Has this ever happened to you? You wake up exhausted, even though you slept eight hours.

Your brain feels foggy—like you’re moving through the world behind a pane of glass. Small tasks feel overwhelming. And maybe there’s a heaviness to your mood that doesn’t quite match your life circumstances.

If this sounds familiar, you’re not alone.

As a psychiatric nurse practitioner who has worked with women over 60 for more than 15 years, I can tell you this: I hear this story constantly. And here’s what troubles me deeply—most of these women are being treated for depression, anxiety, or cognitive decline, when the real culprit might be something much simpler to address: a vitamin B12 deficiency.

The tragedy? This is one of the most overlooked—and most treatable—causes of mental health symptoms in our demographic. Yet it remains invisible to many healthcare providers.

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Here’s the Thing: Your Brain Needs B12 More Than You Realize

Let me share what I’ve observed in my practice. B12 isn’t just another vitamin. It’s a crucial player in the very mechanisms that keep your brain functioning, your mood stable, and your energy available to live the life you want.

B12 is essential for something called myelin formation. Myelin is like the insulation around your nerves—it allows electrical signals to travel quickly and smoothly through your nervous system. When B12 is low, this insulation begins to break down. Your brain’s communication becomes sluggish. Your mood destabilizes. Your memory falters.

Think of it like this: Your nerves are like electrical wires in a house. B12 is the insulation protecting those wires. Without adequate insulation, the signals short-circuit. Everything slows down. Some lights flicker. The whole system becomes less efficient.

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Why This Happens After 60 (And Why Everyone Misses It)

Here’s what I’ve learned after years of working with women in this season of life: B12 deficiency becomes increasingly common as we age, but for reasons that are rarely discussed.

When we’re younger, our stomachs produce plenty of intrinsic factor—a protein our bodies need to absorb B12 from food. But as we journey through our 60s, 70s, and beyond, our stomach acid decreases. We produce less intrinsic factor. Some medications we take (like metformin for diabetes or H2 blockers for acid reflux) further interfere with B12 absorption.

Many of us also shift away from B12-rich foods—red meat, fish, dairy, eggs. Whether for health reasons, digestive reasons, or preference, these dietary changes can quietly leave us depleted.

The result? A slow, steady decline in B12 levels that often goes unnoticed for months or even years.

And here’s where it gets dangerous from a mental health perspective: The symptoms of B12 deficiency look almost identical to depression, cognitive decline, or “just getting older.”

Fatigue? Check. Brain fog? Check. Difficulty concentrating? Check. Low mood? Check. Social withdrawal? Check.

Most of us—and honestly, many healthcare providers—chalk these up to aging or reach for an antidepressant. And while an antidepressant might help something, it won’t address the underlying B12 depletion that’s actually driving the problem.

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The Psychiatric Connection

What I’ve learned in my practice is this: B12 deficiency is one of the most common treatable causes of psychiatric symptoms that gets missed.

Research suggests that B12 is involved in serotonin production—the neurotransmitter most closely associated with mood regulation. Low B12 can literally compromise your brain’s ability to produce the chemicals you need to feel stable and hopeful.

Additionally, B12 deficiency can cause something called pernicious anemia, where your body doesn’t produce enough red blood cells. When your brain isn’t getting adequate oxygen, everything—including your mood, your energy, your ability to think clearly—suffers.

I’ve worked with women who came to me with depression symptoms. We ran a simple blood test for B12. The level came back low. With supplementation, they saw their mood shift dramatically within weeks. Not through medication adjustments or therapy alone, but because we finally addressed what was actually wrong.

This isn’t to say that all depression is B12 deficiency. Of course not. But what I’m saying is: If your mood has shifted, your energy has dropped, or your thinking has become foggy, B12 deserves a seat at the diagnostic table.

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The Warning Signs Your Body Might Be Sending

Your body always tells the truth. Listen to these whispers:

Mental Health Symptoms:

• Persistent low mood that doesn’t improve with the usual self-care
• Anxiety or nervousness that feels disproportionate
• Memory problems or difficulty concentrating
• Difficulty finding words or mental sluggishness
• Depression that seems to resist treatment

Physical Symptoms:

• Fatigue that doesn’t improve with rest
• Weakness or heaviness in your limbs
• Numbness or tingling in your hands or feet (this is particularly important—it can signal nerve damage)
• Shortness of breath
• Mouth sores or a swollen, sore tongue
• Pale or yellowish skin tone

Behavioral Changes:

• Withdrawing from activities you normally enjoy
• Irritability
• Confusion or difficulty making decisions
• Difficulty with balance

Here’s what I want you to know: If you’re experiencing any of these—particularly the combination of mood changes with numbness or tingling—this warrants investigation. Don’t dismiss it as “just aging.” Don’t accept it as inevitable. These are signals that something needs attention.

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Who’s At Highest Risk? You Might Be on This List

Certain factors make B12 deficiency more likely. As we age, several of these often stack up.

