Understanding Vitamin B12 Deficiency During Menopause

Menopause brings its share of challenges, including the perplexing and often overlooked symptom of brain fog. If you're leaving your keys in the fridge, forgetting things off the shopping list, or struggling to remember a word on the tip of your tongue, it might not just be hormonal—it could also signal something more.

A common culprit behind brain fog is vitamin B12 deficiency. As we age, our bodies struggle more with absorbing this crucial nutrient, leading to cognitive difficulties that exacerbate menopausal brain fog.

Understanding Vitamin B12 Deficiency

Vitamin B12 plays a number of roles in your body, but, specifically, it helps keep your blood and nerve cells healthy and helps make DNA. Most people get enough vitamin B12 from their diet, but there are some things that can cause deficiency:

• A vegan diet. Vitamin B12 can only be obtained from animal foods. Vegans should make sure to consume B12 supplements or foods fortified with B12 (like breakfast cereals) in order to avoid deficiency.
• Taking metformin for diabetes. Metformin can interfere with your ability to absorb vitamin B12.
• Being over 50. As you age, your stomach contains less acid, which can reduce your ability to absorb vitamin B12.
• Having pernicious anemia. People with this condition cannot digest vitamin B12 and have to receive it by shots.
• People who have had a stomach bypass or similar surgery.
• People with celiac disease, Crohn's, or similar conditions.

Taking supplements or eating fortified foods is the easiest way to resolve vitamin B12 deficiency, except in people with pernicious anemia. Many breakfast cereals are fortified with enough vitamin B12 to avoid deficiency.

Symptoms of B12 Deficiency

Vitamin B12 deficiency can, have a number of symptoms:

• Numbness or tingling in hands and feet
• Weak muscles
• Trouble walking
• Nausea
• Decreased appetite and weight loss
• Fatigue
• Irritability
• Diarrhea
• Fast heart rate
• A smooth and tender tongue
• Brain fog and cognitive issues.

Because older people can have issues absorbing vitamin B12, it's possible brain fog—especially if you have any of these other symptoms—can be a result of no longer getting enough B12. In some people, these symptoms can even mimic those of dementia, including memory loss, agitation, and irritability.

The Intersection of Menopause, B12 Deficiency, and Cognitive Health

Menopause and vitamin B12 deficiency can tangle together. Not getting enough B12 can aggravate symptoms of menopause. Menopause increases your need for B12 and other B group vitamins. This can easily turn into a cycle that leaves you miserable and can potentially cause cognitive decline, cardiovascular disease, and even stroke. Dementia-like symptoms can also occur, although thankfully these are typically reversible by increasing B12 intake.

Menopause brain fog can be mistaken for B12 deficiency and vice versa, but the two can also work together for an even worse situation. Brain fog causes temporary lapses in mental clarity, reduction in concentration, confusion, memory problems, and overall decreased cognitive performance. Brain fog can also be caused by stress, sleep deprivation, anxiety and depression, all of which can be made worse by menopause.

Some women may find HRT necessary to restore brain function. It's important to investigate brain fog and establish whether it's a symptom of menopause or a sign of something worse. Typically people with brain fog will still pass cognitive tests, but may have ongoing issues.

Differentiating Between B12 Deficiency, Brain Fog, Dementia, and UTIs

If you experience significant brain fog, you should consult a healthcare provider to make sure it is not an early sign of a more serious health issue. There are new interventions available that can slow the progress of cognitive decline.

Another thing that can cause cognitive issues is UTIs, especially in older women. A UTI can cause sudden confusion or delirium, even if you don't have dementia. It can cause agitation, confusion, and withdrawal. This typically resolves once the UTI is treated, although people with dementia may experience a permanent increase in symptoms. Watch for other symptoms of a UTI such as pain while urinating, frequent urination, and bloody urine.

If B12 deficiency is suspected, your doctor may ask questions about your diet. Sometimes the easiest way to determine whether your brain fog is B12 deficiency or menopause is to increase your intake of B12 or take a supplement. There are no risks to taking too much B12—your body will just excrete it.

What to do about B12 Deficiency

If you suspect you have a B12 deficiency, you should talk to your doctor, who can do a blood test to check for B12 deficiency. If they find a deficiency, there are many possible ways to address it.

B12 is typically found in meat, dairy, and fish, but increasing your intake from those sources may not be desirable if you have concerns about cholesterol and cardiovascular health.

An excellent source of B12 that is also suitable for vegetarians and vegans is fortified nutritional yeast. This is an inactivated yeast that also contains other B complex vitamins and high quality protein. Typically you should consume two teaspoons daily, and you can use it to season popcorn, pasta, soups and sauces.

Fortified breakfast cereals are also popular, but make sure to choose options that are low in sugar and high in fiber, such as oat-based cereal and raisin bran. Avoid high sugar cereals marketed to children.

If you are having problems absorbing B12, your doctor may recommend that you take a supplement. They might also prescribe vitamin B12 shots, especially if you have pernicious anemia, Crohn's disease, or are severely deficient. In some cases you may need to take B12 supplements for the rest of your life, while in other cases you will only need to take them for a short period of time while you improve your diet.