Improved Quality of Life

     Millions of individuals over age 60 are suffering from a preventable epidemic of vitamin B12 deficiency. Some younger individuals are also at risk. With early detection by routine uMMA screening and treatment, neurologic disability and vascular disease can be prevented.¹³ Even a 20% increase in function with B12 therapy could make the difference between dependence and independence for seniors.

     A second proposed approach to ending the epidemic is for the US Food and Drug Administration (FDA) to mandate the fortification of enriched cereal grains with B12 similar to the current folic acid program. A petitions has been filed with the FDA (Sept. 1996) to require a minimum of 25 micrograms B12 / 100 g product or per folate supplement⁵⁵, suggested to be the amount needed (25 micrograms daily) to prevent all Americans from ever getting B12 deficient.⁵⁵ However, the lowest daily amount of oral B12 to normalize MMA levels in elderly subjects is not know but subjects with undiagnosed pernicious anemia, estimated 2% of the elderly ⁵⁶, require 300 -1000 micrograms daily to prevent clinical abnormalities.⁵³ Safety studies may be required prior to increasing the vitamin B12 RDA 10 fold through food fortification particularly since little data exists on the affects of increased B12 intake in the younger population.

Reduced Medical Expenses

     Health care cost for Americans over age 65 was nearly $300 billion in 1992.⁵⁷ The medical cost for this age group is expected to significantly increase with the population of this group growing from 30 to 65 million in the next 40 years.⁵⁸

     Dementia from B12 deficiency is identical to that of early stage AD.¹⁴ In 1994, total cost for care of one AD patient was more than $213,000 in additional to other medical expenses.⁵⁹ The total yearly cost for caring for an AD patient, whether living at home or a nursing facility was estimated at $47,000 in 1993.⁶⁰ In 1990, over 10% (3.75 million) of the US population over age 65 had AD and 9 million cases are projected by 2040.⁶¹ AD has been estimated to cost the U.S. approximately 90 billion dollars a year, which includes care as well as loss of productivity for patient and caregiver.^60-2

     A recent study following 370 individuals aged 75 or older for three years found subjects with low levels of serum B12 or folate had twice the risk of developing AD. Subjects with good cognition were especially at risk suggesting damage is done during the earliest prodromal phase of AD.⁶³ These data suggest that delaying uMMA screening until a patient is symptomatic may be too late to completely reverse cognitive loss with B12 therapy.

     A similar study of 1092 subjects, mean age 75, were followed for eight years and dementia developed in 111, including 83 with AD.⁶⁴ An increased plasma Hcys level, characteristic of folate or vitamin B12 deficiency, was found to be a strong , independent risk factor for the development of dementia and AD. Their data indicate that Hcys levels were elevated well before the onset of dementia and suggest as the previous study⁶³ the need for routine uMMA screening. The risk of AD nearly doubled with Hcys levels above 14 micromoles per liter and also causes a similar increased risk of death from cardiovascular causes and strokes. The levels of Hcys were even greater for non anemic individuals with mild vitamin B12 deficiency¹⁴ and gives further support for uMMA screening. For example, 16 subjects, mean age 81, identified with high uMMA levels of 7.8 +-5.1 had Hcys levels of 18.6 +- 8.6 micromoles per liter.¹⁴

     Similarly, vegetarians were shown to have elevated Hcys levels of 11.2 micromole/liter attributed to B12 deficiency compared with a value of 8.64 for non vegetarian women.^65,66 A high Hcys level is associated with risk of heart disease. Meta -analysis of several studies indicate that a Hcys level of 15 micromole/liter results in a 60 to 80% greater risk of cardiovascular disease then volunteers with a more typical concentration of 10 micromoles/ liter.^65,66

     uMMA screening which prevented one person from development of AD or B12 deficiency dementia would save $200,000 for 4000 more screening tests at $50 each. Additional screening of elderly populations, with a prevalence of 5 -15 %, could identified hundreds for early B12 treatment and prevention of dementia as well as other neurologic symptoms and cardiovascular disease.
The findings that asymtomatic individuals with mild vitamin B12 deficiency are at risk for developing both AD as well as cardiovascular disease warrants annual screening of senior populations. The uMMA test is the only practical screening test available.