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.

Do you need more vitamins?

What drug should you avoid taking with vitamin C? Why could your feet be tingling? Long term use of Metamucil make you deficient in a what B vitamin? Easy bruising and bleeding could be a sign of what vitamin deficiency?  What vitamin is made by bacteria?

This is Part 2 of 2 on vitamin deficiency. It covers information on vitamins B5, B6, B12, C, D,E, & K.

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Vitamin B5: Pantothenic acid (B5) is used in metabolic cycles is key to the body’s production of energy, cholesterol, heme and acetylcholine. Cholesterol is used as the back bone of many hormones. Heme is used to carry oxygen in your blood. Acetylcholine is controls involuntary functions mediated by the activity of smooth muscle fibers, cardiac muscle fibers, and glands.

Some body signals that you are low in B5: burning, numbness or tingling in the feet, muscle weakness, swollen tongue (glossitis), cracks at the corner of your mouth (chilosis), recurrent upper respiratory tract infections (colds), fatigue, postural hypotension, hypochlohydria, GERD/heartburn, and depression.

Sources of B5:  whole grains, broccoli, kale, cabbage family of vegetables, mushrooms, legumes & lentils, avocado, eggs, milk, poultry and organ meats.

Vitamin B6 (Pyridoxine/pyridoxyl/pyridoxamine) is involved in over 50 enzymatic reactions and potentially effects the function of cardiovascular, skin health, blood production, nerve function, healthy pregnancy, blood sugar regulation and cognitive function. Signs of deficiency include anxiety, depression, insomnia, irritability, confusion, abdominal pain, weakness, seizures, anemia, and poor immune function. There is even a rare form of B6 deficient epilepsy.

B6 requirements increase with diseases that affect absorption such as Celiac disease. The increased prevalence of hydrazine and hydrazide compounds as found in aerospace fuels, anti-toxicants in the petroleum industry, plating materials in metal manufacturing and ripening agents used on plants. B6-zapping hydrazine is also found in tobacco smoke, tartrazine (FD &C yellow food dyes). There are numerous drugs that deplete B6 and lead to common sides effects such as neuralgias, depression and anxiety.  Those with Parkinson’s disease should consult a medical expert before supplementing with B6 as it can interfere with L-dopa when taken without carbidopa.

Food sources of B6 include potatoes, bananas, meat, poultry, fish and whole grains.

Vitamin B12: Methyl or Hydroxyl cobalamin. Measured via B12 serum levels. Falsely elevated B12 levels may exist in those with renal failure or hepatitis. Those with vegan diets are at increased risk of deficiency as major food sources are animal based.

Pernicious anemia is the result of loss of intrinsic factor, a protein that is excreted by the stomach and helps B12 absorption in the small intestine. If the stomach has low acidity as in long term use of proton pump inhibitors (a lot of medications ending in “-prazole”, presence of H.pylori, aging or damaged parietal cells as in autoimmune disease, or the small intestine mucosa is damaged as in Celiac or Crohn’s disease, B12 absorption will be reduced. Additionally those on long term use of psyllium (Metamucil) will be at increased risk of B12 deficiency. Large amounts of orally dosed B12 may help compensate by allowing for absorption by diffusion. Intramuscular injection (IM) of B12 (available with Dr. Laura) by passing the need for intrinsic factor. IM or intravenous B12 is also more helpful than oral supplementation for those with a defect in the transportation system of B12 to the brain or a an accelerated breakdown of B12 in the brain tissue. Signs of B12 dependency are dementia, depression, headaches, insomnia or chronic fatigue.

Vitamin C (ascorbic acid) is important in immune function, collagen formation (for skin and connective tissue), neurotransmitter formation, plays a role in fighting viruses and bacteria and is a key anti-oxidant. Scurvy is the severe form of vitamin C deficiency. Fatigue, depression and anxiety of health are acute signs preceding the diagnosis of scurvy. Signs are bleeding abnormalities due to poor connective tissue formation and possible vitamin C deficiency include bleeding nose, easy bruising, bleeding gums, bone pain, osteoporosis, arthralgias (pain stiffness and joint swelling), myalgias (muscle aches and pains), edema (swelling), and symptoms of suggestive of cardiovascular disease or mimicking peripheral vasculitis, or venus thrombosis.

