The gut-brain-heart connection

We have seen how the health of the microbiome is essential for digestion, absorption and immunity. Of great importance also is how the health of our good bacteria works to help us handle stress. Because stress can affect our heart directly, I would like to call it the ‘gut-brain-heart connection’. Here we will look at how this universe of bacteria living in our gut can affect how neurotransmitters are manufactured in the body. We will also look at how we can improve this connection using herbs, like the ones in the ‘Healthy Hearts Club’ products.

The microbiome and GABA

According to Dr. Jockers, our gut microbiome plays an important role in the production of the inhibitory and brain relaxing neurotransmitter GABA (Gamma-AminoButyric Acid): “There is a growing body of research linking the gut microbiome to neurological health. Research has shown that breakdown of the intestinal lining along with low levels of good microbial inhabitants such as lactobacillus and Bifidobacterium are linked with lower GABA levels, increased brain excitability and neurological inflammation. These microbes are essential for B 6 absorption and activation, which is the critical cofactor in the conversion from the excitatory neurotransmitter glutamate into GABA. Without adequate activated B 6, we end up with glutamate excitotoxicity and increased risk of anxiety, seizures, depression, dementia and Alzheimer’s.”

According to his research, the way this chained-conversion process happens is as follows:

The amino acid L-glutamine, the most abundant amino acid in the body, is first converted to glutamic acid or glutamate. Glutamate is then converted to GABA by means of the activated form of vitamin B 6 (pyridoxal-5-phosphate, or P5P). It is the good bacteria that activate B 6.

Additionally, other amino acids and minerals help in the GABA conversion process. The amino acid taurine increases the communication and productivity of P5P and promotes the production of GABA. There are studies that have shown that a deficiency of taurine can result in anxiety. Zinc also enhances the release of GABA by working to help activate P5P. Both B 6 and zinc are also essential to the production and utilization of other neurotransmitters such as serotonin, dopamine, norepinephrine, epinephrine and histamine. In addition, magnesium is important for binding and activating GABA receptors. Without adequate magnesium, we are unable to effectively activate GABA receptors and utilize GABA effectively. Magnesium deficiency is extremely common with over 80% of women and 70% of men suffering with this and thus supplementation for most will dramatically impact GABA activity.

GABA also converts serotonin into N-Acetylserotonin which is then turned into the sleep hormone melatonin, which also plays a huge role in the body’s immune function.

Because of the relaxing effects of GABA, it makes sense, in my opinion, to improve our gut-brain connection for better heart health, specially as there are many factors that compromise our GABA production.

Factors that lower GABA

According to Dr. Jockers, there are many factors that lower GABA production in the body. Among some of the most significant we can find:

Stress: “Chronic stress will increase the levels of cortisol, norepinephrine and epinephrine in the brain and body. This also shunts the body into producing more excitatory glutamate and reduces GABA production. Too much glutamate in the brain causes over-excitation of the brain cells. In addition, the increase in stress hormones ramps up cellular activity and causes excessive production of free radicals which damage brain cells and further reduce normal GABA production. Overtime, when an individual is in a long-term, highly stressful condition, they rewire their brain cells and have a functional deficit in GABA production.”

Lack of sleep: “Lack of quality sleep is a chronic stressor on the body and increases stress hormone production…several poor nights of sleep in a row can lead to… a deficit in GABA production.”

Poor blood sugar control: It is not only a stressor for the heart as we have seen, but it is also according to Dr. Jockers “a significant stressor in the brain and disrupts the Blood Brain Barrier, which is designed to protect the brain from oxidative stress, infectious microbes, toxic debris and chronic inflammation. Hypoglycemia, or low blood sugar, causes a partial starvation of the brain tissue, which increases stress hormones and opens up the BBB for more nutrients to cross over. This also allows more toxins and free radicals to effect brain tissue causing elevated stress hormones and glutamate release. Additionally, high blood sugar causes insulin resistance in the brain and a functional starvation where there is enough glucose but we cannot get it into the brain to be used. In this case, it leads to opening the BBB and excessive oxidative damage to the brain with elevated stress hormones and glutamate release.” (1)

Making enough GABA 

Dr. Jockers recommends several ways to improve the production of GABA. First of all, he recommends to improve the Microbiome by consuming fermented foods, anti-microbial and carminative herbs such as garlic, onions, cayenne, oregano, basil, thyme, peppermint, ginger, etc. to help improve the overall constitution of the gut microbes.

He explains that carminative herbs can act as a bowel cleanser in different ways:

By stimulating bile flow and thereby improving fat digestion: Compounds within the oils are broken down which promote the movement of bile substances such as bile salts to move from the liver, into the bile duct, and then into the intestines. What material is not excreted as feces will be recycled.

By reducing surface tension within the intestines: Oxygenated compounds in the herbs, like terpenes, increase in activity and small water bubbles are combined to form larger water droplets. Naturally, this also decreases abdominal pain.

Exhibiting an anti-foaming action: Compounds in these herbs lower the content of CO 2 bubbles created by gut bacteria by binding smaller bubbles together into larger bubbles. These gas pockets are then expelled more readily from the intestines reducing gas discomfort.

Therapeutic Uses of Carminatives

According to Dr. Jockers carminative herbs display various chemical profiles that are used to treat an array of digestive discomfort:

Antimicrobial: Many of the herbs are characterized by antimicrobial properties can heal the gut microflora and destroy harmful bacteria.

Irritable Bowel Syndrome: “Clinical studies have shown that oils extracted from these herbs can treat symptoms of IBS. Peppermint oil in particular releases a strong menthol odor which significantly can increase gastric flow and prevent against stagnation associated with constipation.”

Relieves Symptoms of Nausea: Carminative herbs have been shown to treat nausea resulting from both motion and morning sickness. Some of these types of herbs are anise seed, ginger, cardamom and peppermint.

Reduce Need for Medication: “Extraction methods using a steam distillation process allows some of these carminative herbs to have very strong volatile oils. One study showed that essential oil blends of ginger, peppermint, and cardamom have the potential to treat conditions aromatically. Patients in this study who inhaled the oil blends felt less need to consume medicine prescribed to treat symptoms of nausea following an operation.”

Treat pain from cramping and gas: Spices like cardamom and peppermint can effective numb the stomach and intestinal nerves which lead to pain from cramping and gas.

Diuretic: Sweet fennel is a great source of trace elements and a source for calcium and magnesium essential for overall health and development. This herb functions as a diuretic and is effective and safe in children and pregnant women. (2)

Ginger Enhances Digestion

According to Dr. Jockers, apart from all these benefits, ginger in particular has special digestive properties that are worth taking into account. Ginger is considered a superfood because it has “a unique concentration of nutrients that synergize together to boost potential.”, including “critical fatty acids, anti-oxidant phytonutrients and essential amino acids.” Almost every culture has historically used it for its powerful ability to enhance immunity, improve digestion and reduce inflammation.

Ginger “is 13th on the anti-oxidant list boasting an impressive ORAC score of 28,811. Ginger is composed of several volatile oils that give it it’s characteristic flavor and odor; zingerone, shogaols, & gingerols. These oils are powerful anti-bacterial, anti-viral, anti-fungal, anti-parasitic agents. In addition, it inhibits cancer cell formation while firing up our body’s own inborn ability to destroy the cancer cells formerly present.”

In addition, Dr. Jockers asserts that ginger “has classically been used to improve the digestive process. Nine different substances have been found that stimulate serotonin receptors in the gut which provides benefits to the gastrointestinal system. This reduces gut related inflammation and enhances nutrient absorption. Ginger is classified as a carminative (reducing intestinal gas) and an intestinal spasmolytic (soothes intestinal tract) while inducing gut motility. Ginger is known to reduce fever related nausea, motion sickness… Additionally, it helps aid in the production of bile, making it particularly helpful in digesting fats.”

Ginger helps stimulate digestive juices such as hydrochloric acid from the stomach and bile from the liver and gall bladder. This is why it is good to have ginger on or with your largest meals of the day.

Ginger Provides Pain Relief

According to Dr. Jockers “Ginger is also an important part of a de-inflaming, natural pain-relief program. One compound called 6-gingerol has been shown to significantly inhibit the production of a highly reactive nitrogen molecule, nitric oxide, that quickly forms a dangerous free radical peroxynitrite”. Additionally, ginger helps to protect the bodies stores of glutathione (the super anti-oxidant and free radical destroyer). Due to its effect on glutathione and nitric oxide, ginger has been shown to protect the brain and nervous system from degenerative stress. Ginger is also very high in potassium which aids in electrical energy production and detoxification. It is a great source of manganese which protects the lining of the heart blood vessels and urinary tract. Ginger contains silicon which enhances skin, hair, teeth & nails. It helps assimilate calcium and reduces inflammation in the bone tissue aiding the development of strong bones and teeth.”

Dr. Jockers recommends to use ginger on a regular basis in teas, fresh or in detox products that have ginger as part of a liver detoxification, a digestive program and other excellent health benefits. (3)

Similarly, microbiologist and scientist Karina Pokusaeva, Ph D, in her article ‘Probiotics vs antibiotics or prevention vs treatment’ suggests to use garlic as a pre-biotic to ‘promote growth of good bacteria in (y)our gut’ (4)

How our products can help

The products from ‘Healthy Hearts Club’ are a wonderful combination of herbs that work together to help with digestion, detoxification and the immune system. The ‘Gland Extract’ , for example, contains papaya that helps digestion and cayenne. Cayenne has been found to “increase metabolism, peristalsis and digestion while helping with the breakdown of carbohydrates and fats. Cayenne may be beneficial where there is a lack of function in the stomach or the intestines with poor appetite and weak digestion. As a carminative, Cayenne may be beneficial in helping to relieve gas and bloating or cramping of the stomach and bowels.” (5)

It also contains red clover, which is a great blood purifier. The ‘Female Balance Extract’ contains B vitamins which provide nutrition and build the immune system. The ‘Gentleman Extract’ also contains cayenne. The “Ginseng Extract’ contains echinacia to strengthen the immune system, red clover, Oregon grape and burdock root that purify the blood. The ‘Heart and Body Extract’ contains garlic, ginger and cayenne, making it a great product not only for the heart but for digestion as well as we have seen.

In conclusion, our digestive system is the cradle of our immunity. Not only it allows us to obtain nutrients from our food, but it also hosts the microbiome, the workers that protect us from disease.

Thank you for reading.

References:

(1) http://drjockers.com/is-your-brain-making-enough-gaba/

(2) http://drjockers.com/7-reasons-to-use-carminative-herbs/

(3) http://drjockers.com/10-ways-ginger-enhances-digestion/

(4) https://mygutmatters.com/2016/08/06/probiotics-vs-antibiotics-or-prevention-vs-treatment/

(5) https://thefamilyherbalist.wordpress.com/2014/03/04/the-power-of-cayenne/

Our immune system: the body’s healing and defense mechanism

Good digestion is an essential part of heart health, it helps us absorb nutrients that are important for our heart. If you are using the products from the ‘Healthy Hearts Club’, you may have noticed that they go right to work without requiring much digestion. This is important since digestive disorders and compromised immunity are becoming an increasing health challenge. In particular, it is the health of the universe of bacteria that live in our gut, known as microbiome, that is essential for digestion, absorption of nutrients and immunity. Healthy gut flora digests protein, ferments carbs, breaks down lipids and fiber. On the other hand, unhealthy gut flora compromises digestion, immunity and determines our food choices. If you think you are in control when it comes to food, it may surprise you to learn that the bacteria that live in your gut is choosing your menu for you.

In a recent article from the New York Times titled ‘Educate your immune system’ the author, Moises Velasquez-Manoff, asserts: “In the last half-century, the prevalence of autoimmune diseases — disorders in which the immune system attacks healthy tissue in the body — has increased sharply in the developed world. An estimated one in 13 Americans has one of these often debilitating, generally lifelong conditions….Many researchers are interested in how the human microbiome — the community of microbes that live mostly in the gut and are thought to calibrate our immune systems — may have contributed to the rise of these disorders.” The author quotes a study done by a team of scientists who began following 33 newborns genetically at risk of developing Type 1 diabetes, a condition in which the immune system destroys the insulin-producing cells of the pancreas. “After three years, four of the children developed the condition. The scientists had periodically sampled the children’s microbes, and when they looked back at this record, they discovered that the microbiome of children who developed the disease changed in predictable ways nearly a year before the disease appeared. Diversity had declined and inflammatory microbes bloomed.” (1)

This very interesting research points the role the microbiome has in our health, and confirms what Dr. Natasha Campbell-McBride concludes with her research: “We carry most of our future health problems right in our gut from birth”. Her work as a neurologist and nutritionist proves that it is the universe of bacteria that live in our gut that comprises our immune system almost in its entirety. According to her, the microbiome makes up 90% of who we are and it is the health of these bacteria that determine our immunity.

