When I was working in Corporate Canada I shared an office with a woman who was 8 months pregnant. I watched her lethargy increase each week to the point she could not take her head off of her desk. She was literally pres-enteeism; physically at work but not functional.
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I knew what was going on, she was short on energy. She also had this obsession with tomatoes and lamb, she could not get enough of these two foods. It was all the convincing I needed.
Tomatoes are high in vitamin B9 (folate). Lamb is high in vitamin B12 among other B vitamins. I begged her to speak to her doctor to double her maternity vitamins, to which he agreed. Within a week, she was no longer sleeping throughout her work hours and was not as obsessed with tomatoes and lamb. She was amazed!
A case report in the British Medical Journal reported a 20-year-old 30-week pregnant woman admitted to the emergency room with symptoms of shortness of breath, lethargy and both her legs were numb.
Her blood lab values found her vitamins B9 (folate) and B12 were deficient affecting her hemoglobin. She was a meatatarian however, her diet lacked nutrition. After subscribing to only vitamin B12, her symptoms reversed and pregnancy was carried to term. Medical doctors are still under the belief that taking B12 and folate together will mask a B12 deficiency.
One of my colleagues at the time, an ER nurse found the majority of elderly patients coming in due to falls were also B vitamin Deficient. She wrote an incredibly useful book, Could It Be B12?: An Epidemic of Misdiagnoses.
The crux of her book;
B12 deficiency can cause dementia, multiple sclerosis, early Parkinson’s disease, diabetic neuropathy or chronic fatigue syndrome. It can cause depression and mental illness, infertility in men and women, or developmental disabilities in children.
Vitamin B12 and Folate deficiency can Mask one another with one fatal flaw
Now before you run out and grab a bottle of B12, there is more to the story.
B12 and folate deficiency symptoms overlap so closely they can mask each other. But there is one crucial difference.
A severe folate deficiency can usually be corrected. A severe B12 deficiency, if it progresses, can become irreversible. We are talking neuropathy, inability to walk, cognitive decline, and permanent brain damage.
Now, if you are lucky enough to have the right doctor, most will test B12. But many do not routinely test folate because of food fortification. These two should be tested together. And even how we test, and how those results are interpreted, can sometimes be misleading.
So are we having an epidemic of low B12 and possibly folate? What does the data say in 2025 for the United States?
Based on NHANES and expert summaries, about 2 to 3 percent of U.S. adults have a clinically significant B12 deficiency. In adults over 60, that number rises to about 6 percent or more. That does not sound like a lot, but let’s put it into real numbers:
2 percent equals about 5.2 million adults
3 percent equals about 7.8 million adults
And for older adults, that is roughly 4.5 million people.
Think about that for a moment. That is a lot.
And remember, that is just those meeting strict laboratory criteria for deficiency. It does not include:
Borderline or low normal B12
Functional deficiency with elevated homocysteine or methylmalonic acid
People with symptoms but serum levels still technically “in range”
Functional levels, which are different than standard lab reference ranges
What about Folate Deficiency?
Folate deficiency is much lower because of fortification. Around 2 percent of adults have low red blood cell folate concentrations suggestive of deficiency. However, in older adults, levels can trend lower than in younger adults.
Some literature reports estimates ranging from 5 to 20 percent in older adults when certain cutoffs are used, though that is not always representative of the fully fortified U.S. population.
If estimates range from 5 percent to 20 percent in older adults, depending on the cutoff used, that translates to:
5 percent equals about 3.75 million older adults
10 percent equals about 7.5 million
20 percent equals about 15 million
To be clear, the 20 percent figure is not universally accepted across all fortified U.S. data. It depends on how deficiency is defined and which biomarker cutoff is used. But even at the low end of 5 percent, that is nearly four million older adults.
Let’s talk about us sagers and B vitamin Deficiency
Serum folate in elderly adults can be more variable, and lower levels have sometimes been associated with cognitive and neurological outcomes. Marginal B12 and folate together can influence cognition postively and negatively when in a deficient state.
High folic acid intake from fortified foods can mask a B12 deficiency, especially in older adults prone to malabsorption, and the studies are showing this.
