PREVENTING EARLY MORBIDITY AND MORTALITY IN MILLIONS OF ELDERLY, AND SAVING $ BILLIONS: NEW EVIDENCE THAT 100 µg FREE VITAMIN B12 (Cobalamin) Orally Daily From Age 50 Will Prevent Gastric Atrophy of the Elderly from Producing Subtly Progressive B12-deficiency Neuropsychiatric Dementia & Stumbling and Later Anemia.

V Herbert. Mt Sinai NYU Health System & Bronx V.A. Med Ctr, NYC, NY.

   We started studying the value of B₁₂ ± B₆ ± PGA supplements vs. high homocysteine (Hcy) in 1992 (Nutrit Today 27(6): 30-3). From Framingham data, PFJacques et al reported (NEJM 1999;340:1449-54) that, while fortifying grains with PGA (folate) in elderly adults increased serum folate and decreased serum Hcy, the difference in mean Hcy was largely due to differences in B₁₂ and B₆ status between users of B vitamin supplements and non-users. This supported our studies (MA Flynn, et al. J Am Coll Nutr 1997;16:258-267) which found that, by age 65, 49% of 171 ìhealthyî elderly no longer absorbed B₁₂ from food (as diagnosed by low serum holotranscobalamin II [TC II B₁₂], a surrogate Schilling test- V Herbert, Ed. Vitamin B₁₂ Deficiency. RT Series 66, Roy Soc Med Press, London,1999). Despite ìnormalî total serum B₁₂ (>v200 pg/ml) in all but 7, 60% of this 49% had vasculo- and neuro-toxically high (>17) serum Hcy, but 100 µg of free B₁₂ orally daily normalized serum total B₁₂, TC II BB₁₂, and Hcy (JW Miller, et al. FASEB J 1999;13: A936). Elderly gastric atrophy is insidious. Loss of gastric acid and enzymes precedes loss of gastric intrinsic factor (IF) by years; without them, food B₁₂ is not split from peptide bonds, and lost in the stool. Free B₁₂ continues normally absorbed via the physiologic IF-dependent mechanism. After IF is lost, 1% of free B₁₂ is absorbed by mass action diffusion: 0.1 µg B₁₂ absorbed daily sustains normality (Herbert, 1999: Editorial). The above supports our hypothesis that lower serum and red cell folate and higher MCV in elderly is mainly B₁₂ deficiency gut megaloblastosis producing malabsorption of folate (and B₆),and lack of B₁₂ to transport folate into red cells and keep it there by polyglutamating it. FDA should enact our petition (Am J Clin Nutr 1997;66:450-1)to require 100 µg B₁₂ added to all PGA fortification and supplements.

Published in FASEB J 2000; 14(4): page A292 (Abstract #226.1).

Presented at Sunday, April 16th, 2000, minisymposium on ìVitamin B₁₂ & Health in Older Adultsî at EB 2000 meeting of the Federation of American Societies for Experimental Biology (FASEB) at San Diego Convention Center and the San Diego Marriott Hotel.