Do you experience uncontrollable cravings for some not so healthy foods? Or do you feel rapid heartbeat after eating certain foods? It might be that your gut bacteria is out of balance. How would you like to supercharge your heart health by improving your immunity? In what follows we will focus on the latest research on gut health as explained by Dr. Natasha Campbell-McBride MD, MMedSci (neurology), MMedSci (nutrition). In the revised and expanded edition of her classic book ‘Gut and Psychology Syndrome’ she shares her knowledge about what we could consider the foundation of our health, the gut. After her son was diagnosed with autism, and not being able to find answers in her field of expertise, neurology, she decided to continue her education in human nutrition. This is when she learned how several factors have contributed to the decline of immune health in the general population.

Where does our immune system start?

According to Dr. Natasha it all starts at the moment of birth. As a baby passes through the birth canal, his skin, eyes, mucous membranes in the mouth and nose acquire their first micro-flora from the mother’s gut (mainly the lactobacillus, lactobacillus acidophilus, lactobacillus casei and lactobacillus fermentum). Since a baby is born with an immature immune system, this is crucial for the child’s immunity. This, together with breast milk provides the child with the immunity needed for the rest of his life. As the baby is breast fed, his digestive tract is populated with healthy bacterial flora from the mother. This plays a crucial role in the maturation of their immune system to such extent that if this doesn’t happen in the first twenty days after being born, the baby will be left immune-compromised for life according to Dr. Natasha.

This is how our immune system is supposed to become strong from birth. However, in her research she has found that in just the last few generations the health of our gut bacteria has been dramatically affected, causing an alarming increase in the cases of autism, learning and behavioral disorders in children and adults as well as psychiatric conditions, due to what she calls ‘the gut-brain connection’. In particular, the last few generations of women have experienced a greatly altered microbiome due to several factors. This change in the mothers’ gut bacteria has had a cumulative effect resulting in the current generation of women with a high percentage of pathogenic bacteria in the gut. Children born to these women have acquired the pathogenic bacteria present in the mother. This is in her opinion what explains the alarming increase in the cases of autism in the last decades that have gone from 1 in every 10,000 kids a few years ago to 1 in every 150 kids, both in the UK and the USA. In her clinic, where she treats these children she often finds other symptoms overlap with autism: ADHD/ADD, dyslexia, dyspraxia, behavioral and learning problems, allergies, asthma, eczema. All of these are also reaching epidemic proportions. What do all these conditions have in common? According to her research, the health of the gut. It is possible, according to her, to turn each of these conditions around by detoxifying the child’s gut and allowing it to heal. In her clinic she has seen autistic kids start talking for the first time after a course of colonics. She coined the term ‘GAPS’ to refer to her patients, which stands for ‘Gut And Psychology Syndrome’ and which we will use here often.

What factors have contributed to the decline in our beneficial bacteria?

In the world we live in, it is almost impossible to keep our gut flora healthy. We all face attacks on our gut flora on a daily basis:

1. Antibiotics: Probably one of the most commonly prescribed medications in our modern world. We are exposed to them not only through medication but also through foods. Farm animals and poultry, farmed fish and shellfish  are routinely given antibiotics so we get them when we eat these animals, plus the antibiotic resistant bacteria these animals produce in their bodies and the toxins these bacteria produce.

Research on antibiotics shows evidence that:

They have a devastating effect on human gut flora, as well as other organs.

Antibiotics change bacteria, viruses and fungi, from beneficial to pathogenic giving them the opportunity to invade organs and cause disease.

They make bacteria resistant to antibiotics. This translates into stronger antibiotics being needed and a new resistance to the these antibiotics.

Antibiotics have a direct damaging effect on the immune system, making us more vulnerable to infections, all of which leads to a vicious cycle.

What antibiotics do to the gut

When antibiotics are used on a high dose, they leave the gut with a lot of empty nitches to be populated by whatever bacteria, viruses or fungi get there first. This is a crucial time to administer a good probiotic to make sure that these niches get populated by friendly bacteria instead of pathogenic ones. Even when antibiotics are used for a short time and at a low dose it takes beneficial bacteria in the gut a long time to recover. E.coli takes 1-2 weeks, bifidobacteria and veillonelli 2-3 weeks, bacteroids and peptostreptococci 1 month. If in this period gut flora is subjected to another damaging factor gut dysbiosis may well start in earnest. Antibiotics have a deeper negative impact in children, breast feeding babies can get them through the breast milk if the mother is taking them. Combinations of antibiotic have stronger damaging effects on the gut flora than single drugs. Damage is worse when administered orally and for a long time on a low dose like the ones for acne or chronic conditions.

Among the most problematic we can find:

Penicillins: and all the ones that end with ‘cillin”. These damage two strains of good bacteria, the lactobacilli and bifidobacteria and allow the growth of the pathogenic proteus family, streptococci and staphylococci. These antibiotics allow bacteria only found in the bowel to move up the intestines, which predisposes the person for IBS (irritable bowel syndrome) and other digestive problems.

Tetracyclines: and all the ones ending in ‘cyclines’, usually prescribed for acne. They have a toxic effect on the gut wall by altering protein structure in many membranes. This does two things: makes the gut vulnerable to invasion by pathogenic microbes and alerts the immune system to attack these changed proteins, starting an auto-immune reaction in the body against its own gut. The cyclines stimulate the growth of the candida fungus, staphylococci and clostridia in the digestive tract.

Amino glycosides: Gentamycin, Kanamycin, Erythromycin and other ‘mycins’. These drugs have a devastating effect on colonies of beneficial bacteria in the gut such as physiological E. coli and Enterococci. A prolonged course of treatment can completely eliminate these bacteria from the digestive system, leaving it open to invasion by pathogenic species of E. coli and other microbes.

Antifungal antibiotics: Nystatin, Amphotericin, etc. These drugs cause a growth of the Proteus family and lactose-negative E. coli species, capable of causing serious disease.

Other drugs 

Most drugs when prescribed for long periods of time have a detrimental effect on gut flora:

Pain killers stimulate the growth of haemolytic forms of bacteria and campylobacter in the gut, capable of causing disease. Steroid drugs damage gut flora and shut down the immune system. Steroids in particular are linked with fungal overgrowth, specially candida.

Contraceptive pills have a devastating effect on the gut bacteria. Women on these medications will see a dramatic increase in pathogenic bacteria which will then be passed on to their children.

Many other drugs like sleeping pills, acid reducers, neuroleptics, etc also have a negative impact on gut bacteria.

Drug induced gut dysbiosis is the most severe and the most resistant to treatment.

What other factors can have an effect on gut flora?

2. Diet: processed food have a detrimental effect on gut flora. Sugar and processed carbohydrates (white bread, pasta, pastries, cake , biscuits, etc) increase the number of fungi, candida, bacteroids, worms and parasites. A diet high in fiber from grains (breakfast cereals specially) has a profound negative effect on gut flora, predisposing us for IBS, bowel cancer, nutritional deficiencies and many other problems. Fruit and vegetables are a better source of fiber and are not so harsh on the digestive system.

Starvation and overeating can critically change the composition of the gut flora and start a chain of health problems.

3. Serious infectious diseases like typhoid, cholera, dysentery, salmonella can cause lasting damage to the gut flora.

4. Surgery, chemotherapy, hormone therapy, and radiotherapy can also affect our gut flora.

5. Stress: Long term physical or psychological stress can damage our gut flora too.

6. Other factors: physical exertion, old age, alcoholism, pollution, toxic substances, radiation and extreme climates all have a profound effect on our friendly bacteria.

In all of these cases supplementing with a probiotic is a good treatment. Each of us has a unique mixture of bacteria, so under the influence of the factors listed above each of us will be predisposed to different health problems, completely unpredictable. Science has not developed reliable methods to test the full range of bacteria in the gut, much less treating any abnormalities. This damage is passed from generation to generation and as it does it gets deeper showing up in the severity of the health problems related to abnormal gut flora: digestive problems, immune problems, asthma, etc.

Where is our immune system?

A very important part of our immune system is located in the ileum, which is the last three fifths of the small intestine. The walls of the ileum are full of lymph nodes called Peyer’s patches. They have two major functions:

They filter the lymph removing bacteria, viruses, fungi, dead cells, toxins and even cancer cells. If the lymph nodes cannot destroy these bacteria they trap them.

These lymph nodes make lymphocytes, the most important group of immune cells that fight infections. When there is an infection they produce a lot of lymphocytes to fight infection, which makes lymph nodes large and inflamed sometimes painful–this is called lymphoid nodular hyperplasia.

What is more, the epithelial surface of the digestive system is the cradle of the immune system. This is where the beneficial bacteria live and where they play a major role in our immune system in a number of ways:

Bifidobacteria is the good bacteria mostly found in the human colon. It has a substance called ‘muramil dipeptide’ which activates lymphocytes. A healthy gut wall is literally packed with lymphocytes that protect the body from any offender. Scientific research shows that in people with poor gut flora there are few lymphocytes in the gut wall.

Lymphocytes in the gut produce immunoglobulins, the most important of which is ‘secretory immunoglobulin A (IgA)’. This one is secreted in body fluids so it can be found in the nose, throat, bladder, urethra, vagina, saliva, tears, sweat, colostrum, breast milk and the mucous membranes of the digestive system. Its job is to protect mucous membranes by killing bacteria, viruses, fungi and parasites that would come in from food and/or drink. Beneficial bacteria also slows down the degradation of IgA so it has more time to do its job. Due to abnormal gut flora, IgA is deficient in GAPS individuals and people with deficiency of good bacteria, making them defenseless against fungi, viruses, bacteria and parasites.

Apart from lymphocytes, other immune cells called neutrophils and macrophages are lacking when there is a deficiency of gut bacteria. These two literally swallow viruses, toxins, bacteria and cellular debris. Around 126 billion neutrophils pass through the wall of the gastrointestinal tract. In people with abnormal gut flora this destruction of pathogens doesn’t happen as effectively, allowing these viruses to survive inside the neutrophills and macrophages, the very cells that are supposed to destroy them.

Healthy gut flora also produce interferons, cytokines and many other regulators of immune system response, especially important in fighting viral infections. On GAPS people, these viruses have a good chance of surviving.

Another fascinating way in which the beneficial bacteria work with the immune system is called ‘mimicking phenomenon’. The bacteria on the surface of the gut epithelium swap antigens, improving efficiency of a large number of various immune responses.

Gut flora’s influence of the immune system reaches far beyond the gut itself. When gut flora is damaged the levels of IgA, lymphocytes, macrophages, interferons, cytokines, etc drop in the digestive system, but also in the whole body, getting out of balance. The result is a person that is immune compromised.

The two armies of the immune system 

Our immune system comprises two types of ‘armies’. On the one hand we have the Th1 (T-cell helper type 1). It promotes a so called cell-mediated immunity which is located everywhere in the body that is in contact with the outside world. Its role is to fight infection in the mucous membranes, skin and inside cells. It is the first and most effective barrier to any invasion into the body. Secretory immuno globulin A, interleukin-2 (IL-2), interleukin 12 (IL-12) , gamma interferon, etc belong to this system. Healthy gut flora has a very important role in keeping this part of the immune system healthy. When the flora is damaged it starts allowing microbes and toxins which activates the other part of the immune system, the less effective one, the Th2 immunity (T-cell helper type 2). This other part of our immune system is responsible for immunity in the liquids of the body. To this belongs interleukins 4, 5, 6 and 10. Alpha interferon and IgE (Immunoglobulin E)are activated in allergic reactions in the body. They are very active in people with asthma, eczema, hay fever and other allergies. In someone with abnormal gut, Th1 becomes low and Th2 becomes overactive, meaning the person is prone to allergies, chronic inflammation, auto-immunity, chronic viral infections, chronic fatigue syndrome, candidiasis, asthma, eczema, autism, etc. We need both Th1 and Th2 in the right balance. The reason behind this is that all these conditions share dysbiosis.

All of this points to an important fact: around 80% of our immune system is located in our gut wall with its bacterial layer. GAPS people and people with dysbiosis in general, because of abnormal digestion and absorption have unbalanced immune system. On top of that, someone with abnormal bacterial flora is exposed to extremely toxic substances, which damage immunity even more. Because of the absence of beneficial flora all the opportunistic microbes grow out of control. When this happens, the gut wall gets damaged and leaky, which causes a constant stream of invaders and undigested food to come through those holes compromising immunity further. People with GAPS have a compromised immune system, they lack some immunoglobulins, while others are out of proportion. Deficiencies in enzymes are also common. The most scary thing is that their immune system starts making antibodies that attack the body’s own tissues, including the brain and the nervous system, all because of the poorly functioning digestive system.

Many patients with compromised immune system have typical symptoms of IBS (Irritable Bowel Syndrome): abdominal pain, bloating, stool abnormalities and flatulence. A small percentage have normal stools but have malnutrition, reflux, heartburn and abdominal pain.

The roots of a tree

We could compare our body to a tree, with the roots being our digestive system and gut bacteria. A tree without healthy roots cannot be strong. Similarly our body cannot be strong without a healthy digestive system and good bacteria.

