Q&A: vitamin B12 deficiency; magnesium supplements; best exercise advice; & how to switch doctors

Health Hub: Your Weekly Medical Q&A 💊

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Disclaimer: The views expressed here are entirely my own. They are they a substitute for advice from your personal physician.

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The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: VITAMIN B12 DEFICIENCY

Could you speak about B12? My father is in a nursing home and the doctor said that his low B12 level could have caused his falls …? Does that sound right to you? My level is normal (299) but now I wonder if that is normal? Any help appreciated!

- Kendra

Dear Kendra,

Thanks for this question! Low vitamin B12 levels absolutely can contribute to falls, especially in older adults. Vitamin B12 plays a crucial role in maintaining the integrity of the nervous system. When B12 levels are persistently low, it can negatively affect sensation in the feet and legs. This sensory impairment increases the risk of losing balance and falling.

Additionally, vitamin B12 deficiency can cause symptoms like anemia, fatigue, weakness, and cognitive issues, which can further affect physical strength and coordination, potentially leading to an increased risk of falls.

Addressing vitamin B12 deficiency (through supplementation or dietary changes) can help mitigate these risks and improve balance and mobility, especially in older adults who are more susceptible to falls. Supplementing with certain specific vitamins is sometimes medically necessary, depending on the person’s health profile. Most evidence suggests that we get enough B12 from our diet, primarily through animal-based food such as meat, poultry, fish, eggs, and dairy products. This is why patients who adhere to a vegetarian or vegan diet commonly have low B12 levels.

Other patients are at risk for B12 deficiency because of low absorption of this vitamin in the stomach. The common risk factors for low B12 absorption include age; certain GI disorders (such as atrophic gastritis, pernicious anemia, celiac disease, and Crohn’s disease); past gastrointestinal surgery (i.e., weight loss surgery); medications (such as proton pump inhibitors for stomach acid, and Metformin for diabetes); and alcohol overuse.

Because vitamin B12 is a water soluble vitamin, it is difficult to overdo. That said, I usually recommend 500-1000 mcg daily by mouth for patients with low B12 levels. I will recommend B12 shots to patients who are unable to absorb the oral form. For more information, the National Institutes of Health’s Office of Dietary Supplements offers a fact sheet on B12.

I hope that helps!

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QUESTION #2: MAGNESIUM SUPPLEMENTS

I see various forms of magnesium in the supermarket and pharmacy. I hear it is recommended for some of the issues I deal with - like muscle spasms, joint pain, sleep and digestion. My gynecologist recommended Magnesium L-threonate, but would another form be better? Like glycinate, oxide, citrate etc. Can you break down which versions do what?

-Lee

Hi Lee,