Medications: If you take metformin (for diabetes), proton pump inhibitors or H2 blockers (for acid reflux), or certain other medications, your B12 absorption is compromised. This is important clinical information your doctor should be discussing with you.

Digestive Changes: If you have a history of gastric surgery, celiac disease, Crohn’s disease, or irritable bowel syndrome, B12 absorption is affected.

Dietary Patterns: If you’re vegetarian or vegan, you’re at higher risk (plant-based foods don’t contain B12). If you’ve significantly reduced your intake of animal proteins, consider whether this might be contributing.

Pernicious Anemia: This autoimmune condition prevents intrinsic factor production. It runs in families, so if relatives have had it, you’re at higher risk.

Age Itself: The older we get, the less stomach acid we produce naturally. By some estimates, up to 30% of people over 50 have reduced ability to absorb B12 from food.

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What to Do: Taking Charge of Your Own Health

So if this resonates with you, what’s the next step?

First: Get Your Level Checked

I recommend asking your healthcare provider for a B12 blood test. Make it specific—request both the total B12 level and methylmalonic acid and homocysteine levels. Why? Because sometimes total B12 appears “normal” but you still have functional B12 deficiency. These additional markers tell the fuller story.

When you ask for this, you’re taking charge. You’re being proactive about your health. This matters.

Second: Have the Conversation with Your Doctor

Come prepared. Tell your doctor:

• What symptoms you’re experiencing (bring my list if it helps)
• Whether you take any medications that affect B12 absorption
• Your dietary patterns
• Whether anyone in your family has pernicious anemia

This information helps your doctor assess your actual risk.

Third: Explore Your Options

If your B12 is low, there are several approaches. Some work better than others depending on why your B12 is low.

Dietary Optimization: If your deficiency is mild and related to diet, increasing B12-rich foods can help. This includes beef, fish, eggs, cheese, and fortified plant-based milks. The key word here is “can”—it depends on your absorption capacity.

Oral Supplements: B12 supplements come in various forms (cyanocobalamin, methylcobalamin, hydroxocobalamin). Some people absorb them reasonably well. Others don’t, particularly if their absorption issue is related to intrinsic factor deficiency.

Sublingual or Lozenges: These bypass the stomach, allowing absorption through mouth tissues. For some people, these work beautifully.

Injections: If your absorption issue is significant (especially with pernicious anemia), B12 injections bypass the digestive system entirely. They’re given intramuscularly, typically monthly or quarterly. In my clinical experience, many women see dramatic improvements with injections—sometimes within days or weeks.

Nasal Spray: A newer option, B12 nasal spray is another way to deliver B12 without relying on stomach absorption.

The key is finding what works for your body and your specific absorption challenge.

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Here’s What’s Important: A Gentle Word About Agency

You are the expert on your body. You know yourself—your patterns, your changes, your intuition about what feels off.

If something in this post resonates deeply, trust that. If you’ve been struggling with mood, energy, or cognitive changes, and no one has checked your B12, this is worth investigating. Not because I’m saying it’s definitely the problem, but because if it is the problem, it’s so easily addressed.

Don’t accept vague reassurance that “everything’s fine” if you don’t feel fine. Don’t let anyone convince you that fatigue and brain fog are just inevitable parts of aging. They’re not. They’re signals. And sometimes, those signals are pointing to something as straightforward as B12 deficiency.

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What I’ve Learned, and What I Want You to Know

After 15 years of working with women in this season of life, I’ve learned something important: Many of the things we assume are untreatable, or permanent, or “just how it is now,” actually aren’t. They’re symptoms pointing to something that can be addressed.

B12 deficiency is one of those things.

I’ve watched women feel their energy return. I’ve witnessed foggy thinking clear. I’ve seen mood shift from heavy to hopeful. I’ve observed a kind of relief wash over their faces when they realize they’re not losing their mind—they were just missing a crucial nutrient their brain desperately needed.

There is a quiet kind of power in taking this kind of charge of your own health. In asking the right questions. In insisting on investigation when something feels wrong. In refusing to accept “that’s just aging” as an answer when your body is clearly asking for more support.

So if this speaks to you, take the next step. Make an appointment. Ask for the test. Have the conversation.

Your brain, your energy, and your future self will thank you.

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Remember

It’s perfectly okay to feel confused about what’s happening with your health. It’s okay to insist on answers. And it’s perfectly okay to take charge of your own wellbeing, even if you’re not sure exactly what you’re looking for.

Sometimes the most important thing we can do is ask the question: “What if this could be different?”

And sometimes, the answer comes in the form of something as simple—and as transformative—as addressing a B12 deficiency.

Here’s to clarity, energy, and the possibility that what feels permanent might actually be changeable.

Warmly, Inge

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A Note on Medical Guidance

This article is educational in nature and should not replace a conversation with your healthcare provider. If you’re experiencing symptoms of B12 deficiency, or if you’re considering supplementation while taking medications, it’s important to consult with your doctor. B12 supplements can interact with certain medications, and your healthcare provider can help you determine the best approach for your specific situation.