8/9/2016 B12deficiency:asilentepidemicwithseriousconsequences

B12deficiency:asilentepidemicwithserious
consequences

Whatdoallofthesediseaseshaveincommon?

Alzheimers,dementia,cognitivedeclineandmemoryloss(collectivelyreferredtoasaging)
Multiplesclerosis(MS)andotherneurologicaldisorders
Mentalillness(depression,anxiety,bipolardisorder,psychosis)
Cardiovasculardisease
Learningordevelopmentaldisordersinkids
Autismspectrumdisorder
Autoimmunediseaseandimmunedysregulation
Cancer
Maleandfemaleinfertility

Answer:theycanallmimicthesignsandsymptomsofvitaminB12deficiency.

B12deficiency:aninvisibleepidemic

B12deficiencyisntabizarre,mysteriousdisease.Itswrittenaboutineverymedicaltextbookanditscauses
andeffectsarewellestablishedinthescientificliterature.

However,B12deficiencyisfarmorecommonthanmosthealthcarepractitionersandthegeneralpublic
realize.DatafromtheTuftsUniversityFraminghamOffspringStudysuggestthat40percentofpeople
betweentheagesof26and83haveplasmaB12levelsinthelownormalrangearangeatwhichmany
experienceneurologicalsymptoms.9percenthadoutrightdeficiency,and16percentexhibitednear
deficiency.MostsurprisingtotheresearcherswasthefactthatlowB12levelswereascommoninyounger
peopleastheywereintheelderly.

Thatsaid,B12deficiencyhasbeenestimatedtoaffectabout40%ofpeopleover60yearsofage.Its
entirelypossiblethatatleastsomeofthesymptomsweattributetonormalagingsuchasmemoryloss,
cognitivedecline,decreasedmobility,etc.areatleastinpartcausedbyB12deficiency.

WhyisB12deficiencysounderdiagnosed?

B12deficiencyisoftenmissedfortworeasons.First,itsnotroutinelytestedbymostphysicians.Second,

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8/9/2016 B12deficiency:asilentepidemicwithseriousconsequences

thelowendofthelaboratoryreferencerangeistoolow.Thisiswhymoststudiesunderestimatetruelevels
ofdeficiency.ManyB12deficientpeoplehavesocallednormallevelsofB12.

YetitiswellestablishedinthescientificliteraturethatpeoplewithB12levelsbetween200pg/mLand350
pg/mLlevelsconsiderednormalintheU.S.haveclearB12deficiencysymptoms.Expertswho
specializeinthediagnosisandtreatmentofB12deficiency,likeSallyPacholokR.N.andJefferyStewart
D.O.,suggesttreatingallpatientsthataresymptomaticandhaveB12levelslessthan450pg/mL.Theyalso
recommendtreatingpatientswithnormalB12,butelevatedurinarymethylmalonicacid(MMA),
homocysteineand/orholotranscobalamin(othermarkersofB12deficiency).

InJapanandEurope,thelowerlimitforB12isbetween500550pg/mL,thelevelassociatedwith
psychologicalandbehavioralmanifestationssuchascognitivedecline,dementiaandmemoryloss.Some
expertshavespeculatedthattheacceptanceofhigherlevelsasnormalinJapanandthewillingnesstotreat
levelsconsiderednormalintheU.S.explainthelowratesofAlzheimersanddementiainthatcountry.

WhatisvitaminB12andwhydoyouneedit?

VitaminB12workstogetherwithfolateinthesynthesisofDNAandredbloodcells.Itsalsoinvolvedinthe
productionofthemyelinsheatharoundthenerves,andtheconductionofnerveimpulses.Youcanthinkof
thebrainandthenervoussystemasabigtangleofwires.Myelinistheinsulationthatprotectsthosewires
andhelpsthemtoconductmessages.

SevereB12deficiencyinconditionslikeperniciousanemia(anautoimmuneconditionwherethebody
destroysintrinsicfactor,aproteinnecessaryfortheabsorptionofB12)usedtobefataluntilscientists
figuredoutdeathcouldbepreventedbyfeedingpatientsrawliver(whichcontainshighamountsofB12).But
anemiaisthefinalstageofB12deficiency.Longbeforeanemiasetsin,B12deficiencycausesseveralother
problems,includingfatigue,lethargy,weakness,memorylossandneurologicalandpsychiatricproblems.

B12deficiencyoccursinfourstages,beginningwithdecliningbloodlevelsofthevitamin(stageI),
progressingtolowcellularconcentrationsofthevitamin(stageII),anincreasedbloodlevelofhomocysteine
andadecreasedrateofDNAsynthesis(stageIII),andfinally,macrocyticanemia(stageIV).

WhyisB12deficiencysocommon?

TheabsorptionofB12iscomplexandinvolvesseveralstepseachofwhichcangowrong.CausesofB12
malabsorptioninclude:

intestinaldysbiosis
leakygutand/orgutinflammation
atrophicgastritsorhypochlorhydria(lowstomachacid)
perniciousanemia(autoimmunecondition)
medications(especiallyPPIsandotheracidsuppressingdrugs)
alcohol
exposuretonitrousoxide(duringsurgeryorrecreationaluse)

ThisexplainswhyB12deficiencycanoccureveninpeopleeatinglargeamountsofB12containinganimal
products.Infact,manyofmypatientsthatareB12deficientarefollowingaPaleodietwheretheyeatmeat
23timesaday.

