Dr. Laura: Is it aging or low B12?

B12 deficiency has been estimated to affect about 40% of people over 60 years of age, and about 40% of the general population are on the lower end of normal.

Vitamin B12 deficiency can look like the signs and symptoms of diseases that are commonly associated with aging such as Alzheimer’s, dementia, cognitive disorders, multiple sclerosis, Parkinson’s, and other neurological problems; depression and anxiety; cardiovascular disease; cancer; and low libido. If someone you love has these symptoms, best to get there B12 levels checked and supplement if help reduce the symptoms.

Supplementing with an active form of B12 can help reduce inflammation, which has improved symptoms of arthritis and eczema.

Vitamin B12 works with folate to make DNA, red blood cells and the insulating sheath around the nerves to help with nerve signalling. This is why when I inject B12, I always include folate with it.

Causes/Risks of B12 deficiency

  • Vegan/vegetarianism
  • Intestinal malabsorption due to low stomach acid
  • Celiac disease
  • Crohn’s disease
  • Pernicious anemia (an autoimmune condition affecting our ability to absorb B12)
  •  Atrophic gastritis (usually H. pylori infection in the elderly)
  • Long term use of Proton Pump Inhibitors (PPI’s)
  • People on Metformin therapy

If someone you know or love fall into any of these categories, best they get tested even if they don’t have symptoms, as deficiency can start before the symptoms show up.

Symptoms of B12 Deficiency

  • not much if  it’s mild
  • weakness
  • fatigue
  • strange sensations
  • numbness, or tingling in hands, legs, or feet
  • difficulty walking such as staggering or balance problems
  • anemia
  • a swollen, inflamed tongue
  • yellow skin
  • jaundice
  • difficulty thinking and reasoning
  • memory loss
  • paranoia or hallucinations

Testing for B12

It is easy to run a B12 test, however there are other blood and urine markers that can provide a more complete picture, such as methylmalonic acid (MMA) and homocysteine. Homocysteine may be more sensitive and accurate for detecting the early stages of B12 deficiency. When I run tests, I look at things from a functional medicine perspective and this may involve the more complete profile.

If there is an absorption issue suspected, we need to identify and correct that, if possible. Further testing and treatment may be required to do that.

The results of the tests are also interpreted differently when you come to see me. I look at things from a functional range – your optimum level of performance- not the point at which you have disease. The conventional medical system in North America regard a low B12 to be below 200 pg/mL. This is the point where irreversible neurological damage can happen. I prefer to go at the guidelines set out by Europe and Japan – somewhere over 550 pg/mL.

Supplementing

Best to get B12 from animal based sources – strongest providers are the organ meats (liver, kidney) and seafood like oysters and clams. To get ahead quickly or to supplement a vegan or vegetarian diet, you will need activated B12, so hydroxy or methyl based cobalamin are the best. If there is intestinal absorption issues, then you’ll need a pill to dissolve under the tongue or an injection to provide the boost. What I carry in the clinic is an activated form of B12/B complex so it absorbs easily and we see good results on the before and after blood work, or we can go for the injection – usually weekly for a month and then once a month for a few months. Then we re-test.

 

Dr. Laura M. Brown ND is a Naturopathic Doctor with a Functional Medicine approach. She is a Certified Gluten Practitioner, A HeartMath Certified Practitioner and is engaged in ongoing education with the Kresser Institute of Functional Medicine.

Dr. Laura: Surprising Number of Conditions Linked to Celiac Disease

I just received this post… hot off the press from the World Congress of Gastroenterology. We learn about all the conditions that are linked to Celiac disease. This means if you have migraines or anxiety attacks, more people with Celiac have them than not. Or, if you have a specific type of rash called dermatitis herpatiformis, you are pretty well guaranteed to have celiac. Have a look at the chart below and see if you have any of the following conditions and then look at the odds ratio that you may have Celiac Disease.

Celiac disease is an autoimmune condition related to the ingestion of gluten, or wheat. Wheat has over 100 proteins in it and gluten and gliadin are just two of these proteins. Your body can launch an immune attack to any of these proteins, then these could cross react with tissues in your body including your brain, liver, pancreas, skin muscles, or as in Celiac, your small intestinal villi. If your villi are damaged, then you are not absorbing vitamins, minerals and nutrients. So this can additionally lead to things like B12 deficiency (depression, brain fog, neuropathy) iron deficiency (dizzy, weak, pale), or osteoporosis.

Conventional medical testing will look at 2 markers for these proteins immune reactions. Functional Medical tests that I run will cover 24 markers, including these 2 from conventional means. You have to pay for both tests out of pocket, so I figure you may as well run the more complete test to get the bigger picture of what’s going on in your body. The broader testing means we can catch wheat related diseases – non-celiac gluten related disorders like cerebellar ataxia (problems with balance and walking) or wheat addiction (it’s like opioid addiction!) or tell it if is reacting with you muscles (polymyalgia?) or skin.