Symptoms may not fully reveal themselves, and testing may not happen. Or the symptoms that are being experienced are not being recognized as a reason to check B vitamins and folate. And then we layer in genetics. About 50 to 60 percent of the U.S. population carries at least one common MTHFR polymorphism.
So if this is as clear as mud, let’s let the sediment settle for just a moment and break it down.
Your body needs folate to make red blood cells, repair DNA, and support brain and nerve function.
But folate does not work as is. It must be converted into its active form, known as methylfolate, by the MTHFR gene. We all have this gene. But for some of us, this gene does not function as efficiently as it should.
Think of the MTHFR gene like a factory worker converting folate into its usable form. If you carry a common SNP, that worker may simply move slower. Synthetic folic acid, the form used in fortification, requires conversion. If your body cannot convert it efficiently, it becomes ineffective.
If that is the case, you may take folic acid and not fully benefit from it. And you may not recognize that your symptoms are actually because the worker is too slow to give you what you need.
The same concept applies to vitamin B12. There are gene SNPs affecting absorption, transport, and utilization. The synthetic or fortified form, cobalamin, may not be processed efficiently in some individuals. So the type of B12 and folate formulation becomes important.
Could B vitamin Deficiency be the root cause of Aging Symptoms?
Now combine genetics with a diet of processed, polished foods, devoid of fruits and vegetables, along with declining stomach acid as we sage. Add in medications and stress. Over time, vague symptoms can emerge and go undetected because we assume they are part of aging, or we have had them so long we think they are normal.
Without genetic insight or proper testing, misdiagnoses such as early onset dementia or other cognitive diagnoses can occur. Or neuropathy like in someone diagnosed with diabetes.
Now the symptoms of B vitamin deficiencies can either mimic other problems or be the root cause. I know I have not fully outlined the symptoms yet, but what I am talking about today are the symptoms (see chart below).
Cardiovascular markers and B Vitamins
B Type Natriuretic Peptide
Cardiologists use B Type Natriuretic Peptide, or BNP, or ProBNP to assess heart strain. Essentially, BNP is a protein. When there is too much, the test comes back elevated, and depending on the lab result, it may indicate the heart is not pumping efficiently, especially the left ventricle. It can also help determine stages of heart failure.It sounds terrifying, I know. But there is some things we can do.
Homocysteine
Another test some cardiologists perform is homocysteine. Homocysteine is an amino acid that can build up in the body but is also designed to be cleared. So when a lab reveals elevated homocysteine, and depending on the level, it can trigger further testing for cardiovascular disease.
If these labs come back high, discussions often turn to ACE inhibitors, ARBs, beta blockers, and other medications. And yes, those have their place. I am not saying do not take medications. That would be morally wrong.
But what if, now that you are a savvy sager, the next question to ask is, did anyone check my vitamins B6, B12, and folate?
What if you checked those next, and depending on the results and the right type of testing, you had a discussion with your doctor about bringing those numbers into proper functional lab ranges and then seeing what happens?
Or what if you are already taking a good B complex. When is the last time you had your nutritional markers for B12, B6, and folate checked? Or what if there is a chance you have genetic mutations and your factory workers are simply too slow?
Perhaps you combine B vitamins with medications and then retest in a couple of months to see how your body responds. And if you are not responding, perhaps you look into nutritional genetic testing to see if you are dealing with slower gene variants and need a different form of B vitamins.
The more we question the norm, the better at saging we become.
And this long answer comes down to this. These B vitamins are required to metabolize homocysteine and support cardiovascular health.
It really begins with addressing nutritional deficiencies. Then imagine how that may shift the entire picture without complicated symptoms down the road.
My Mum, Heart Failure and a Fractured Spine
Last year I spent about five months back home in Canada with my mum. She had fractured her spine. And I will point out, nothing was done until I came in roaring unapologetically.
My mum was in severe pain and the doctor said to just take Tylenol. I politely asked for a CT scan or X rays. After some argument, reluctantly, he ordered the CT scan.
It should have been automatic if he had asked basic questions like what were you doing before this happened. She had tried to move her bed after a snow and ice storm flooded her bedroom. She twisted as she pulled and hurt her back. That alone, along with her age, should have prompted action.