Dose limiting symptoms of vitamin C are diarrhea and cramping.  Vitamin C increases the absorption of non-heme iron this is good for those with low levels of iron/anemia. Vitamin C also seems to help the absorption of aluminum, which isn’t so good as it builds up in the bone, brain and liver and may contribute to the development of osteoporosis and Alzheimer’s disease. Avoid taking vitamin C at the same time as antacids, or aluminum hydroxide compounds. Chewable vitamin C may erode your dental enamel (it is an acid). Vitamin C supplementation can help or hinder the function of various medications; check with your medical practitioner for details.

Good sources of vitamin C include bell peppers, citrus fruits, cantaloupe, broccoli, Brussels sprouts, cauliflower, potatoes. Vitamin C is lost in high temperature and prolonged cooking.

 Vitamin D (cholecalciferol) The body makes vitamin D when the skin is exposed to sunshine or ultraviolet light. About 20 min of unprotected exposure mid day in the summer months in Ontario will produce about 1000IU of vitamin D. Small amounts may be found in food sources such as fish, egg yolk, beef liver, however, when sunlight is inadequate (no exposure or seasonal variance), supplementation is essential.

Vitamin D helps the body absorb calcium and phosphorous, builds bone mineral matrix, helps the nerves and muscles function, boosts the immune system, and modulates autoimmune diseases. When the supplemental D3 taken with K2, vitamin D helps get calcium out of the blood stream and into the bones. Vitamin D deficiency can be suspect in multiple sclerosis, cancer, pancreatic deficiency, Crohn’s, Colitis, fibromyalgia, chronic fatigue, chronic low back pain, or severe muscle weakness. You may purchase D3+K2 drops at Forward Health.

Vitamin E: There are 8 different kinds of vitamin E – each a different type of tocopherol. Vitamin E is known as an antioxidant and the most potent, bioavailable form is alpha-tocopherol. When supplementing it is best to have a mixed or blend of tocopherols. Vitamin E is also involved in anticoagulation (inhibits platelet aggregation), is anti-inflammatory and stabilizes the cell membrane. Those with fat malabsorption issues at risk for deficiency. Vitamin E is also depleted in those with a high consumption of fatty foods, as thermally oxidized vegetable oil depletes vitamin E status. Good food sources of vitamin E include almond oil, wheat germ oil, nuts and seeds, whole grains, egg yolks and leafy green vegetables.

Vitamin K: There are actually four different kinds of Vitamin K. Vitamin K1 is what is often tracked so closely for those on warfarin because warfarin is an anticoagulant and affects the INR – the measurement we use to factor coagulation, or thickening of blood. Vitamin K1 is found in lots of leafy greens. K1 is also given to newborns to help prevent hemorrhage; a newborns’ intestinal tract is not yet making its own Vitamin K. K2 is made by some bacteria in our gastrointestinal tract, and by bacteria in some foods, like brie cheese. K2 helps Vitamin D3 get Calcium into the bones, so is useful in those suffering with osteoporosis or steroid induced bone loss and also can help lower total cholesterol in people on kidney dialysis. K3 and K4 still have much research pending. Those with Celiac disease not on a gluten free diet, chemotherapy, anticonvulsants or antibiotics may be at risk of vitamin K depletion, most likely due to the disruption in the bacteria of the gastrointestinal tract.

Good food sources of Vitamin K include dark leafy greens and to maximize absorption are best eaten with a source of fat (butter, olive oil, coconut oil, avocados). Olive oil actually is a source of vitamin K1 so it’s on double duty! Cheese, especially brie, egg yolks and fermented soy beans (natto) are also sources of Vitamin K.

Again, emphasize a diet with a full variety of  fresh wholesome foods, rather than supplementation. There are cases however where supplementation for the short term, and sometimes even the long term, is necessary for optimum health status. A naturopathic doctor has the training and resources to help you decide what is best for your individual requirements.

Dr. Laura M. Brown, ND

Source:

Gaby, A. (2011) Nutritional Medicine. Fritz Perlberg Publishing. Concord, NH.

Vitamins: Could you be deficient?

Habitual eating habits that lack variety, medications or certain medical conditions  put us at risk for nutrient deficiency. A medical expert review of your current health condition, medications and diet diary is key to screening and finding potential changes that could be a substantial difference in your health and well being. This short review may provide some reminders and insight. Daily requirements for any vitamin vary on age, gender and current system demands. Some supplementation of one vitamin can mask a deficiency of another.

This and more will be covered in Dr. Laura M. Brown’s next complimentary talk entitled Food or Mood at Goodness Me! in Guelph on January 13th, 6:30pm. Register here.