Of extreme importance is the kind of bacteria we have living in our gut. Our body lives in coexistence with trillions of highly organized invisible micro-organisms, with some predominating over others. The largest colonies of microbes live in our digestive system, where a healthy adult carries around 3-4 pounds of them. Their functions are so important that without them we would not survive. We can divide them as follows:

Essential/beneficial flora. The most important and numerous in a healthy person. To this belong bifidobacteria, lactobacteria, propionobacteria, e. coli, peptostreptococci and enterococci.

Opportunistic flora. There are around 500 various species of microbes that have been found so far in the human gut. In a healthy person their numbers are limited and controlled tightly by the beneficial flora. Each of these microbes are capable of causing various health problems when they get out of control. Among them we can find: yeasts, bacteroids, peptococci, staphylococci, streptococci, bacilli, clostridia, enterobacteria, fuzobacteria, eubacteria, catenobacteria, etc.

Transitional flora. These are microbes from the environment swallowed daily with food and drink. When the gut is well protected these microbes go through the digestive tract and do no harm, but if we have damaged flora they can cause disease.

Health and the integrity of the gut. The ‘sacred’ gut wall

The human digestive system is a long tube open at both ends. Harmful organisms from the outside world can enter it. We actually eat and drink micro-organisms, chemicals and toxins everyday. How do we survive? In healthy people there is a thick layer of indigenous bacteria that coats the whole digestive tract providing a natural barrier against invaders, undigested food, toxins and parasites. In inflammatory bowel disease, on the contrary, different pathogenic bacteria are found which allow the pathogens to reach the gut wall.

Apart from being a physical barrier, these protective bacteria produce antibiotic-like, anti-fungal, anti-viral substances, including interferon, lizocym and surfactins that dissolve the membranes of viruses and bacteria. The beneficial bacteria also reduce the pH near the wall of the gut to 4.0-5.0 making it acidic, which makes it almost impossible for bad microbes to survive because they require an alkaline environment to survive.

This is all important because pathogenic microbes produce a lot of very potent toxins, plus the toxins from the food we ingest. Healthy gut flora can neutralize nitrates, indoles, phenols, etc as well as inactivate histamine and chelate heavy metals. They also absorb carcinogenic substances making them inactive. However, if the beneficial gut bacteria are not present, all these invasions will cause disease. A pathogen like candida, and other viruses, bacteria, parasites, can then cause chronic inflammation in the gut. To this we need to add the opportunistic flora which live in the gut, they are always ready to cause trouble if their guardians, the good bacteria, get weak.

The gut lining is also coated with finger-like protusions called villi with deep crypts between them. These villi are coated by cells called enterocytes, they are of key importance because they digest and absorb the food we eat and convert it into food for the gut lining. The good bacteria in our gut work very hard to keep these enterocytes young. The enterocytes are constantly dying and being replaced by new ones, which means that the epithelium of the intestines is constantly being renewed. The problem comes when there is no good bacteria. Without good flora, the gut wall also becomes malnourished. This is because good flora are a source of energy for the enterocytes. When good bacteria are not present, this process of renewal gets out of order and can cause these enterocytes to become cancerous so fewer cells are born. When they are malnourished, degenerative changes start in the digestive wall, which further impairs its ability to absorb nutrients. All this is so important to understand, without good bacteria the cells that digest our food start dying, compromising absorption of nutrients, causing nutritional deficiencies and food intolerances.  What is more, holes start forming in the gut, which allow food particles to make it into the blood stream, causing auto-immune diseases and thickening the blood. This is all to say that the gut flora is the ‘housekeeper’ of the digestive system.

To make matters worse, the absence of good bacteria always coincides with bad bacteria getting out of control, which now are going to create havoc, release toxins and compound health problems even more.

Nourishment of the body

Healthy gut flora is essential for good digestion, it digests protein, ferments carbs, breaks down lipids and fiber. Byproducts of bacterial activity in the gut transport minerals, vitamins, water, gases, and other nutrients through the gut wall into the bloodstream. If the gut flora is damaged, the best foods and supplements in the world may not have a chance of being broken down and absorbed.

Apart from E. coli, other beneficial bacteria in the healthy gut flora will not only ensure appropriate absorption of nutrients from foods but will also synthesize nutrients like vitamin K 2, B 5, folic acid, B 1, B 2, B 3, B 6 and B 12. Healthy gut flora are our own factory for these vitamins. When healthy flora is damaged, despite adequate nutrition, we develop vitamin deficiencies. This is because many vitamins have a short life in the body, so a person without good gut flora is unable to provide a constant steady stream of vitamins and other active substances for the body to use. Every GAPS patient and person with dysbiosis is deficient in these vitamins that their gut flora is supposed to produce. Restoring the beneficial bacteria in their gut is the best way to deal with those deficiencies.

People with abnormal gut flora have multiple nutritional deficiencies, the very minerals, vitamins, essential fats, amino acids that are necessary for the brain, immune system and rest of the body: magnesium, zinc, selenium, copper, calcium, manganese, sulphur, phosphorus, iron, potassium, sodium, vitamins B 1, B 2, B 3, B 6, B 12, C, A, D, folic acid, pantothenic acid, omega 3, 6, 9 fatty acids, taurine, alpha keto glutaric acid, glutathione, etc.

Fiber for your heart

Certain foods like fiber are impossible to digest without beneficial bacteria. In a healthy gut, fiber gets broken down into oligosaccharides, amino-acids, minerals, etc that feed the gut wall and the rest of the body. The beneficial bacteria feed on fiber, producing a whole host of good nutrition for the gut wall and the whole body. Good bacteria also engage fiber in:

Absorbing toxins.

Water and electrolytes metabolism.

Recycling of bile acids and cholesterol, etc.

It is the bacteria acting on fiber that allows it to perform all of these good functions in the body. When gut bacteria is damaged, they are not able to work on the fiber, so fiber can become dangerous for the digestive system, providing a good habitat for the pathogenic bacteria to grow and aggravating the inflammation in the gut wall.

The opportunistic flora

The opportunistic flora is a large group of around 500 various microbes living in our gut in a unique number and combination. The most common are: bacteroids, peptococci, staphylococci, streptococci, bacilli, clostridia, yeasts, enterobacteria (proteus, clebsielli, citrobacteria, etc), fuzobacteria, eubacteria, spirochaetaceae, spirillaceae, catenobacteria, different viruses and many others. In a healthy gut their number is limited and tightly controlled by the beneficial flora with which they live in balance. When this is the case, these opportunistic bacteria fulfill some beneficial functions in the gut like digesting foods, breaking down lipids and bile acids.

However, when the good bacteria get weak, the opportunistic bacteria get out of control. Each of these microbes is capable of causing various health problems. Because each of us have a unique microbiome, the character of our individual opportunistic flora will determine what disease we succumb to. According to Dr. Natasha “We carry most of our future health problems right in our gut from birth”. The best known of these pathogens is candida albicans. The problem with candida is that it never acts alone in the human body. What many times is described as candida is actually dysbiosis, which includes lots of other opportunistic and pathogenic microbes. Candida’s ability to survive and cause disease depends on the state of trillions of its neighbors: bacteria, viruses, protozoa, other yeasts, etc. In a healthy body, candida is well controlled by beneficial bacteria. However, the usually prescribed broad spectrum antibiotics kill the different microbes in the body but have no effect on candida. What this means is that after a course of antibiotics, candida is left alone to thrive. In her years of experience, Dr. Natasha has observed that when antibiotics started being used doctors would prescribe Nystatin (an anti-candida antibiotic) as part of the antibiotic treatment, but that practice has been abandoned, which has caused an epidemic of candida infections in the general population. Apart for antibiotics, she has observed that our diet high in sugar and processed carbs has also contributed to the increase in candida overgrowth.

How do these pathogenic bacteria affect us?

The pathogenic bacteria listed above, when they get out of control can make it through the gut wall barrier into the bloodstream affecting different organs of the body, but first and foremost the digestive system. The most common result of dysbiosis is IBS (Irritable Bowel Syndrome) caused by these opportunistic bacteria populating the intestines. More and more research is coming out linking Crohn’s disease and ulcerative colitis with these opportunistic bacteria getting out of control.

Some of these opportunists, when not controlled by good bacteria, can reach the gut wall and damage it, making it ‘leaky’. The spirochaetaceae and spirillaceae for example, because of their spiral shape can push apart intestinal cells, breaking down the integrity of the intestinal wall and allowing through substances which would normally not get through. Candida albicans has this ability as well, its cells attach themselves to the gut lining, literally putting ‘roots’ through it and making it leaky. Partially digested foods then make it into the blood stream, where the immune system attacks these ‘foreign’ substances. This is how food allergies or intolerances develop. In many cases when the gut wall is healed food allergies disappear.

Another way in which opportunistic flora affect us is that they are constantly releasing toxic substances. An example are the proteus family, E. coli family, staphylococci and other bacteria. All of these pathogens in the gut make histamine. Histamine is an important neurotransmitter in the body and many cells in the body naturally produce histamine, the problem is when these bacteria get out of control and there is no good bacteria to stop them. If this is the case, they produce too much histamine. Since histamine has many different functions in the body, when these bacteria start producing too much histamine it travels through the blood and affects all these functions in the body. This can manifest as: allergies, low blood pressure, excessive body fluids like saliva, dysfunction of the hypothalamus with hormonal changes like PMS, emotional instability, sleep abnormalities, addictions, etc. According to Dr. Jockers, histamines can effect the gut, lungs, skin, brain and the entire cardiovascular system. He asserts: “This is why there are such a wide array of health problems associated with histamine and it is quite challenging to pinpoint and diagnose if you are not aware of the condition.”. (2) Signs of histamine intolerance are:

Headaches/Migraines

Difficulty falling asleep, easily arousal

Hypertension

Vertigo or Dizziness

Arrhythmia, or accelerated heart rate 

Difficulty regulating body temperature

Anxiety

Nausea, Vomiting

Abdominal cramps

Flushing

Nasal Congestion, Sneezing, Difficulty Breathing

Abnormal menstrual cycle

Hives

Fatigue

Tissue swelling

Unexplained cravings?

A group of opportunistic gut bacteria, the bacteroids, is found in abundance in adult population in the western world. This bacteria like to eat sugar, starch and lactose. So far 22 different members of this family have been identified in the human gut. The most common are ‘bacteroides fragilis’ and ‘bacteroides melaninogenicus’. These bacteria are almost always found in infected tissues of the digestive tract, abscesses, ulcers, lung infections, peritonitis, infected heart valves, blood infections, urinary infections, mouth infections, teeth and gum disease, gangrene and post-operative infections. These bacteria are opportunists which means they are always present in every mucous membrane of the body waiting for their opportunity to cause trouble. However, they never act alone and always need other bacteria to really cause damage, like clostridia, which is even more dangerous than bacteroids.

There are around 100 different clostridia known so far. Many clostridia members are normal inhabitants in the human gut. For example, ‘clostridium tetani’ is found in the gut of healthy animals and humans. Spores of these bacteria are passed from the stools to the soils, where they can survive for years. Most soils in the world have spores of this bacteria. ‘Clostridium tetani’ normally lives in the gut where it causes no harm, even though it can produce a very powerful neurotoxin. What keeps it from being harmful? The health of our gut wall, which is always maintained by good flora. When this gut wall becomes vulnerable, it allows clostridia to make it through the gut wall. Dr. Natasha has observed that her GAPS patients, because they do not have a healthy gut wall, have this toxin in their blood. In her patients these neurotoxins produced by clostridia can cause nervous system and brain problems. Just like candida, clostridia has been allowed to grow out of control with every single course of broad spectrum antibiotics. Different species of clostridia cause severe inflammation of the digestive system, for example ‘Clostridium difficile’ can cause fatal colitis, others cause crohn’s disease and ulcerative colitis. Anti-clostridia drugs like ‘Metronidazole’ (Flagyl) and ‘Vancomycin’ have been shown to reduce autistic symptoms and improve digestion in autistic kids, but as soon as the drug is stopped the symptoms come back. What is more, anti-clostridia drugs are toxic and have serious side effects so they cannot be prescribed for long. Clostridia are spore forming bacteria, because of this they are impossible to eradicate, we can only keep them under control with good bacteria.

Other opportunistic bacteria are the ‘sulphate reducing bacteria’. They break down sulphate from food into sulphites, many of which are toxic. Sulphates are needed by the body for the detoxification of brain neurotransmitters. An abundance of these bacteria make sulphate unavailable to the body. It will also make sulphur unavailable and will turn it into toxic substances like hydrogen sulphide (rotten egg gas). For this reason GAPS people’s feces have a characteristic smell.

Other viruses active in GAPS people are the ‘measles virus’ and the ‘herpes virus’. There are many others that haven’t been studied yet. In the meantime, the only way to protect ourselves from candida, clostridia, and bacteroids is with good bacteria.