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Ingeneral,thefollowinggroupsareatgreatestriskforB12deficiency:

vegetariansandvegans
peopleaged60orover
peoplewhoregularlyusePPIsoracidsuppressingdrugs
peopleondiabetesdrugslikemetformin
peoplewithCrohnsdisease,ulcerativecolitis,celiacorIBS
womenwithahistoryofinfertilityandmiscarriage

Notetovegetariansandvegans:B12isfoundONLYinanimalproducts

B12istheonlyvitaminthatcontainsatraceelement(cobalt),whichiswhyitscalledcobalamin.Cobalamin
isproducedinthegutofanimals.Itstheonlyvitaminwecantobtainfromplantsorsunlight.Plantsdont
needB12sotheydontstoreit.

AcommonmythamongstvegetariansandvegansisthatitspossibletogetB12fromplantsourceslike
seaweed,fermentedsoy,spirulinaandbrewersyeast.ButplantfoodssaidtocontainB12actuallycontain
B12analogscalledcobamidesthatblockintakeofandincreasetheneedfortrueB12.

Thisexplainswhystudiesconsistentlydemonstratethatupto50%oflongtermvegetariansand80%of
vegansaredeficientinB12.

TheeffectsofB12deficiencyonkidsareespeciallyalarming.Studieshaveshownthatkidsraiseduntilage
6onavegandietarestillB12deficientevenyearsaftertheystarteatingatleastsomeanimalproducts.In
onestudy,theresearchersfound:

asignificantassociationbetweencobalamin[b12]statusandperformanceontestsmeasuringfluid
intelligence,spatialabilityandshorttermmemorywithformerlyvegankidsscoringlowerthan
omnivorouskidsineachcase.

Thedeficitinfluidintelligenceisparticularlytroubling,theresearcherssaid,because:

itinvolvesreasoning,thecapacitytosolvecomplexproblems,abstractthinkingabilityandtheabilityto
learn.Anydefectinthisareamayhavefarreachingconsequencesforindividualfunctioning.

Irecognizethattherearemanyreasonswhypeoplechoosetoeatthewaytheydo,andIrespectpeoples
righttomaketheirownchoices.Ialsoknowthat,likeallparents,vegetariansandveganswantthebestfor
theirchildren.Thisiswhyitsabsolutelycrucialforthosethatabstainfromanimalproductstounderstand
thattherearenoplantsourcesofB12andthatallvegansandmostvegetariansshouldsupplementwith
B12.Thisisespeciallyimportantforvegetarianorveganchildrenorpregnantwomen,whoseneedforB12
isevengreaterthanadults.

TreatmentofB12deficiency

OneofthegreatesttragediesoftheB12epidemicisthatdiagnosisandtreatmentisrelativelyeasyand
cheapespeciallywhencomparedtotreatmentofthediseasesB12deficiencycancause.AB12testcan
beperformedbyanylaboratory,andshouldbecoveredbyinsurance.Ifyoudonthaveinsurance,youcan
orderityourselffromalablikeDirectLabs.comfor$60.

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8/9/2016 B12deficiency:asilentepidemicwithseriousconsequences

Asalways,adequatetreatmentdependsontheunderlyingmechanismcausingtheproblem.Peoplewith
perniciousanemiaorinflammatorygutdisorderslikeCrohnsdiseasearelikelytohaveimpairedabsorption
fortheirentirelives,andwilllikelyrequireB12injectionsindefinitely.Thismayalsobetrueforthosewith
severeB12deficiencycausingneurologicalsymptoms.

Somerecentstudieshavesuggestedthathighdoseoralornasaladministrationmaybeaseffectiveas
injectionsforthosewithB12malabsorptionproblems.However,mostB12expertsstillrecommendinjections
forpeoplewithperniciousanemiaandadvancedB12deficiencyinvolvingneurologicalsymptoms.

CyanaocobalaministhemostfrequentlyusedformofB12supplementationintheUS.Butrecentevidence
suggeststhathydroxycobalamin(frequentlyusedinEurope)issuperiortocyanocobalamin,and
methylcobalaminmaybesuperiortobothespeciallyforneurologicaldisease.

Japanesestudiesindicatethatmethylcobalaminisevenmoreeffectiveintreatingtheneurologicalsequelae
ofB12deficiency,andthatitmaybebetterabsorbedbecauseitbypassesseveralpotentialproblemsinthe
B12absorptioncycle.Ontopofthat,methylcobalaminprovidesthebodywithmethylgroupsthatplayan
roleinvariousbiologicalprocessesimportanttooverallhealth.

IfyoususpectyouhaveB12deficiency,thefirststepistogettested.Youneedanaccuratebaselinetowork
from.IfyouareB12deficient,thenextstepistoidentifythemechanismcausingthedeficiency.Thisis
somethingyoullprobablyneedhelpwithfromamedicalpractitioner.Oncethemechanismisidentified,the
appropriateform(injection,oral,sublingualornasal)ofsupplementation,thedoseandthelengthof
treatmentcanbeselected.

So,nexttimeyouorsomeoneyouknowishavingaseniormoment,remember:itmightnotbejustaging.
ItcouldbeB12deficiency.

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