Are We Missing Vitamin B12 Deficiency in the Primary Care Setting?

Vitamin B12 deficiency is present in 5% to 20% of the elderly population and may begin in middle age, although there is a paucity of research to demonstrate this suspicion. One common cause, malabsorption, is affected by many factors often seen in the primary care setting, including prolonged use of proton pump inhibitors or metformin or as a result of gastric bypass surgery. The traditional sign of B12 deficiency, macrocytic anemia, can be masked by the folic acid supplementation in all enriched cereals/grains mandated by the US Food and Drug Administration since 1998. Vitamin B12 deficiency causes neurologic deficits that significantly impact quality of life and other conditions and is therefore worthy of recognition and treatment.