The gut-brain connection

Because every organ in the body exists and works in contact with the rest, one should not look at, let alone treat any organ, without taking the rest of the body into account. The usual treatment with antidepressants, sleeping pills, etc end up affecting the brain too. According to Dr. Natasha, psychiatry likes to look at the brain alone separated from the rest of the body and never looks at the gut for a solution, but research is showing how severe psychiatric conditions can be cured by simply “cleaning out’ the patient’s gut. Most psychiatric patients she has seen suffer from digestive problems. In these patients, the gut is a constant source of neurotoxins coming from abnormal flora which are absorbed through the gut wall into the blood and then the brain. The mixture of toxins is very individual and this is why GAPS patients are all different. The number of toxins is unknown, but research has accumulated a lot of information on what kind of neurotoxins are found in GAPS patients:

1. Ethanol and acetaldehyde:

Yeasts including candida eat sugar and glucose. These two come from the digestion of carbohydrates from our diet. In a healthy person glucose is converted into lactic acid, water and energy through a process called glycolisis. In people with candida, this fungus highjacks glucose and digests it in a different way. This is what is called alcoholic fermentation. By this process candida converts glucose into alcohol (ethanol) and its byproduct acetaldehyde. This makes the person ‘drunk’ after consumption of carbohydrates even when they didn’t drink any alcohol. Alcohol is absorbed into the blood stream very quickly. In the case of pregnant women, this alcohol can make it into the placenta and affect the fetus and its development directly. When the baby is born, breastfeeding will affect the baby too because the alcohol is in the blood and can make it into the breast milk. Then because the baby inherits the mother’s flora, overrun by yeast, the child will start producing its own alcohol and other toxins. Chronic presence of alcohol in the body have these effects:

Reduced ability of the stomach to make acid.

Pancreatic degeneration which reduces the ability of this organ to make enzymes, impairing digestion.

Direct damage to gut lining, causing malabsorption.

Vitamin, mineral and aminoacids deficiencies due to malabsorption, specially vitamin A and D.

Damage to immune system.

Liver damage with decreased ability to detoxify toxins, drugs, pollutants and poisons.

Inability for the liver to dispose of old neurotransmitters, hormones and other by-products of normal metabolism. All these accumulate in the body causing behavioral and other problems.

Brain damage with loss of self-control, impaired coordination, speech development, mental retardation, loss of memory,etc.

Peripheral nerve damage with altered senses and muscle weakness.

Direct muscle tissue damage with altered ability to contract and relax and muscle weakness.

Alcohol has an ability to enhance toxicity of most common drugs , pollutants and toxins.

Alteration of metabolism of proteins, carbohydrates and lipids in the body.

Acetaldehyde is one of the most toxic of alcohol by-products, it can alter the structure of proteins in the body. This is significant because we are mostly protein (from hormones to enzymes). When these proteins in our body are changed by acetaldehyde, they cannot do their job. This is when many auto-immune diseases start. One of the parts of our body that can be attacked is the ‘myelin’ that coats nerve and brain cells, resulting in multiple esclerosis in adults. In children this will show up as neurological problems like autism.

Acetaldehyde also makes many essential nutrients useless in the body, like is the case of B 6, which is a cofactor in the production of neurotransmitters, fatty acid metabolism, etc. Even if the person is consuming B 6 rich foods, acetaldehyde keeps this vitamin from being where it can be used, so B 6 floats around in the body and eventually gets excreted. This also happens to other vitamins in the body that usually bind to proteins to do their job.

Another organ that acetaldehyde affects is the thyroid. The thyroid gland may be producing plenty of hormones but their working sites are occupied by acetaldehyde and other toxins, causing thyroid dysfunction: depression, lethargy, fatigue, weight gain, poor body temperature control, poor immunity, etc.

2. Opiates from gluten and casein

Gluten is a protein found in grains like wheat, rye, oats and barley. Casein is a milk protein in cow’s, goat’s, sheep’s, human’s and all other milk products. In GAPS people these proteins don’t get digested properly and turn into substances similar to opiates, such as morphine and heroin. These substances called gluteomorphins and casomorphins have been detected in the urine of patients with schizophrenia, autism, ADHD, post-partum psychosis, epilepsy, down’s syndrome, depression, and some autoimmune diseases like rheumatoid arthritis. These opiates from wheat and milk are thought to cross the blood brain barrier and block certain parts of the brain, just like morphine and heroin would do. Why does this happen? It all starts with digestion, the digestion of proteins starts in the stomach with the action of pepsin, a protein digesting enzyme produced in the stomach. Stomach acid is essential for the digestion of protein, as it produces the right conditions for pepsin to do its work of breaking down proteins. GAPS people commonly have low stomach acid due to abnormal gut flora and pathogen overgrowth. For example, candida alone can make toxins that have a strong suppressing ability on stomach acid production. A pregnant woman can have these toxins from candida in her breast milk and it is possible that children that are being breastfed can get these toxins and have their stomach acid reduced early in life. While being breastfed, since breast milk doesn’t require much digestion, symptoms may not show up, but they will when other foods are introduced. By the time breastfeeding stops, the child’s body will have produced enough on his own candida and other toxins to keep reducing his stomach acid. Usually the first weaning foods after breastfeeding are milk and wheat. If the child is not making enough stomach acid, the first steps in digestion will already be compromised, so proteins will not be able to be broken down. These undigested proteins will go into the intestines where the pancreas is supposed to release enzymes to break down food further, however, without stomach acid, the pancreas is not going to release enzymes, so the next step in digestion is also compromised. Next, these undigested proteins reach the final stage, the intestinal wall, which is lined up with highly sophisticated cells, the enterocytes, which on their surface have a whole host of different digestive enzymes to complete the breakdown of food. Because in GAPS people these cells are in poor shape due to abnormal gut flora, they are not able to digest gluten, casein etc. Some research done on one of the enzymes found on the enterocytes, known as dipeptidyl peptidase IV (DPP IV), has shown that GAPS children, alcoholics, schizophrenics, depression sufferers and people with auto-immune diseases are deficient in this enzyme. Some enzyme products in the market incorporate this enzyme. The problem is that there are so many more enzymes we haven’t researched that digestive problems continue to be an health problem.

With the lack of beneficial bacteria the enterocyte cells fall sick, the result is indigestion and malabsorption. What is more, pathogenic bacteria, fungi and viruses damage the gut wall and allow undigested food to end up in the bloodstream where they can reach the brain. While some GAPS patients do well on a gluten and milk restricted diet (GFCF DIET), others do not, this is because there are many other aspects in these patients to take into consideration.

Research has shown a direct link between the consumption of grains and milk and the increase in the cases of schizophrenia and mental diseases. Mainstream medicine never considers the root cause to be the gut, instead they prescribe drugs that cause dependency and in the long term shrink the brain. Dr. Natasha recommends to slowly wean the patient off those drugs, while healing the gut and repopulating the good bacteria.

Treatment

Dr. Natasha’s treatment for digestive disorders consists on detoxifying the person and lifting the toxic fog off their brain to allow it to fully function. To achieve this first the gut has to be cleaned up and the digestive system healed, so it stops being the first source of toxicity and becomes a source of nourishment as it is intended to be. Second, to remove toxicity that is already stored in the tissues of the body. This is what she called the GAPS program, which she developed from her personal experience with her own son, and the many children and adults she has personally treated in her clinic. Her program has three parts: diet, supplementation and detoxification. In our next blogs, we will look with detail at the diet.

Thanks for reading.

References:

(1) http://www.nytimes.com/2016/06/05/opinion/sunday/educate-your-immune-system.html

(2) http://drjockers.com/suffering-histamine-intolerance/

(3) http://drjockers.com/is-your-brain-making-enough-gaba/

(4) http://drjockers.com/7-reasons-to-use-carminative-herbs/
(5) http://drjockers.com/10-ways-ginger-enhances-digestion/

Could it be B 12? (Pt. 2)

B 12 deficiency not only affects heart health, in their book Sally Pacholok, R.N., B.S.N. and her husband Jeffrey J. Stuart, D.O. go into detail about how it can influence other aspects of health, namely, neurological disorders like multiple sclerosis, mental illness, developmental and learning disabilities in children, autism, cancer, immune function and autoimmune diseases. Similarly, B 12 deficiency can affect the health or our kidneys, a key organ when it comes to heart health. In what follows we will list the effects of low B 12 levels when it comes to learning disabilities, brain health, aging, etc  and focus with more detail on kidney function.

Homocysteine and kidney disease

Individuals in end-stage renal disease are nearly always dangerously high in homocysteine levels. These people’s kidneys no longer function and they are significantly debilitated. Their homocysteine levels puts them at vastly increased risk for strokes, heart attacks and other vascular problems. Doctors trying to lower homocysteine levels of patients on dialysis resort to high doses of folic acid, but folic acid cannot lower homocysteine alone in the absence of sufficient vitamin B 12. In a prospective trial doctors found that the injected form of B 12 reduced plasma homocysteine by an average 32%, even though the patient initially appeared to have adequate B 12 stores.

What is more, there is evidence that homocysteine, in addition to damaging blood vessels, acts as a potent uremic toxin that disrupts normal cellular function. This finding should urge doctors to treat patients with kidney problems, monitor homocysteine, provide oral folic acid and high dose B 12 at the sign of any problem. All dialysis patients should receive high dose methyl B 12 lozenges or injections according to the authors.

Similarly, Alessandra Perna, M.D. and colleagues point out that chronic renal failure patients ‘have a high mortality rate, due to mainly cardiovascular disease, 30 times the risk in the general population. Cardiovascular disease mortality remains 10-20 times higher’. The authors strongly suggest that the role B 12 plays in the astronomical incidence of heart and blood vessel disease needs to be studied, specially taking into account that elevated homocysteine damages the lining of veins and arteries throughout the body, including those in the kidneys. What percentage of patients genetically prone to high homocysteine levels end up with renal failure because excess homocysteine has been scarring and injuring their kidneys for years? Doctors have assumed that high homocysteine is a side effect of kidney failure but they have never contemplated it could be a culprit.

If you have been diagnosed with kidney problems, being properly tested for B 12 deficiency together with the ‘Kidney/Bladder Extract’ can help protect the health of these important organs.

Diet. Rethinking fortified cereals

Fortifying foods like cereals implemented in the United States and Canada has changed the way in which homocysteine levels has affected the population. In one study researchers recently conducted, 53 healthy adults received increasing doses of folic acid over a six moth period. At the beginning of this study the levels of homocysteine in these patients dropped in response to this nutrient. But as the folic acid decreased, homocysteine levels dropped less in response to this vitamin and more in response to B 12. This finding, researchers say, indicates that the ‘fortification policy based on folic acid and B 12, rather than folic acid alone is likely to be much more effective at lowering …homocysteine concentrations with the potential benefits for reduction of risk of vascular disease’.

Only recently have scientists studied the potential ill effects of adding excess folic acid to grains and cereals without B 12. On one hand, the prevalence of B 12 deficiency has since increased , “neural tube defects attributable to B 12 deficiency has tripled in the same period” The ‘National Health and Nutrition Examination Survey’ in the USA presented data showing that with B 12 deficiency, high folic acid is directly related to anemia and cognitive impairment in older adults. In the same way, a study on children born to mothers with the combination high folic acid, low B 12 ‘had higher truncal adiposity and insulin resistance‘ and they cite research where they show that B 12 deficiencies is increasing in countries with mandatory folic acid fortification and affecting all ages.

Studies are urgently needed, the researchers said. Fortifying foods with B 12 sounds good but it is not as easy as it sounds because it is hard to absorb and would require very large doses in the grain to correct the deficiency. There is also the problem with the current daily recommended intake (DRI) or RDA for B 12, which in the author’s opinion is much too low for health and prevention of disease.

Lastly, the U.S. uses cyano-cobalamin rather than the active form of B 12 methycobalamin. Until all of these issues are worked out, the authors believe fortification would be a great waste of economic resources and it would offer a sense of false protection for many people.

B 12 and developmental disabilities or learning problems in children

The authors mention that the most common cause of B 12 deficiency in infants and young children is maternal dietary deficiency. Women with B 12 deficiency are at higher risk of giving birth to children with potentially disabling or fatal birth defects. Any infant with an unexplained developmental disability should be screened for B 12 deficiency. B 12 deficiency in infants and young children frequently causes symptoms similar to those seen in autism. There is a critical window of opportunity for treating B 12 deficiency before permanent cognitive changes or injury results. The same effects have been reported in people in their twenties even toddlers.

B 12 deficiency can destroy your nerves at any age. In young children, these symptoms often baffle doctors, specially when the blood count is normal and symptoms are subtle, the result can be a dangerous delay in receiving treatment.

