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.

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

Reduce Sciatica Pain with Acupuncture

Multiple studies show acupuncture is more effective than medication for effective treatment of sciatica pain. Sciatica is most often caused by an acute injury to the intravertebral disc – the fatty pad between the vertebrae. Usually some nerve root compression happens as the disc pushes out of its natural canal onto the nerve roots that sits along the spine.

From a Chinese Medicine perspective, sciatica is a gallbladder meridian channel disorder. Pain may be considered a blockage of energy or blood flow, like a dam holding up water when it is meant to run down stream. When sciatica is treated with acupuncture on points along the gallbladder meridian, it will help the energy flow again by promoting qi and blood circulation. The addition of an infrared heat lamp on the area of the disc herniation will help promote healing by stimulating the cells beneath the surface of the skin.

A herniated disc will usually take up to six months to resolve, however the pain intensity may be managed and healing may be promoted using acupuncture. The results usually last 3-5 days after the treatment, so weekly to bi-weekly treatments are recommended. Typically 6-8 treatments will serve the healing process best, but relief may be experienced in as little as 1-3 sessions.

Acupuncture pain relief seems to be instigated by the stimulation of high-threshold, small-diameter nerves in the muscles. Animal experiments have revealed that regeneration of crushed sciatic nerves is better with acupuncture than diclofenac sodium (a type of pain medication).

Dr. Laura M. Brown, ND is licensed to provide acupuncture and has been trained in Traditional Chinese Medicine. Acupuncture therapy is part of her holistic care as a Naturopathic Doctor. A 30min initial intake at $80, followed by a package of 3 acupuncture treatments at $65 each will get you well on the way to living pain free while your herniated disc heals. Call today to book your evaluation and appointment. We can get started the same day if you mention the “sciatica” as your reason for calling.

Common symptoms of sciatica:

  • Sciatica usually affects only one side of the lower body.
  • Pain in the rear or leg that tends to be worse when sitting
  • Burning or tingling down the leg, past the knee
  • Weakness, numbness, or difficulty moving the leg or foot
  • A constant pain on one side of the rear
  • A shooting pain that makes it difficult to stand up
  • Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes

If you have issues with bowel or bladder control, progressive loss of strength in the lower body, or numbness in the upper thighs please seek emergency medical attention as you may have a life-threatening injury.

References:

Ji M., Wang X., Chen, M., Shen Y., Zhang X., and Yang J. 2015. The Efficacy of Acupuncture for the Treatment of Sciatica: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. Hindawi Publishing Corporation. Volume 2015, Article ID 192808, 12 pages. http://dx.doi.org/10.1155/2015/192808