No. of Recommendations: 8
I enjoyed everyone's responses to the Medical Mystery.

Here's the answer:

New York Times, March 1, 2013
Think Like a Doctor: The Wobble Solved!

Solve the mystery of a 56-year-old man who suddenly became too dizzy to walk....

The correct diagnosis is…

Vitamin B12 Deficiency

Vitamin B12 is necessary for every cell in the body, but a deficit of the vitamin usually shows up first in nerve cells or in red blood cells, or sometimes both. It is one of the most common nutritional deficiencies seen in the United States, but it is usually not caused by a lack of B12 in the diet. The vitamin is found naturally in eggs, milk and meat and is added to some cereals. While vegans who don’t eat these animal products are at risk for B12 deficiency, most people get plenty of B12 in their diets. However, for people with B12 deficiency, the issue typically is not a lack of B12 in the diet; it is a problem with absorbing the nutrient once it is in the body. ...

<snip lots of reasons>

No matter where the machinery breaks down, high doses of the vitamin can overcome it. Patients can flood their systems with B12 and, in most cases, all the problems caused by the deficiency will be reversed....
[end quote]

I thought this case would be interesting to METARs because age 56 is not very old (I sure don't consider myself "geriatric" at age 59) so some of us might be affected. Vitamin B12 deficiency is common and easy to reverse...if it's recognized.

Annu Rev Nutr. 1999;19:357-77.
Vitamin B12 deficiency in the elderly.
Baik HW, Russell RM.

Absorption of crystalline vitamin B12 does not decline with advancing age. However, compared with the younger population, absorption of protein-bound vitamin B12 is decreased in the elderly...

...elderly people should try to obtain their vitamin B12 from either supplements or fortified foods (e.g. fortified ready-to-eat breakfast cereals) to ensure adequate absorption from the gastrointestinal tract....
[end quote]

Since vitamin B-12 is found naturally in eggs, milk and meat, it's usually bound by proteins. The free vitamin has to be split away from the proteins, but that's the step that can decline with age and other conditions.

Bottom line: If you have any of the symptoms of B-12 deficiency, a quick experiment with supplementation is an inexpensive way to see if that's the problem.

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