B 12 deficiency and aging 

In “Postgraduate Medicine” T.S. Dharmarajan, M.D. and Edward P. Norkus, Ph.D. assert that “Vitamin B 12 deficiency affects about one quarter of the U.S. population and is more common in the elderly and in adults with several predisposing conditions…Health care professionals need to recognize that vitamin B 12 deficiency is often undetected and can lead to devastating and irreversible complications. Early treatment is effective and prevents disability”

Seniors are a high risk group for severe B 12 deficiency. Between 15% and 40% of people over sixty have low serum B 12 levels and there is also critical window of opportunity for treating B 12 deficiency before permanent cognitive changes or injury result. The most striking piece of information is that there is mounting evidence of the link between B 12 deficiency and Alzheimer’s disease.

According to neurologist Sydney Walker III, M.D., many patients with Alzheimer’s and other dementias are actually suffering from problems that can be corrected”.  Up to 60% of patients labeled as having dementias actually have treatable and reversible disorders, and in many cases that disorder its B 12. The symptoms of B 12 deficiency include confusion, memory loss, personality changes, paranoia, depression, and other behaviors that look like dementia. In one reported case, a patient with dementia recovered completely when doctors discovered and treated his B 12 deficiency.

The degree of recovery may depend on how long the person had B 12 deficiency and other conditions. Studies have shown that people with low levels of B 12 are twice as likely to develop Alzheimer’s and patients with the disease and low levels of B 12 showed more behavioral and psychological symptoms of dementia than patients with normal levels.

More research has shown that low B 12 causes the brain to atrophy, probably disturbing the integrity of brain myelin or by causing inflammation. The authors recommend even in the last stages of dementia, to test the individual, then supplement with a high dose of 2,000 mcg-5,000 mcg lozenges daily and/or have the doctor perform a trial of injectable B 12. There is a possibility it could slow down or halt the progression of the dementia or even reverse some symptoms. This information can be used to treat other members of the family as B 12 deficiency runs in the family.

Other B 12 ills that mascarade as aging are nervous system impairment that can cause tremors, handwriting difficulties and other symptoms serious enough to resemble the early stages of Parkinson’s. Vitamin B 12 needs to be ruled out in Parkinson’s type symptoms and in patients already diagnosed with the disease. Because Parkinson’s and B 12 deficiency share some of the same signs and symptoms and there is no diagnostic test that can confirm Parkinson’s, it only makes sense to investigate and rule out B 12 deficiency.

Since B 12 deficiency affects all the nerves, it can affect the nerves of the eyes too. Diabetics can have failing eyesight also caused by B 12 deficiency but may be wrongly attributed to age or macular degeneration or diabetic eye damage.

B 12 deficiency a cause of frequent falls and fall related trauma

Frequent falls is the most common cause of fatal injuries among people over 65 causing 10,000 deaths a year. B 12 deficiency attacks the nervous system, especially the nerves in the lower part of the body, it damages the myelin of the nerves making it harder to carry messages. Sufferers feel a weakness, balance problems, leg and back pains and numbness in hands and feet. B 12 deficiency can also cause visual problems, vision loss, dizziness, vertigo, postural hypotension, all of which increase the chance for falls.

Doctors often mistake this for strokes. The authors report that so many cases of elderly people who had developed tingling, pain and weakness to the point they couldn’t walk, when the doctor identified it as a B 12 deficiency and they were treated within a month, they could walk again. Similarly, caught in the early stages of near paralysis treatment with B 12 can reverse the symptoms within a few months.

The authors argue that it is unconceivable that hospitals don’t routinely provide B 12 screening for patients suffering from weakness or repeated falls, specially taking into account that it is a mere $100 rather than the costs of CT scans, etc which are more expensive and don’t solve the problem. Falls can also cause hip fractures. Not all falls stem from B 12 deficiency but a big percentage do. Pain, numbness, weakness, dizziness, difficulty walking and falls are all signs that B 12 could be the case.

B 12 and osteoporosis

There is a strong link between B 12 deficiency and osteoporosis. Osteoporosis is the thining of the bones mineral density. Studies have shown that those people low in B 12 and high homocysteine levels therefore, had four times more likelihood of having osteoporosis. This, together with the high risk for falls in people deficient in B 12 makes it more crucial to make screenings for B 12.

Is it multiple sclerosis or is it B 12 deficiency? 

The symptoms of B 12 deficiency mimic those of multiple sclerosis, they both damage the myelin on the nerves causing lesions or disease in the brain and spinal cord. Scientists report intriguing evidence tentatively implicating low B 12 levels in the development or exacerbation of MS, meaning B 12 deficiency could possibly be contributing to the disease.

35,000 Americans have MS, which indicates that a significant number are likely to have B 12 deficiency. Both diseases have the same symptoms: numbness, gait problems, pins and needles, depression, memory loss, dementia, weight loss, tremors, fatigue, pain, incontinence and vision loss. Both MS and B 12 deficiency damage the myelin causing short circuiting of nerve impulses. The only difference is that with B 12 it can be reversed. Accurate diagnosis requires ordering a battery of tests that can conclusively prove and rule out B 12 deficiency. Even is MS if the diagnosis, B 12 should be tested too.

Many physicians lack even the most basic knowledge about B 12 deficiency. What is alarming about MS according to the authors is that the steroids commonly used to treat MS can normalize the anemia and enlarged cells characteristic of B 12, while allowing the neurological damage to continue unchecked. Thus, they think doctors should rule out B 12 deficiency in all patients suspected of having MS or diagnosed with it. Failing to do so is negligence. Leading scientists are exploring the possibility that even classic MS may involve a defect in B 12 metabolism.

Other conditions 

B 12 deficiency suppresses the immune system’s ability to fight off viruses and bacteria.

Also, B 12 plays a crucial role in myelin formation. B 12 deficiency attacks the nerves stripping them of their protective myelin coating and disrupting the communication between cells in the brain and other parts of the nervous system. This damage can make you lose your balance, develop multiple sclerosis-like symptoms or suffer shooting pains or numbness in your feet, arms and legs like we  have seen but this damage can affect nervous system in other ways. Because nerve cells in your brain control how you feel, think and behave, B 12 deficiency can cause severe mental illness including depression, paranoia and even symptoms resembling schizophrenia.  Studies have shown that B 12 deficiency doubles the risk of severe depression. B 12 deficiency is not the cause of most mental problems but it clearly plays a role in a number of cases. Because physicians don’t screen for B 12 deficiency we don’t really know the incidence of B 12 deficiency in mental illness. In bipolar disorder, B 12 levels are so low that the brain cannot function correctly.

Over a century ago, in the 1900’s doctors discovered that pernicious anemia (one form of B 12 deficiency) caused mental illnesses of all kinds like dementia, delirium, depression, hallucinations, hysteria, paranoia, mania, etc. All of these conditions were termed ‘megaloblastic madness”. In the late 1920’s doctors first learned to treat pernicious anemia with success by giving patients large amounts of raw liver. How come at the turn of the new century with the benefit of more than one hundred years of research and documentation proving that B 12 deficiency causes psychiatric illness, very few mentally ill patients are being evaluated for underlying B 12 deficiency? The authors show their concern that serum B 12 is not being universally screened for in psychiatric facilities.

Mental disorders can make you more vulnerable to B 12 deficiency, because they increase the odds you are eating poorly or taking drugs that compromise B 12 metabolism. It is not part of the most standard psychiatric evaluations or admissions and it is not required for medical clearance.

Lastly,  B 12 deficiency has a role to play in cancer, where deficiency appears to promote its development. In the case of surgeries, being deficient in B 12 makes the simplest of surgical or dental procedures dangerous, even deadly. Nitrous oxide, a common anesthetic agent inactivates B 12 in the body. In the case of infertility, B 12 deficiency contributes to male and female infertility, even impotence in men.

Conclusion

In June 2009, the CDC reported B 12 deficiency is present in 1 in every 31 people over the age of 50. What is most alarming is that this number under-reports the true incidence of B 12 deficiency. There is much work left to do to bring awareness about B 12 deficiency. Change can start with you, if you learn you are deficient in B 12, you can get the proper tests and start treatment. B 12 together with the products from ‘Healthy Hearts Club‘ can ensure that you keep many terrible diseases at bay. Even if you find out you are not deficient in B 12, there is still a lot you can do to help bring awareness about this disease.

Thanks for reading.

Could it be B 12? (Pt. 1)

What do Alzheimer’s disease, multiple sclerosis, autism, depression, schizophrenia, diabetic neuropathy, infertility, developmental disabilities in children, strokes, heart attacks and cancer all have in common? It is vitamin B 12 deficiency, although we could add, it is vitamin B 12 deficiency misdiagnosis. Because B 12 deficiency affects all body systems, it can masquerade as many other diseases. In addition to neuropathy and psychiatric problems it can manifest as shortness of breath, fatigue, generalized weakness, anemia, poor digestion, GERD-like symptoms, constipation, diarrhea, weight loss, recurrent miscarriages, infertility, osteoporosis, poor wound healing and poor immune response. Patients with B 12 deficiency may have a few or many of these symptoms and most times they are easy to blame on other disorders or pre-existing conditions.

Despite this, B 12 deficiency is very rarely taken into account when diagnosing any of these disorders. According to the authors of the book “Could it be B 12? An epidemic of misdiagnoses” Sally M. Pacholok R.N., B.S.N. and her husband Jeffrey J. Stuart, D. O., doctors are not educated in it, so they fail to test for it. The authors assert that 40% of seniors with severe mental and physical problems are suffering from B 12 deficiency. ‘Millions of people labeled as having many severe and uncurable disorders could actually be victims of the easily diagnosable, treatable and, in its early stages, completely curable B 12 deficiency.’ In their book they explain their alarm at how B 12 deficiency is very common, not only in seniors and middle-aged people but in teens, children and infants.

In what follows we will look in depth at vitamin B 12, what it is, how it is absorbed, sources of B 12 as well as best supplemental forms. We will also look at how B 12 deficiency could affect your heart as well as other systems in the body. We will also look at how the ‘Heart and Body Extract’ and other products from ‘Healthy Hearts Club’ are a perfect supplement to take with vitamin B 12.

We will start with the story of how Sally Pacholok, R. N. became aware of what she calls ‘an epidemic of misdiagnoses’.

A nurse’s intuition

Sally shares her personal story with B 12 deficiency to show how getting a diagnosis is not always easy. How many times was she misdiagnosed? Not just one, but three times and by three different doctors.

It all started when she was only 19. She was the picture of health, or so she thought, she had no idea that an invisible disease was attacking her body. The first clue came when she went for a pre-employment physical examination. When the examining physician reviewed her blood tests, he commented on her abnormally large red blood cells and sent her on her way. Looking back, she realizes that the fact that this test came back positive is what saved her life. She asserts many people are not so lucky and ‘suffer neurological damage decades before their blood tests become abnormal, and by then it’s too late’. In her case, the doctor simply dismissed this blood abnormality as low folic acid. One month later, another doctor commented on how large her red blood cells were but concluded the lab results were ‘insignificant’.

Two years later, in nursing school she bought a manual describing laboratory tests and their meanings. The manual outlined two major problems associated with large red blood cells, folic acid deficiency and B 12 deficiency. Since her diet was rich in B 12-rich meat but low on folate-rich vegetables, she understood why the doctor had commented on the folate, but he had never considered B 12 deficiency as well. She also learned that most cases of B 12 deficiencies stem from malabsorption, not diet. Because of this, she persuaded a doctor to order tests for folate and B 12. That night, as she mentioned the tests to her parents she learned her grandfather had been diagnosed with pernicious anemia, the most well-known, although not the only symptom of B 12 deficiency. His grandfather was misdiagnosed as having leukemia, but upon insistence he received a second opinion and this time he was diagnosed correctly. He was treated for it and his condition was reversed. Learning this, when her results came back she was prepared to learn her B 12 would be low. She started being treated with shots. Her insistence to have this rechecked is what saved her life.

However, that wasn’t the end of her story. Two years later, even after being diagnosed with B 12 deficiency, she visited a doctor who questioned her diagnosis. The doctor could not believe pernicious anemia could be found in such a young patient. Upon her insistence, he ran some tests and was surprised to find out that was the case. If it had not been for her nursing training, and her insistence, her B 12 shots would have stopped, damaging her for life.

It was her own experience with the disease that caused her to want to know more. She started doing research and became an expert on the topic. She found out that studies from the 1980’s revealed that more than a third of people with B 12 deficiency show no evidence in routine blood tests. Her husband, an emergency medicine physician also got involved and did studies on the percentage of patients in his department who were deficient in B 12. What they found was the alarming number of undiagnosed cases. They learned how B 12 deficiency plays a role in so many seemingly hopeless problems and how unexpensive the treatment is. All of this was very exciting but their excitement didn’t last very long when they found out doctors simply didn’t care about it, despite the tests available for its diagnosis. She was forced to drop the subject or lose her job.