Part 1 of 2:

Part 1: Vitamin A, B1, B2, B3 and Folic Acid

Vitamin A: Conditions that may be associated with Vitamin A deficiency include hypothyroidism (thyroid plays a role in converting beta carotene from our diet to vitamin A), liver disease, alcoholism, gastric or intestinal surgery, intestinal parasites, other gastrointestinal disturbances that cause malabsorption like Celiac, Crohn’s or food sensitivities. Increased levels of inflammation in the body will also decrease your vitamin A status.

Often you can tell if you are deficient if you have mild follicular hyperkeratosis – often felt at the back of the upper arms as you run your hands along, skin has multiple little bumps or feels rough to the touch. Night blindness can also be from Vitamin A deficiency but this can also be from a Zinc deficiency. Vitamin A is best absorbed from your diet and is found in foods like liver, fish liver oils, dairy, eggs. Foods that are high in beta carotene that your body converts to vitamin A are carrots, spinach, kale, cantaloupe and other fruits and vegetables. Women who are pregnant or are capable of becoming pregnant and smokers should never supplement with vitamin A. Vitamin A can put the baby at risk for birth defects and has been linked to increased risk of lung cancer in smokers.

Vitamin B1: Thiamine Conditions associated with psychiatric conditions, aging or insomnia can often be helped with supplementation. A diet low in thiamine can lead to deficiency is as little as 4-5 days. Other triggers can include pregnant women with severe morning sickness including multiple bouts of vomiting, alcoholism, thyrotoxicosis, and major surgery.

Thiamine deficiency is known as “beriberi”. Signs of mild deficiency include fatigue, insomnia, loss of appetite, vague headaches, pain, and difficulty with mental concentration and memory. Some people also experience weakness, weight loss, peripheral neuropathy, edema, tachycardia. Deficiency can also contribute to congestive heart failure. Severe deficiency is known as Wernicke’s encephalopathy in the early stages and Wernicke-Korsakoff syndrome in the later stages. Early signs include psychiatric disturbances, ataxia, ocular palsy, nystigmus. Later stages progress to a chronic neuropathic/psychiatric condition.

Good food sources of B1 include whole grains, legumes, nuts, meat, and enriched flour products.

B2: Riboflavin. B2 is important for helping convert B6 to its active form and is active in homocysteine metabolism, something that is important to cardiovascular /cholesterol health. B2 is also used to help prevent or treat migraines, Parkinson’s disease, psoriasis and some myopathies (muscle pain).

Indications that you may be deficient in vitamin B2 include cracks at the corners of your mouth, swollen tongue, changes in personality, anemia, weakness, depression, seborrheic dermatitis (moist, oily flaky skin condition – cradle cap in newborns and psoriasis/eczema mocking skin reaction in adults aged 30-60), excessive tears, inflammation of the clear membrane that lines your eye (results in vision distortion). Good food sources include meat, dairy, eggs, legumes, fish, poultry, green leafy vegetables, fruits, and whole grains.

Vitamin B3: Niacin B3 is critical in supporting health as it relates to cardiovascular, dermatological, hearing, taste, balance, Alzheimer’s, anxiety, ADHD, dementia, schizophrenia, sleep, osteoarthritis, trigeminal neuralgia, diabetes and alcohol addiction.

Classic deficiency is known as pellagra – the “three d’s”: diarrhea, dementia, dermatitis and sometimes the fourth D…. death.

Early signs that you may be deficient include nervousness, headaches, forgetfulness, apprehension and/or gastrointestinal disturbances.

Food sources include meat, chicken, fish, whole grains, legumes and dairy products.

Folic Acid: Known as folate in foods, folic acid in supplements. Folic acid is key to the intrauterine development of the spinal cord. It is also involved in cardiovascular health, dermatological and neurological conditions, psychiatric many other conditions within the body as it is a key methylator to many biochemical transactions.

As adults, folic acids needs stomach acid to help absorb, so if H.pylori present or on a proton pump inhibitor you may be at risk for deficiency. However people with low stomach acid are also at risk for overgrowth of bacteria in small intestine, and these bacteria can make folic acid – so deficiency is not eminent. If you are supplementing with high doses of B12, you may not be able to tell if you have a folic acid deficiency as they present as one in the same – megaloblastic anemia. Other symptoms can be vague or similar to other B vitamin deficiencies: depression, anxiety, headache, fatigue, apathy, confusion, dementia, polyneuropathy, cracks at the corners of your mouth, swollen tongue, brownish pigmented skin, low muscle tone in babies, poor immune response. This is just one of many reasons why it is always advised to seek a medical expert opinion on your supplement regime.

 

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

 

Source:

Gaby, A. (2011) Nutritional Medicine. Fritz Perlberg Publishing. Concord, NH.