The CT scan showed a fracture at T11, one of the thoracic vertebrae in the middle of her spine. The doctor suggested Tylenol and said to come back in 8 weeks because it would take 6 to 8 weeks to heal.
While in the office, I asked to have her vitamin D3 checked. He said it was not necessary. My feathers were officially ruffled.
She had a fractured vertebra, which is a bone. Bone requires vitamin D3, along with K2, calcium, manganese and magnesium.
My mum is a sager. She smokes. She eats processed foods. She lives in the darkest part of Ontario Canada where in winter the sun appears maybe once every two or three weeks. That is reason enough to check vitamin D3.
After more discussion, he reluctantly agreed.
Then I asked when she had last been checked for heart disease in the past 10 years. She had quadruple bypass surgery and a follow up is warranted. His response— quiet—which translated to —never. At this point, my ruffled feathers were falling out.
After a great deal of arguing, we came out with testing for ProBNP, homocysteine, and B12, although he refused a urine organic acid test, which is better, and folate. That is all I could negotiate.
In the interim, my mum was in severe pain, taking Tylenol around the clock and alternating with Robaxacet, which still contains acetaminophen. There was no way she could do this for 6 to 8 weeks.
I took her to the emergency room in her small town. Same diagnosis. Same prescription. Just keep taking Tylenol.
The emergency doctor brought up her latest ProBNP test. I asked if they had tested it. No. It must have been in her chart.
My mum was in a wheelchair, exhausted, from being in pain, sleeping in the chair, and just looked physically and energetically depleted of life. The ER doctor said she was in second stage heart failure.
“Wait, am I going to have a heart attack?”
I asked what we do for that. The doctor said nothing. She reviewed the medications my mum was on, typical blood pressure meds, cholesterol medication, baby aspirin, and something else, I can’t remember.
My mum is finally processing what is going on as we talked over her sitting in the wheelchair and said, “Wait, am I going to have a heart attack?”
I said, “Yes, mum, you are going to croak.” I say.
“What are we going to do?” She says in the littlest of voice full of fear.
The doctor stayed quiet. Said nothing could be done. No referral to a cardiologist. No follow up. Just go home. We left, with me absolutely fuming.
The Chiropractor
For her back, we got her into the town’s chiropractor who used a laser technique that was incredible. It significantly reduced her pain and helped get her off Tylenol within about a week. about 6 weeks earlier than recommended by the physicians.
Can we reverse ProBNP and homocysteine lab values? With B Vitamins?
As for the ProBNP, homocysteine, and potential heart failure, there is a lot we can do, from diet and lifestyle to supplementation.
Now, symptoms of B12 and folate deficiency can include numbness or tingling in hands and feet, balance issues, brain fog, memory changes, mood shifts. Advanced cases can lead to permanent nerve damage.
And yes, let’s talk about numb legs. Because sagers seem to suffer with body extremities going numb, neuropathy especially in diabetics.
In a clinical nerve conduction study, nearly 80 percent of patients with neurological symptoms from B12 deficiency showed clear peripheral neuropathy. The damage primarily involved the nerve fibers themselves, called axonal injury, with some demyelinating features. Both sensory and motor nerves were affected. Outcomes were generally favorable when treatment began early.
A 2025 systematic review found supplementation with Vitamin B12 improved neurological symptoms in clinically deficient individuals.
Clinical references consistently list peripheral neuropathy, numbness, gait disturbance, and sensory loss as classic B12 deficiency presentations.
Myelin Sheath and Vitamin B12
Let’s think about the myelin sheath. It is the protective coating around nerves. It requires essential fatty acids and B vitamins (among other minerals). When vitamin B12, and also vitamin B6, are severely deficient, that sheath can break down.
B Vitamin Deficiency Symptoms
B12 and folate deficiency symptoms are so close that they can mask each other. The difference is a folate deficiency if severe can be corrected. However, a B12 deficiency if becomes severe can be irreversible and lead to permanent damage including not being able to walk, neuropathy, and brain damage. I understand why the doctor only gave B12 however, if B12 is low, typically the other B vitamins are too. During pregnancy, B12 and folate are required in higher doses than average recommendations. And, just for symmetry here, all B vitamins are needed as they work synergistically.
What causes B vitamin deficiencies?