She continued to see so many patients with obvious B 12 deficiency being labeled as ‘nuts’ and being written off as ‘hopeless cases’. As soon as she had to write the discharge papers for another patient, her anger hit a critical high. She knew these patients would end up some day back in the hospital with strokes, dementia, depression, fall related trauma, etc due to B 12 deficiency. She couldn’t live with herself knowing that a couple of tests could prevent serious cases of disabilities even death and nothing was being done about it. They wrote the book to bring awareness about this disease, hoping things can change.

In the book they share their concern for what they consider a lack of awareness about B 12. They explain that despite the fact that B 12 deficiency is considered an ‘old man’s disease’, it can strike any person at any age.

Why is it so hard to diagnose B 12 deficiency? 

During her career as a nurse she sees many cases of misdiagnosed diseases. In many cases she sees patients getting worse to the point of getting into a vegetative state from which they never recover.

There are several reasons she has observed that lead to this:

  1. Doctors are trained to recognize only the blood abnormality, a classic sign of B 12 deficiency known as ‘macrocytosis’, which is characterized by the presence of large, immature red bloods cells. However, it has been well documented that B 12 deficiency damages the brain, spinal cord, peripheral nerves and the nerves of the eye, often before blood abnormalities appear. Doctors who think of B 12 deficiency in terms of anemia only will miss the majority of cases and will fail to recognize the neuro-psychiatric signs and symptoms.  In their opinion, physicians must be aware that macrocytic anemia is a late sign of vitamin B 12 deficiency, frequently occurring long after potentially irreversible neurological damage has been done. The common and striking neuropsychiatric manifestations of B 12 deficiencies like depression, altered mental state, dementia, psychosis, vertigo, tremor, neuropathy, visual problems, extremity weakness, dizziness, balance problems, and gait disorders have long been forgotten by physicians. This is tragic according to the authors because their research shows that in the 18th century B 12 deficiency was a known and accepted fact among doctors. There are reports of autopsies done on patients with pernicious anemia where there was great degree of damage to the spinal cord. Similarly, there are many medical articles describing neurological symptomatology preceding the classic blood signs. In their opinion, clinicians either ignore this or have forgotten.
  2. The name ‘pernicious anemia’ is misleading. ‘Pernicious anemia’ was coined in 1872, 50 years before B 12 deficiency was discovered. The medical community kept the name for historical purposes, adding to the confusion. Due to this, physicians believe that to have B 12 deficiency a patient must have anemia, which is not completely accurate.
  3. Practice mistakes of the past. Many physicians remember the days when thousands of patients got B 12 shots whether they needed them or not. Their justified scorn for this practice leads them to overreact now by making the opposite mistake, failing to realize B 12 deficiency is a serious medical disorder. In this respect, the authors mention that when diagnosis-related groups started in the 1980’s, physicians billing for B 12 shots had to prove there was a disease that justified the need for the shots. Because doctors were not testing to see if patients needed the shots or not, many stopped the injections for fear of legal consequences. Many doctors also administered the shots to get insurance money from their patients. All of this has given B 12 a bad name in the medical community.
  4. The serum B 12 test ‘normal’ low limit that physicians consider is 200 pg/ml, or below 180 pg/ml. However, the fact that symptoms of neurological damage start showing even with this ‘normal’ low is a cause of concern . This practice even increases costs because in these cases doctors have to order more expensive tests to ‘prove’ the deficiency. These additional tests have limitations (MMA, Homocysteine, holo-TC), can actually confuse the misdiagnoses, delay treatment and possibly cause physicians to stop what was already started.
  5. The proper definition of ‘subclinical’ and ‘clinical’ are not being followed, causing confusion, late diagnoses and misdiagnosis of B 12 deficiency. The authors assert that the CDC statement ‘Most health providers are far less likely to screen and diagnose the majority of patients with subclinical or midly symptomatic  B 12 deficiency’ is confusing. ‘Subclinical’ means without symptoms, so it cannot be compared to ‘mildly symptomatic’ which refers to those patients with a clinical disease. In doing so they are trying to minimize symptoms. The authors have observed that many physicians fail to recognize the signs and label the patients as subclinical, withholding treatment. Some other statements made by the CDC are misleading and can misguide physicians. For example, the statement that ‘unexplained signs should be evaluated’ can lead doctors to believe that diagnosed diseases like neuropathy, anemia, dementia, etc do not to be tested for B 12 deficiency. The authors have found that in many cases B 12 deficiency is the cause of these diseases, in other cases both B 12 deficiency and the disease co-exist. They also feel the CDC statement that the ‘MMA and homocysteine tests can be used to confirm deficiency in case of ambiguous initial results’, causes doctors to not treat patients that show normal levels in both, even when they still have symptoms. Lastly, the statement that ‘Clinical B 12 deficiencies are relatively rare’ is particularly troubling because in their experience that is not the case.
  6. Lack of universally accepted screening protocol for vitamin B 12 deficiency. In the authors’ opinion, physicians and other health professionals are failing to address B 12 deficiency, ignoring patients’ symptoms and discharging them without diagnosing the cause of their symptoms. They also claim orthopedic surgeons should be involved, because not only B 12 deficiency will cause falls, but B 12 is needed for proper healing of bone fractures. Many doctors may assume the lack of healing is due to age or debility, when it could be just B 12 deficiency.
  7. Outdated treatment protocols. Treatment protocols were developed more than fifty years ago, when researchers were more focused on resolving the blood disorder rather than the neuropsychiatric symptoms. This is the reason why treatment with injections is performed monthly. But many patients assert these are not enough, therefore the dose is very individual, some patients might need injections every weak, others every month. The irony of all this is that many physicians prescribe narcotics much more liberally than they do B 12 for patients that are highly symptomatic. Unlike narcotics, B 12 is not addictive and doesn’t have any side effects.
  8. Doctors order blood transfusions before they perform the tests to check for B 12 deficiencies. Doing so they mask abnormalities and can misdiagnose the neurological symptoms related to B 12 deficiency: tingling, and burning in hands and feet, memory loss, depression, personality changes, dizziness, loss of balance, even dementia.
  9. High levels of folic acid can hide B 12 deficiencies. With the government mandate in 1998 to introduce folate to foods, this made B 12 deficiencies harder to recognize even though it helped in lowering spina bifida and related birth defects. Because of all these reasons, the authors feel physicians need to be educated on the neurological presentation of B 12 deficiency. By learning to identify risks and obtaining a real diagnosis and treatment before it is too late and making B 12 screening, not just inaccurate blood counts, a part of our health protocol, many people can be spared unnecessary suffering.

What is B 12 and why is it so important?

Vitamins are tiny molecules that participate in thousands of chemical reactions, build your tissues and organs, provide you with energy from the food you eat, clean the toxins from your body, protect you against infections, repair damage and allow your cells to communicate with one another. Some vitamins are fat soluble and can be stored, others are water soluble and need to be provided on a daily basis through foods. From all the 13 different vitamins the body needs to stay alive and be healthy, B 12 is unique. What makes B 12 unique is also what makes it harder to absorb. One of the unique things about B 12 is that is has a trace element of cobalt, therefore the name cobalamin. Vitamin B 12 is the only vitamin made in the gut of animals, not found in plants or sunlight. Therefore it is obtained through meat, poultry, fish, eggs, dairy, fortified foods or supplements. However, for many people this is not enough. Despite the tiny amount needed (2-4 mcg) it is very easy to become deficient in it, even people ingesting plenty amounts of this vitamin.

Why is B 12 difficult to absorb?

This has to do with the complex pathway vitamin B 12 follows. Any block in this pathway can cause B 12 levels to plummet. This pathway is as follows:

  1. B 12 from animal foods is bound to proteins and needs to be freed. To split B 12, the protein pepsin is required, which is produced in enough amounts only if there is enough stomach acid.
  2. Intrinsic factor, a protein made in the stomach is also needed for later use in the intestine.
  3. Other proteins called R-binders take the B 12 into the small intestine.
  4. With the help of enzymes called pancreatic proteases, intrinsic factor latches onto the B 12 and carries it to the last section of the small intestine, the ileum. Cells lining the ileum have receptors that grab onto the B 12 Intrinsic factor complex pulling it to the bloodstream.
  5. In the blood, another protein, transcobalamin II, carries B 12 to the different cells of the body and the excess to the liver for storage. Any breakdown in this process will affect B 12 absorption, one of these is pernicious anemia an autoimmune disease that used to cause death. This disease occurs when the body stops producing intrinsic factor which makes the B 12 consumed useless.

A far more common source of B 12 deficiency is atrophic gastritis, inflammation and deterioration of stomach lining which reduces the production of stomach acid needed to separate B 12 from protein, a problem made worse by antiacids or PPI’s (proton pump inhibitors). Elderly people have smaller number of cells that produce intrinsic factor.

Other risk factors are gastric bypass surgery and stomach surgery which cause loss of the cells that produce intrinsic factor. Intestinal surgery removes the ileum where receptors that absorb B 12 are located. Crohns’s disease, celiac disease, alcohol, medications, GERD drugs, ulcer drugs, diabetes medications. Also, mercury can keep B 12 from reaching the cells where it is needed. This is all despite supplementing with B 12.

The National Institute of Health asserts that only 100 mcg out of 500 mcg is absorbed by healthy people. People with neurological symptoms need B 12 shots at least initially, until problem is controlled then they need monitored by their physicians on a regular basis.

Who is at greatest risk for B 12 deficiency?

Vegetarians, vegans, people over 60, gastric or intestinal surgery patients, people who use antiacids or PPI’s (proton-pump inhibitors), H 2 blockers, metformin and other diabetes drugs or any medication that interferes with B 12 absorption. Also, anorexics or bulimics, alcoholics. Patients with pernicious anemia in the family or iron deficiency anemia, sickle cell anemia. Other reasons for deficiency are any digestive disorder that causes malabsorption, any auto-immune disorder, women with a history of infertility or miscarriages, infants born to B 12 deficient women.

All the symptoms listed here have many other causes, so these need to be considered but because B 12 deficiency is one of them, it needs to be addressed too.

According to the authors, it is alarming to see many of us consider things like forgetfulness or falling a ‘normal’ part of aging, when in many occasions it is a sign of B 12 deficiency. Over the age of 60 vitamin B 12 deficiency is very common.

Additionally, in 30 % of cases B 12 deficiency is due to atrophic gastritis, inflammation or wasting away of the stomach lining which decreases the ability to make stomach. Doctors normally treat stomach upsets in elderly people with antiacids, which drop their acid levels even lower or they consider their symptoms part of a pre-existing condition. Neuropathy due to B 12 deficiency if left untreated will become a major disability and even cause death.

How B 12 deficiency attacks the body

B 12 deficiency takes many guises depending on age, genetics and the length and severity. Because it is progressive, signs and symptoms may take years to develop. Signs and symptoms include:

  1. Mental changes: Depression, memory loss, dementia, intellectual deterioration, irritability, apathy, sleepiness, paranoia, personality changes. In children, developmental delay or autistic behavior.
  2. Neurological:
    • Pain, tingling and or numbness in legs, arms, trunk or other area, etc. Diminished sense of touch, pain and /or temperature.
    • Loss of position sense (awareness of body position)
    • Weakness in legs, arms, etc.
    • Tremor, symptoms mimicking Parkinson’s or multiple sclerosis, incontinence, paralysis, vision changes, damage to optic nerve.
  3. Heart health: Ischemic attacks, strokes, coronary artery disease, heart attacks, congestive heart failure, palpitations, orthostatic hypertension (low blood pressure when standing up which can cause fainting and falls), deep vein thrombosis, pulmonary embolism.
  4. Immunologic: poor wound healing, increased susceptibility to infections, increased risk of cancer, poor antibody production after vaccines.
  5. Gastrointestinal: Indigestion (feeling full after small meals), abdominal pain, constipation, diarrhea, gastroesophageal reflux disease (GERD), gastric stasis, weight loss (in some people).
  6. Musculoskeletal: Fractures, osteoporosis, suppressed activity of osteoblasts (cells that build bone).
  7. Genitourinary: Abnormal PAP smears, urinary incontinence, impotence, infertility.
  8. Additional signs: shortness of breath, weakness, chronic fatigue, loss of appetite, weight loss or anorexia, tinnitus, premature gray hair.

The reason for all these symptoms is B 12 plays roles in the health of nerves, brain, blood, immune system and DNA formation. Specially, B 12 deficiency strikes the nervous system, damaging the myelin, which is linked to mental problems like memory loss, depression and dementia. As B 12 deficiency progresses, the immune system also follows because it can no longer produce enough disease fighting white blood cells making the sufferer a target for viral and bacterial infections. The gastrointestinal system suffers as well because the body cannot make enough cells to replace your intestinal lining. Also anemia will make the sufferer fatigued. B 12 deficiency also causes a breakdown in detoxification pathways that keep homocysteine levels from raising up, increasing risks of coronary artery disease, stroke and blood clots. The good news is that if caught in time it can be prevented. If you have any of these signs you can get tested to make sure.

Protecting yourself: are you at risk for B 12 deficiency? 