Table 1. Prevalence of Diagnoses in People With and Without Celiac Disease (P < .0001 for All)

Diagnosis With Celiac Disease, % Without Celiac Disease, % Odds Ratio
Migraine 18.6 4.1 5.5
Anxiety disorder 25.9 8.7 4.0
Arthritis 28.9 8.4 4.9
Dermatitis herpetiformis 1.3 0.0 4563.5
Liver disease 23.2 4.2 7.1
Gastroesophageal reflux disease 36.8 13.0 4.5
Eosinophilic esophagitis 0.6 0.1 8.8
Atrophic gastritis 3.9 0.1 8.0
Glossitis 0.4 0.1 4.4
Pancreatitis 15.8 0.7 25.0
Disorder of the pancreas 17.2 1.1 19.0
Cerebellar ataxia 0.1 0.0 4.1
Autism 4.0 0.2 19.9
Colitis 25.9 4.2 8.4
Turner syndrome 0.1 0 17.8
Down syndrome 0.6 0.1 8.1
Common variable immunodeficiency 0.2 0.0 10.2

New! B12 injections & more

B12 intramuscular injections are useful for those deficient in B12, pernicious anemia, fighting depression, stress or fatigue, diabetic neuropathy, chemotherapy induced neuropathy, herpes zoster (including prevention and treatment of shingles).

Book your Appointment Now

Existing patients:

Injection B12 1000ug + 1mg Folic Acid = $16.00b12folic
Injection B12 5000ug + 1mg Folic Acid = $18.00
You could be at risk for B12 deficiency if you are taking the following medications: Metformin, H2 blockers (Pepcid, Zantac), Proton Pump Inhibitors (PPI’s) (Nexium, Prevacid, Losec, Tecta, Pantoloc, Pariet, Dexilant) , Phenytoin, also long term use of Oral Contraceptives or Aspirin. Excessive alcoholic intake longer than 2 weeks, inflammatory bowel disease, Celiac disease,  gastric or small intestinal resection, prolonged vegan diet, no meat, poultry or dairy product consumption, age over 75 years. Long term supplementation of Folic Acid.

Signs of B12 deficiency: Unexplained neurologic symptoms like paresthesias, numbness, poor motor coordination, memory lapses or cognitive and personality changes.

B12 status is measured through a Complete Blood Count (CBC), blood analysis and Serum B12 (cobalamin), and folate. Related tests include Complete Blood Count, Methylmalonic Acid, Homocysteine, B Vitamins, Intrinsic Factor Antibody, Parietal Cell Antibody, Reticulocyte Count, Blood Smear. It is a good idea to get tested when you have symptoms of anemia such as weakness, tiredness, pale skin and/or tingling or itching sensations, eye twitching, memory loss, altered mental status which are signs of neuropathy. It is useful to have a baseline status before supplementation so you can monitor treatment effectiveness when if you have vitamin B12 or folate deficiency. Ask about costs of testing.

Why is folic acid included?  It helps B12 get into the red blood cell.

Naturally occurring Folic Acid, known as folate,  is found in leafy green vegetables, citrus fruits, dry beans and peas, liver, and yeast. Vitamin B12 is found in foods from animals, such as red meat, fish, poultry, milk, yogurt, and eggs.  Dietary sources of B12 and folate also include fortified cereals, breads, and other grain products.

What else is new?

2) New naturopathic service – Ear lavage – for those with a lot of ear cerumen (wax)  a naturopathic protocol involves home treatments then an in-office ear wash. This will be assumed as part of the appointment fee, however please note we can do this! Some ear cerumen is healthy, but too much or a blockage can impact hearing and can be uncomfortable.

Also a reminder that these services are available to patients:
a) Laboratory analysis pay for service – many of the same lab tests requested by your family doctor may be ordered through Dr. Laura M. Brown, ND, just know you have to pay out of pocket. I cannot post a price list but can provide pricing on an individualized, as needed basis.

b) Urinalysis $3 -additional to appointment fee Naturopathic medicine has great choices for relieving chronic cystitis and acute or persistent urinary tract infections. We also are trained to know when to get the patient to their MD for antibiotics.

c) Strep Throat Swab – $7 fee additional to appointment fee. Rapid Strep Test – the same one your family doc will do, just added convenience of getting some great advice and prescription for natural medicine and antimicrobials, if it turns out you don’t need mainstream antibiotics.

From the heart and mind of your local naturopathic doctor, Dr. Laura M. Brown , ND