If you have been following me for a while, then you know what I am going to say. B vitamin Deficiency can happen from a poor diet including
Vegan/vegetarian diet
High in sugar, grains, and refined foods
Low in vegetables
Low in beans, nuts and seeds
Caffeine
Alcohol
B vitamin deficiency can also be a contributing factor with
Genetics, SNPs, mutations, variations
High stress
Inflammation
Poor stomach acid
Bowel resections
Gut infections
Medications
Antibiotics
Organic Acid Testing and B Vitamin Deficiency
It is not just vitamin B12. I have been using Diagnostic Solutions Labs OMX| Organic Metabolomics Plasma and Organic acid test with my clients. What I have found is at least one deficiency of a B vitamin at the root cause of their health concerns. Typically it is vitamin B1, B2, B6, B12.
I could not understand why every single client was dealing with B vitamin deficiencies and I took it one step further. I started running their 23andme data through a PureInsight™ (formally PureGenomics®) program that gives incredible nutritional data.
I have found those who have B vitamin Deficiencies had an enzyme mutation that did not allow them to properly absorb B vitamins. Or, depending on their gene mutation needed more than the average recommended amount of specific B vitamins.
By then putting the right type of B vitamins and amount in place we have been getting incredible results including hormone issues, coming off of antidepressants and antipsychotics, and other medications. One of my clients who was struggling to bring her cancer markers into balance did so after 3 months of a specific B vitamin regime. It was such a delight to see the needles move! It is absolutely incredible to see my clients bounce back with so much energy and happiness. And Homocysteine and ProBPN? The lab markers trended in the right direction.
B vitamins affect Amino Acids
Also, keep in mind, there were other concerns on the test that we would also address. On this note, there were also plasma amino acid deficiencies differing in each. B vitamins are co-factors for amino acids to work properly. So, do you give them amino acids or B’s?
The short term we would add in amino acids to help, but in the long term it is the B vitamins. They are the cofactors for amino acids to work better. But, depending on symptoms and level of deficiency it may take a couple of weeks before the B vitamins can kick and do their job.
Amino acids play a crucial role in immunity, stress, sleep, energy, mental health cardiovascular, and gastrointestinal health. In other words, just about everything. So, what is better to take, B vitamins or amino acids? It is really about getting to the root cause. I say if there are symptoms check both, supplement short term with the deficient Amino acid until the B vitamins kick in.
B Vitamins and Genetic Mutations
It’s one thing to take a B vitamin complex, it is another to understand if you are taking the right type of complex for your genetic chemistry.
If you have your 23andMe raw data and you would like your own PureInsight™ (formally PureGenomics®) Nutrition Report including what foods are the best for your weight, activity level and so much more you can get this information for a nominal fee. Reach out.
You can make it super private by uploading your own or I can help you with this and still be private by uploading it for you. A quick email and you are on your way. If you are interested in this email me at hellokarenlangston@gmail.com and I will send you the details.
Update on 23andMe
23andMe was owned by pharmaceutical companies. As of 2021, there was a merger with special purpose acquisition company VG Acquisition Corp., which was founded by U.K. billionaire Sir Richard Branson. Anne Wojcicki, the cofounder, and CEO of 23andMe. In March 2025, 23andMe filed for Chapter 11 bankruptcy and ceased operating as an independent public company. Its shares were delisted from the Nasdaq. Initially, Regeneron Pharmaceuticals agreed to buy most of 23andMe’s assets (including its Personal Genome Service and research divisions) for about $256 million. However, a nonprofit called the TTAM Research Institute, led by 23andMe co-founder and former CEO Anne Wojcicki outbid Regeneron with a higher offer (~$305 million). In July 2025, a bankruptcy court approved the sale of 23andMe’s assets to TTAM. Under that deal, the company’s genetic testing services continue, but 23andMe is now owned by the TTAM Research Institute rather than operating as the old publicly traded 23andMe Holding Co
They may be using health data for drug development however, you must opt in if you want this. In other words, you can make your DNA as private as you want.
If you are thinking of getting your DNA done through 23andMe there are specific kits you need to get. It is the Health + Ancestry Service. You do not need a monthly subscription. You will get a ton of information from the company itself and connect with other DNA relatives or keep your information completely private.