C. Everett Koop, M.D. former surgeon general of the United States asserts “an informed patient is the best patient. My advice to people has always been ‘Take charge of your health’. Now it’s more important than ever because with managed care, no one else is’.

According to the authors, since so many people suffer from B 12 deficiency and it’s so hard to get an accurate diagnosis, each of us should take matters in you own hands. In what follows we will explain how to determine if one is a candidate for B 12 deficiency and what to do if that is the case.

The good news is that treatment can cost under $50 a year and if caught in time it can save lives. If you receive a late diagnosis, it is even more critical that you receive aggressive methyl-B 12 injectable therapy. Some patients with late diagnoses see great improvements within weeks or months, some even a complete reversal of neurological damage. The sooner the better. Sometimes the diagnosis is made too late. In case of doubt, they insist “don’t hesitate, find out!”

Calculating your odds

B 12 deficiency doesn’t have any visible signs like having a rash does, instead there are symptoms and risk factors of deficiency that make B 12 deficiency more likely. Everybody should be familiar with them and if spotted, the next step would be to call the doctor.

The following is a checklist of risk factors and a point score to assign to each:

  1. Neurological symptoms. If you have any of the symptoms listed here give yourself 2 points, for any additional you have add another point.
    1. Do you experience ‘pins and needles’ feeling or numbness/burning feet, hands, legs and/or arms?
    2. Have you been diagnosed with diabetic or peripheral neuropathy
    3. Do you suffer from weakness in your arms/legs?
    4. Do you experience light-headedness or dizziness?
    5. Are you prone to falling or fall frequently?
    6. Have you noticed unusual changes in your ability to move? for example, do you walk clumsily or with feet wide apart, or have difficulty writing legibly?
    7. Have you noticed problems with your memory or thinking?
    8. Do you have trouble knowing where various parts of the body are if you are not looking? like trouble walking in the dark if you cannot see your feet?
    9. Does your sense of touch or perception of pain appear distorted
    10. Has your doctor ever told you that you have muscular spasticity? (lack of coordination and excessive muscle contraction)
    11. Do you have a tremor?
    12. Do you suffer from incontinence (urinary or fecal)?
    13. Do you suffer from impotence?
    14. Do you have visual impairment, visual loss?
  2. Psychiatric symptoms. If you have any of the symptoms listed below, give yourself two points. For each additional symptom you have give yourself an additional point.
    1. Have you noticed any personality changes? For example more irritability or not ‘being yourself’
    2. Are you unusually apathetic or depressed or have suicidal thoughts?
    3. Do you suffer from hallucinations or delusions?
    4. Do you exhibit violent behavior?
    5. Have you been diagnosed with psychosis, mental illness, like schizophrenia or bipolar disorder?
    6. Do you find yourself becoming more paranoid about other people’s actions or intentions?
  3. Hematological signs (abnormalities of the blood cells). If you have any of the symptoms listed below, give yourself two points. For each additional symptom you have give yourself an additional point.
    1. Has your doctor ever told you that your red blood cells are abnormally large (macrocytosis)?
    2. Has your doctor ever told you that you have abnormally small red blood cells, an iron deficiency or iron deficiency anemia?
    3. Has your doctor ever told you that you are anemic? Do you have low platelets or low white blood cell counts?
  4. Gastrointestinal risk factor. If you have any of the symptoms listed below, give yourself two points. For each additional symptom you have give yourself an additional point.
    1. Have you been diagnosed with inflammation and/or wasting of the stomach lining (gastric atrophy)?
    2. Have you been diagnosed as having low stomach acid?
    3. Do you suffer from gastritis?
    4. Do you suffer from ulcers?
    5. Have you been diagnosed with gastroesophageal reflux disease (GERD)?
    6. Do you have diverticulosis?
    7. Have you been diagnosed with precancerous gastrointestinal growths or gastrointestinal cancer?
    8. Have you undergone a gastrointestinal resection (partial or complete gastrectomy), undergone a gastric bypass surgery for weight loss, or had either partial or complete removal of your ileum (last part of the small intestine)?
    9. Have you been diagnosed with a malabsorption syndrome (Crohn’s disease, inflammatory bowel disease, irritable bowel syndrome, or celiac disease?
    10. Do you have a family history of pernicious anemia?
    11. Have you been diagnosed with small bowel overgrowth?
    12. Have you been diagnosed with a tapeworm or other gastrointestinal parasite?
  5. General risk factors. If you have any of the following factors , give yourself a point.
    1. Are you 60 or over?
    2. Do you have a thyroid disorder, or any auto-immune disease?
    3. Have you ever had cancer? Have you undergone chemotherapy or radiation therapy?
    4. Have you undergone surgery, including dental, in which nitrous oxide was used?
    5. Do you abuse nitrous oxide as a recreational drug?
    6. Are you a vegan or follow a macrobiotic or raw food diet?
    7. Are you an alcoholic?
    8. Are you taking acid reducers, H 2 blockers, anticonvulsants, Phenobarbital, potassium supplements, birth control pills, colchicine, neomycin, methotrexate, cholestyramine, colestipol or aminosalicylic acid?
  6. Other signs often associated with B 12 deficiency. If you have any of the signs below give yourself one point.
    1. Do you suffer from fatigue, lack of energy, or weakness?
    2. Do you suffer from generalized weakness?
    3. Have you experienced a loss of weight or loss of appetite?
    4. Do you suffer from chest pain, shortness of breath with small exertion?
    5. Are you unusually pale, grayish, or yellow skin color?
    6. Do you have a sore, inflamed or ‘beefy red’ tongue?
    7. Do you suffer from tinnitus (ringing in the ears)?
    8. If you are a female, has your doctor told you that your Pap Smear showed abnormal cells (cervical Dysplasia)?
    9. Do you suffer from infertility?

Add all the points. If your score is less than 3 points your risk is low. If this is your case it means your B 12 levels are probably fine, but this doesn’t guarantee that as you age they will stay that way. Keep checking your levels every year and be aware of the symptoms. If you scored 3-6 points your risk is moderate, in this case you need B 12 screening. Make an appointment with your doctor and get tested. If greater than 7 your risk is high, there is no time to waste, call your doctor as soon as possible and get tested. If your doctor is skeptical be assertive. Your doctor must rule out other diseases that mimic B 12 deficiency.

Regardless of your scores, you also need to be tested if you suffer from any neurological disorder, have chronic pain, have an occlusive vascular disorder, have a history of stroke, pulmonary embolism, heart attack, coronary artery disease or deep vein thrombosis. People with anemia, history of alcoholism, kidney problems, liver problems, people on dialysis need to have urinary MMA test along with the serum B 12 because these disorders give falsely elevated serum B 12 results.

Avoid self-testing

Self-treating possible symptoms of B 12 deficiency before undergoing tests will make it difficult to diagnose the disease by affecting the lab results. If you have any symptoms get tested before you start supplementing with B 12 supplements. After testing, your doctor can determine if you have B 12 deficiency and start treatment. Once tested you can begin with over the counter high dose lozenges while waiting for test results, but not before. Depending on the results your doctor will prescribe OTC lozenges or injections. If you have been taking B 12 and still have symptoms you still need to be tested. Make sure you tell your doctor and interrupt your supplementation before the test. If you have been supplementing and you feel improvement, you may still have tests done, your doctor may want to tweak your treatment depending on the physical exam.

Testing 

The tests the authors recommend are, in order of effectiveness, as follows:

  1. The serum B 12 test with the updated range > 450 pg/ml or 332 pmol/L. There is much controversy as to what is a normal result for this test. Because of this, this test is used together with the rest mentioned below. The problem with this test is that the ‘normal’ low (200 pg/ml) is actually low and needs to be raised to at least 450 pg/ml according to them ‘because deficiencies begin to appear in the cerebral spinal fluid below 550 pg/ml”. Normal serum B 12 should be greater than 550 pg/ml. In the case of brain and nervous system disorders and in older patients, serum B 12 levels should be maintained near of above 1,000 pg/ml.
  2. MMA: The Methylmalonic acid test also has limitations and can result in false readings, so this test needs to be done in conjunction with serum B 12.
  3. HoloTC: Holotranscobalamin test. Raising the levels of the serum test would make this test unnecessary. This is true for all the other tests.
  4. Homocysteine test: Elevated homocysteine levels can indicate deficiencies in B 12, B 6 and folic acid. This test is not necessary to test for B 12 deficiency but it is a valuable adjunct to the B 12 serum test.

The authors feel the many different OTC B 12 products (lozenges, pills, drops, nasal gels, skin patches, gums, drinks, etc) do not come with a guarantee they will be effective for each individual case. Therefore, they recommend shots. Something else in favor of injections is the fact that they are cheaper than the oral doses if you get the self injectable form hydroxocobalamin. If a loved one uses injections, the caregiver can inject the doses and thus avoid forgetting them. In her own experience, shots take minutes to prepare and they are simple to administer.

How to interpret tests results

Reference ranges for diagnostic tests are as follows:

Deficient: <200pg/ml

Borderline: 200-270 pg/ml

Normal: 271-870 pg/ml

Clinical laboratories express values in ‘picograms per milliliter’ (Pg/ml). (Sometimes they also use ‘nanograms per liter’, ng/L).

In some research studies B12 values are measured in ‘picomoles per liter’ (pmol/L). To convert from one to another, you can follow this formulas:

pgmol/L = pg/ml x 0.738

pg/ml = pmol/L divided by 0.738

ng/L = pg/ml

What does all this mean for your heart?

Sally Pacholok also recognizes the important contribution that Dr. McCully’s research provided when he discovered homocysteine in young children. She asserts ‘More than thirty years after Dr. McCully’s research, researchers around the world are proving the link between elevated homocysteine and heart disease’. According to her research, there is a tremendous avalanche of publications, about twenty to thirty per month totaling over 1,500 publications on homocysteine and vascular heart disease. According to the ‘Journal of Longevity’ Dr. McCully’s research has been a turning point in health science. Sally Pacholok believes that if he had not been so persistent in the face of criticism by his peers, ‘this entire facet of cardiovascular health might have remained hidden and many instances of circulatory problems might have remained mysteries’.

In our last article, we went into detail about how homocysteine can wreak havoc on our cardiovascular system, putting us at risk for coronary artery disease, heart attacks, strokes and deep vein thrombosis. Sally Pacholok also explains the importance that properly diagnosing B 12 deficiency can have for cardiovascular diseases. During her career as a nurse, she has seen many cases of cardiovascular patients who were misdiagnosed. 

During her research, she found many instances of misdiagnosed heart disease. In an article from the ‘Thrombosis Journal’, doctors describe a 27 year old man who went to the hospital complaining of ongoing and progressive lower extremity weakness, numbness and abnormal sensations in both legs. On the second day of admission, still with no diagnosis, the man started complaining of crushing chest pain and shortness of breath and started sweating profusely. His EKG showed he was having a heart attack, so he underwent emergency angioplasty. The surgeon found a large blood clot in his left coronary artery and inserted a stent. Doctors started the man on aspirin, a blood thinner and other cardiac medications. The next day, his echocardiogram showed reduced left ventricular function at 45%. Despite the successful cardiac stent placement he continued to complain of difficulty breathing and shortness of breath. A CT of the man’s chest revealed multiple small blood clots in this left lower lung. His blood work revealed macrocytic anemia and elevated LDH which are classic signs of B 12 deficiency. His serum B 12 was very low at 158 pg/ml and he had normal serum folate. His homocysteine was severely elevated. At this point the man’s doctors tested him for pernicious anemia. They found that he was positive for anti-intrinsic factor antibodies and started him on B 12 therapy. Seven days after his heart attack, a repeat echocardiogram showed normal left ventricular function. After ten days of B 12 therapy his homocysteine decreased dramatically from 105 to 12.9 umol/L. His neurological signs and symptoms gradually improved and after his hospital stay he was transferred to a physical therapy rehabilitation center not only to address his cardiovascular event, but to address the original neurological problems caused by chronic severe B 12 deficiency.

Cases like this are not rare, they have been reported world wide, yet few doctors consider the B 12-homocysteine connection when treating cardiac or occlusive vascular disorders. In cases like these, it boils down to the patient and family being assertive and insisting on B 12-homocysteine testing. If you are reading this and have observed signs of what could be B 12 deficiency, you would be wise to be tested for B 12 and add B 12 to your ‘Heart and Body Extract’ health protocol.

