and symptoms,” says Pacholok, a registered nurse who published the book with her physician husband.

Pacholok was diagnosed at age 19 with a hereditary form of pernicious anemia, a disease that causes B-12 deficiency. Over the years, when she urged that patients be tested, “they looked at me as if I was some kind of nut,” says Pacholok, 42. She got some of her colleagues at Mt. Clemens General Hospital to probe further if patients showed symptoms.

Some doctors question the cost-effectiveness of testing people in high-risk groups or people who have diseases, such as Alzheimer’s or multiple sclerosis, with symptoms that mimic B-12 deficiency. Routine blood tests are highly inaccurate. A more accurate urinary test costs $90 to $200.

Dr. Jeffrey Halter, chief of geriatrics at the University of Michigan Medical Center, says the center doesn’t routinely test for B-12 deficiency unless an elderly person is malnourished. Testing people with slightly low B-12 levels or who have memory loss is controversial and not cost-effective, he says.

Estimates vary about the incidence of B-12 deficiency, but two experts agree the consequences of not treating the problem can be devastating.

Research by Katherine Tucker, a professor of nutrition at Tufts University, found that as much as 16 percent of the population has B-12 deficiency or low levels of B-12.

“It’s a real problem,” she says. “The awareness of it certainly needs to be raised.”

Among vegetarians or vegans, B-12 deficiency “is a viable concern,” says Suzanne Havala Hobbs, a registered dietitian with the University of North Carolina at Chapel Hill and a well-recognized writer on vegetarian issues. She and others say there’s now good information about the deficiency.