If you are not sure how to get your data, You can go to 23andMe and they have instructions on how to download your raw data. If you have downloaded your data in the past, I recommend a fresh download. Information is continuously being updated on the site. It is better to get the most current bang for your buck!
Once the raw data from 23AndMe has been downloaded and uploaded to PureInsight™ (formally PureGenomics®), the cutting-edge report is super easy to read, and can tell you which vitamins and the form is best for your genes or if you do not absorb them at all (now that is a money saver!). The report will also include two categories; Consider Action and Enhanced Benefit so you can decide where you would like to focus your efforts.
There are several trait categories including
Vitamins
Minerals
Intestential microbial balance
Inflammation (inflammatory pathways)
Weight management
Energy and Fitness
Stress management
GI health
Cognitive and Memory
Glucose metabolism
Sleep management
Sun exposure
Environmental exposures
Medication and substance use
Lifestyle and food suggestions
Intolerances
Here is how it works
Upload raw data from either 23andme or Ancestry
Fill out a questionnaire for even more targeted results
Recent blood work? Upload that too and get really specific
Receive and download your report within 24 hours
The report comes with diagrams, supplemental nutrition and diet suggestions unique to your genes. All while keeping it really easy to understand and incorporate.
Super easy, get better results, get the right supplements and food to eat, save money and have better peace of mind you are doing the right thing for your unique physiology.
If you are uncomfortable with 23andMe, I get it. There are other options. I work with Evexia and there are tons of DNA testing that are from a nutritional perspective. If this is something you would like to explore, reach out for a 30 minute consultation. HelloKarenLangston@gmail.com (656) 222-0848
What happened to my MUM?
As for my mum… she has not croaked. Yet.
At 78 years old, she has tons of energy. I mean, she is slow and meanders a bit, but she is doing things now. When I first got there, she had no life in her.
I want you to understand that my mum does not believe in what I do. None of my family does. But when she heard she could have a heart attack at home, she was willing to listen. Well, that and I showed her pages of studies associating low B vitamin status with cardiovascular disease. She was willing to at least entertain the idea.
She did not have her 23andMe genetic testing done and was not interested in doing it. But I figured since she gave birth to me, our genetics are going to be pretty close. I have the MTHFR gene SNP, as well as SNPs related to B6, B12, and zinc and require more vitamin D3 than the average person.
So she started taking a methylated multivitamin, a methylated B complex, magnesium, and a D3 complex. You can get these through my online store. I would appreciate your support and business.
Pure Encapsulations PureGenomics® Ultramultivitamin (for mineral-vitamins)
Pure Encapsulations Magnesium (Glycinate) For muscles, and foot cramps
About three weeks in, I noticed my mum was not falling asleep as much during the day and actually wanted to go out. A couple of weeks after that she said to me, in mid-thought, “You know those medicines you have me on…”
I corrected her. “Mum, they are vitamins.”
“Yeah, whatever. I think they are working. I feel better.”
Later, when she had her ProBNP and homocysteine tested again, they were normal.
So I guess she is not croaking any time soon.
Know Your Vitamin B12 and Folate at the very least!
As for your B vitamins ask your doctor to test your
Serum folate
Serum B12
URINE methylmalonic acid. (MMA)
At the very least!
Order Your own B vitamin Test
if it is a no to the urine test, get an organic acid test done that looks at all your nutrition or order your own. Or order your own serum folate, serum B12 and urine MMA. Most states you can order your own labs except for a couple of states. ..Rhoad Island, New York and New Jersey. Laws vary and specific tests or requirements can differ by state. Some tests may still require clinician review even where direct access is permitted.
Bottom line is this.. if you want to sage with sass and grace with all your marbles, your stamina and energy… get the right functional nutritional testing. Life is not about sitting with your friends comparing aches, pains and medications. Heck no! this second act in life is about feeling good and getting out and enjoying life. Are you with me?
Thank you for joining today’s discussion. Remember, Small shifts, big impact. You deserve to feel strong, vibrant, and capable, because you are.
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Stay well, and until next time, question the norm, trust your wisdom, elegantly and unapologetically roar. And most of all, Lady,, keep being fascinating and sage with sass and grace in every day life.