As we saw in our previous blog, excess homocysteine causes your blood vessels to lose elasticity, making it harder for them to dilate and damaging their inner lining. This damage allows cholesterol, collagen and calcium to attach to the inner walls of your blood vessels, where they can form sticky deposits called arteriosclerosis plaques. These plaques narrow your arteries and drastically increase your risk of suffering deadly disorders such as heart attacks, strokes, blood clots, carotid and renal artery stenosis or aneurysms. Homocysteine is also an oxidant that decreases the production of nitric oxide, a substance crucial to healthy blood vessels function which decreases the incidence of arteriosclerosis and high blood pressure. It is the B vitamins B 12, B6 and folic acid that convert the toxic homocysteine into a non-toxic aminoacid with the help of the liver. Being deficient in these vitamins allows homocysteine to build up and wreak havoc. According to B 12 expert Ralph Green, M.D. “For each 5 umol/L increment in total plasma homocysteine there is a corresponding increase of about 40% in the relative risk of developing coronary artery disease”. Again, supplement with these B vitamins and the products at ‘Healthy Hearts Club’ are a perfect winning combination for your heart. The ‘Female Balance Extract’ contains two important B vitamins, B 5 and B 3 and the ‘Ginseng Extract’ is a general tonic that works well with the B complex. The ‘Gland Extract’ is equally a great product that complements great with the B vitamins. It has nutrient and digestive properties, increases absorption and utilization of nutrients and stimulates the glandular system of the body. All of these products can assist your heart in lowering homocysteine levels because B 12 works best when taken with the whole B complex.

Increasing numbers of doctors are aware of the dangers of high homocysteine and the benefits of folic acid therapy. Unfortunately, few do fully understand the critical role vitamin B 12 plays in detoxifying homocysteine. According to the authors, people with high homocysteine levels often respond fully only when they are given large amounts of B 12 as well. The reason for this is that people deficient in B 12 cannot assimilate folic acid properly and as a result much of the folic acid is trapped in an inaccessible form. Many cardiologists prescribe only folic acid to patients with high homocysteine levels or give a multivitamin containing small amounts of B 12 . This is often ineffective because a few micrograms of B 12 cannot correct a significant deficiency. If you have high homocysteine levels your doctor needs to test you to determine if a B 12 deficiency exists. Proper treatment of homocysteine may include high doses of folic acid, vitamin  B 12 and B 6.

A considerable amount of research is being done on the topic. Some of this research has shown that high levels of homocysteine are associated with a subsequent risk of myocardial infarction (heart attack) independent of other coronary risk factors. Just a 5% increase in homocysteine makes it three times more likely for a person to suffer heart attacks. Vitamin supplementation, according to research, can be used to treat high levels of homocysteine. Similarly, in the ‘New England Journal of Medicine’ Norwegian researchers followed 587 patients and found a strong relation between plasma homocysteine levels and overall mortality. Another study of more than 400 patients who had suffered a heart attack or unstable angina showed that the death rate from cardiac disease was more than twice as high for patients with higher homocysteine. Finally, another study performed by physician David Wald and his colleagues studied the effects of a common gene variant that raises homocysteine levels concluding that the association of homocysteine and cardiovascular disease is causal.

Similarly, in women, even young women, high homocysteine levels has been shown to nearly double the risk of stroke. The magnitude of the increase in stroke risk was similar to that of smoking a pack of cigarettes a day. Dozens of additional studies corroborate these findings, implicating high homocysteine is one of the most powerful cardiovascular risk factors ever identified. Luckily this is easy to treat. One recent study tested the effects of supplementation with folic acid alone, B 12 alone and folic acid B 12 together. Research showed that all three approaches worked but the combination approach yielded the most remarkable results with plasma total homocysteine reduced by 38.5 %. Evidence shows that the same impressive results can be achieved by the majority of people who stick with the vitamin regiment. In my opinion, it is important to stress that B 12 should be taken with the whole B complex because all the B vitamins work together.

Additional studies on the effectiveness of the homocysteine therapy show lowering homocysteine can dramatically lower the risk of death or debility. We can list the following:

In a study of patients that had undergone angioplasty to correct coronary artery stenosis (narrowing of the arteries). After one year, the researchers reported the incidence of major adverse events was one third in the treatment group.

In a separate six month double blind study a Swiss research group administered folic acid, B 6 and B 12 to a group of patients who had undergone successful coronary artery angioplasty. The rate of restenosis (re-narrowing of the arteries) was significantly lower and the group had less than half the need for a repeated procedure on the targeted lesion. The researchers concluded the vitamin treatment, with minimal side effects, should be considered as adjunctive therapy for patients undergoing coronary angioplasty. 

In another study, Australian researchers reported 90% reduction in cardiovascular events in people with homocystinuria who received homocysteine lowering therapy.

Similarly, researchers in the United Kingdom and Norway evaluated 89 men, ranging in age from 39 to 67 with existing coronary artery disease to determine if oral B vitamins would have an effect on the health of the arteries. After eight weeks of treatment with folic acid and vitamin B 12, the subjects’ plasma homocysteine levels dropped significantly compared to levels in similar men taking a placebo. In addition, the arteries of men taking the vitamins dilated more efficiently in response to blood flow demands. These findings, the researchers concluded, ‘support the view that lowering homocysteine through B vitamin supplementation may reduce cardiovascular risk‘.

Physician Tedd Mitchell shares his testimony of how his grandfather died at the age of 50 of a massive heart attack and his father had a quadruple bypass in his 50’s, even though they were non-smokers, had no high blood pressure, diabetes, high cholesterol or obesity. After learning about homocysteine he decided to get checked and lo and behold…, his homocysteine was significantly elevated. As a result of this he changed his life style, started taking supplements of folic acid, B 12 and B 6 after which his homocysteine levels became normal. All this evidence shows how simple, non-toxic preventive measures like this may be one of the most powerful and simple preventive measures we can implement for people at risk for cardiovascular disease. While many patients are told to stop smoking, exercise, lose weight and lower their cholesterol, many patients with heart attacks do not have these risk factors. Similarly, many people who seemingly are in good health are suffering from strokes, blood clots, etc at earlier ages. Many of these people carry very common gene variants that can cause their homocysteine levels to rise to dangerous levels. For these people, early and accurate testing for high homocysteine and low B 12 levels might mean the difference between dying young and leading a long healthy life.

These reports are exciting because they indicate that homocysteine-reducing vitamin therapy, an inexpensive, simple, and safe treatment may significantly reduce the rate of cardiovascular disease. What is more, these studies used low dose oral B 12 which is less effective than high dose B 12 in patients with existing deficiencies. They also used oral tablets, which are less effective than B 12 lozenges or injections, and used cyanocobalamin, which does not stay in the body as effectively as the bioactive form methylcobalamin.

The authors assert that in order for researchers to fully understand B 12, studies need to include serum B 12 levels in the ‘normal’ low or perform urinary MMA testing of subjects. People who discover their homocysteine levels to be high should not take any chances.

Despite all this evidence, the medical community shows mixed feelings toward the effectiveness of lowering high homocysteine. However, the authors believe that if early testing for high homocysteine became common place, it would be possible for such life threatening vascular events in young people to become far more rare. “We might be able to help hundreds of thousands of people who can be treated with vitamins at a very early age, before they ever begin to develop blood vessel lesions that can cause premature heart attacks, blood clots or strokes. Identifying B 12 deficiencies that can lead to high homocysteine levels would also have huge health benefits.” the authors assert.

As a practicing physician and nurse, Sally Pacholok does not see cardiologists including B 12 in their cardiac work-ups. The few cardiologists that order homocysteine tests typically treat high levels only with folic acid. She does not see internists or general practitioners testing for B 12 deficiency either or ordering homocysteine levels although they have no problem ordering numerous lipid profiles for cholesterol. She sees hundreds of cardiac patients coming through the emergency department who have been prescribed high doses of folic acid but no B 12. She shares the real story of a 56 year old man who complained of chest pain. He had a history of a previous heart attack, non-insulin dependent diabetes, GERD, depression and five stents. He was borderline anemic, he complained of numbness and tingling in his feet but his doctors had told him it was due to diabetes. He had been taking a PPI for five years, an antidepressant for three years, a cholesterol lowering agent and a multivitamin prescribed by his doctor for he last five years. He had all the symptoms of B 12 deficiency. The doctor ordered tests including  B 12 and homocysteine. The results indicated normal renal function and his lipid profile was picture perfect. He was found deficient in B 12 and his homocysteine levels were very elevated, all the evidence showed that this is what caused his significant coronary artery disease and poor health. Had the doctors tested his B 12 levels, all of this could have been avoided.

If you are at risk, get tested

Given the evidence that high homocysteine is a risk factor for vascular disease in both young and old people, screening for B 12 should be commonplace for people at risk. Homocysteine should also be routine for senior citizens, pregnant women and people with diabetes, patients with renal disease, auto-immune disease, thyroid disease. Also people that use of medications that raise homocysteine levels like lipid lowering drugs, metformin, anticonvulsants etc, people who already have a diagnosis for cardiovascular disease should be tested for homocysteine and B 12. Patients with high homocysteine levels should be evaluated for underlying B 12 deficiency and should be treated with standard doses of folic acid, B 6 and B 12. “Even people in the upper range of what’s considered normal should be started on homocysteine-lowering therapy, because levels only 12% above the highest normal level are linked to a threefold increase in the risk of heart attack.”

Equally important when the patient undergoes homocysteine lowering therapy is the need to insist that you doctor first obtains a baseline B 12 and urinary MMA. As the authors have noted, folic acid corrects the anemia and enlarged red blood cells that doctors generally look for when checking for B 12 deficiency, but does nothing to stop the neurological damage caused by depleted B 12 stores. B 12 testing will allow doctors to tailor the homocysteine lowering program to the patient’s individual needs. In some cases, high-dose oral B 12 will be sufficient. In others, injected B 12 will be necessary. This is all to say doctors cannot merely guess how much B 12 is enough for each patient, therefore the need for adequate testing.

Treatment

In the authors’ opinion, B 12 injections are preferable to oral B 12 because of the difficulty with absorption. In the case of neurological symptoms, injections are absolutely necessary. The authors have personally seen that in these cases high doses of oral B 12 do not work.

There are three forms of supplemental vitamin B 12: cyanocobalamin, hydroxocobalamin and methylcobalamin. Current evidence shows that the retention of hydroxocobalamin is three times superior to that of cyanocobalamin 28 days after injection. Also, methycobalamin is superior to hydroxocobalamin for neurological disease but it is not widely used in the United States. Japanese studies show methylcobalamin bypasses several potentially problematic steps in B 12 metabolism. In addition, methylcobalamin provides the body with essential methyl groups that reduce oxidation. Oral methylcobalamin is retained better than cyanocobalamin in the liver and other tissues.

In addition, there are concerns about the use of cyanide based vitamin B 12 derivative, which has to be detoxified and cleared by the liver. Some people with certain conditions like ‘Leber’s hereditary optic neuropathy (LHON), hepatitis sufferers, smokers  and children with inborn errors of B 12 metabolism should not take the cyanide form of B 12. In all these cases, hydroxocobalamin has an antagonistic effect on cyanide.

Whether it is the methylcobalamin or the hydroxocobalamin form, what it is important to know is that in severe cases (auto immune pernicious anemia, gastric or ileal surgery patients) the treatment needs to be continued for life.

B 12 deficiency is a publich health crisis, particularly in the Baby Boomers generation.

The oral versus the injected forms

While there is a need for more research on the topic, there are small studies showing that daily high-dose oral B 12 (2,000 mcg) was effective in producing hematologic and neurologic responses as a standard injectable regimen with patients with B 12 deficiency. Proving that, in some cases oral B 12 can replace injections. For patients with a variety of symptoms, more research is needed comparing oral and injectable forms of B 12.

Regarding the dose, most B 100 supplements may contain 6 mcg of B 12 versus the 2,000 mcg the authors consider to be a normal dose. To this, we need to add we don’t know how much of it is absorbed, all of which might prove fatal for many patients. Adding the fact that the efficacy of injections has been well studied, which cannot be said of many over the counter B 12 products, the authors lean toward the injectable form as the best form.

Treatment for B 12 deficiency is very inexpensive. One year costs $36 when patients administer the injections themselves. High-dose methyl-B 12 lozenges (2,000mcg) can cost between $48-72 a year depending on the brand. This is far cheaper than having to treat a demented patient with undiagnosed B 12 which could be over 1,000 a year, or 60,000 a year for a Alzheimer’s patient, multiple sclerosis or developmental disability.

Don’t quit

Taking B 12 for a few weeks only will not solve the problem, not in the case of severe cases. In these cases, the patient will have to take them for the rest of their life. Once they have been regular taking their B 12 shots, your levels will stay normal for several months even years. This is because B 12 is stored in the liver, however, this is not a reason to stop treatment. Eventually, the symptoms will come back if treatment is stopped. The authors also advise to always keep medical records, specially when switching doctors. They recommend to be assertive with doctors that are not knowledgeable about B 12.

Spread the word

It’s not unusual for B 12 deficiency to run in families, so if someone is diagnosed with this disorder, they should let their relatives know. In most cases, several other cases of deficiency are usually discovered.

According to the ‘Centers for Disease Control and Prevention’, June 29, 2009 “Vitamin B 12 deficiency should be on our radar screen …Prevention, early detection and treatment of B 12 deficiency are important public healthy issues, because they are essential to prevent development of irreversible neurological damage which can impact quality of life”