Micronutrients in Mental Health Series II
Vitamin B12 is nutrient is critical in proper mental functioning and overall health. If intake or absorption of vitamin B12 is insufficient, a wide array of psychiatric (anxiety, depression, psychosis to name a few), cognitive (memory loss and confusion) and gastrointestinal (constipation and low stomach acid) can result. Vegetarians and vegans are particularly at risk of deficiency as the main sources of this nutrient are from foods of animal origin. In my practice, vitamin B12 injections have proven very helpful in addressing anxiety and other conditions mentioned herein. Here is a former patient’s experience of how this nutrient affected her health:
“When I started B12 injections in 2009—-I know this sounds dramatic—my vision became clearer-brighter, my mind clearer, my well-being calmer. I’d been living with a low-grade anxiety all of my life assuming that feeling was normal. I am no longer anxious! With B12 injections every two weeks, I have more energy and joie de vivre.”
To understand how common signs and symptoms relate to this nutrient, I will briefly describe the biochemistry of B12. (Please bear with me- it should all make sense soon!)
Functions of B12
One of the functions of B12 is to be involved in transferring methyl groups (3 hydrogen molecules with a carbon) in the body. This type of reaction is a key step in a myriad of biochemical reactions in the body, one of which involves the formation of SAMe (S-Adenosyl methionine), an intermediate in the synthesis of neurotransmitters.
Another key function of Vitamin B12 is DNA synthesis; this explains why red blood cells are enlarged in deficiency (the insufficient DNA synthesis keeps them from dividing sooner). This effect also helps one diagnose a vitamin B12 deficiency. The term for anemia due to vitamin B12 deficiency is ‘megaloblastic anemia’, i.e. the cells are larger (recall if you read last month’s blog on iron-deficiency, that the cells are smaller (microcytic) when iron deficient.) Folate (vitamin B9), also causes megaloblastic anemia – we will discuss this further in the next blog post.
Finally, the third key function of vitamin B12 to discuss is its role in synthesizing myelin – a protective sheath on nerves. This is responsible for a number of the signs and symptoms of B12 deficiency .
Signs & Symptoms of Deficiency
Vitamin B12 deficiency can manifest with a number of different signs & symptoms due, at least in part, to its aforementioned roles in methyl transfer reactions, in DNA and myelin synthesis:
- Psychosis, often with paranoia
- Delusions, Hallucinations
- Poor memory
- Mental confusion
- Mental ‘slowness’
- Weakness, Fatigue
- Shortness of breath
- Vision loss (partial- certain fields of view are diminished)
- Numbness & tingling in the hands and feet
- Loss of vibration and position sense
- Poor muscle coordination
- Tongue soreness
- Decreased stomach acid
- Suboptimal intestinal absorption/malabsorption
- Elevated homocysteine (a marker that signals increased risk of cardiovascular disease)
- Abnormal liver function tests
Causes of deficiency
- Malabsorption, Celiac disease, Inflammatory Bowel Disease (Crohns and Ulcerative colitis)
- Low stomach acid, gastrectomy
- Tapeworms, Gastrointestinal floral imbalance?
- Intrinsic factor deficiency (a factor required for proper absorption of B12)
- Strict vegetarian/vegan diet (without adequate supplementation)
- Chronic alcoholism
- Medications, including anticonvulsants & antibiotics and possibly oral contraceptives, (interfere with B12 absorption)
- Liver disease (affects storage of B12)
- Hyperthyroidism (increases B12 needs)
- Pregnancy (increased demands for B12 )
- Megadoses of vitamin C (may destroy B12 )
- And a number of other medications, diseases & conditions (methotrexate (medication), pancreatic disease, HIV/AIDS, GI cancers,….)
Laboratory tests, which may include all or some of the following: Complete Blood Count (CBC), serum B12, Homocysteine and Methyl Malonic Acid are often used to determine if you have a vitamin B12 deficiency. Genetic testing to determine enzyme aberrations that may predispose to B12 deficiency may also be performed (MTHFR (Methylenetetrahydrofolate Reductase) polymorphisms are one such aberration). It is imperative to be properly evaluated by a trained physician before supplementing with vitamin B12 as it is possible to mask deficiencies of other nutrients, or to induce additional vitamin imbalances with self-medication.
The following questionnaire, produced by Mark Hyman, MD is a helpful tool to determine if your methylation pathways (which involve vitamins B12, B9 & B6 ) are impaired due to a deficiency of one or more of these nutrients. You will assign a ‘1’ beside each of those questions which you answer ‘yes’ to.
Scoring the test:
0-8; generally indicates a low-level problem with methylation
≥9; may indicate a severe problem with methylation. A visit to a skilled medical provider who works with nutrient supplementation and diet is advised.
Treatment for deficiency
Depending on the cause and severity of deficiency, vitamin B12 may be administered by injection, (intramuscularly), sublingually, in capsule form or via a nasal spray. Adding rich sources of vitamin B12 to the diet, wherever possible, is highly recommended.
Vitamin B12 is produced in nature from microorganisms and is thus not found in plant foods, unless they are contaminated with microorganisms, (which occurs with seaweed). It can also be obtained from organ meats and other animal products (vitamin B12 is stored in some of the organs and is present in other tissues). Rich sources of this nutrient include organ meats (liver, kidney and heart in particular), clams and oysters. Moderately rich sources include fish and seafood (salmon, sardines and crab) and egg yolks. Moderate sources include dairy products.
Addressing Mental Health Concerns with Vitamin B12
It is recommended that those suffering from anxiety, depression, or psychosis, especially if accompanied by other signs and symptoms outlined in this blog post, have screening blood work to rule out nutrient deficiency/deficiencies. If a nutrient deficiency is present, supplementation and some dietary changes can often make a world of difference!
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- Hyman, M. (2009). The UltraMind Solution Companion Guide. Retrieved from http://drhyman.com/downloads/UltraMindCompanionGuide.pdf
- Herbert, V. & Kshitish, C.D. (1994). In Shils, M.E. , Olson, J.A. & Shike, M. S. (Eds.), Modern Nutrition in Health and Disease. (8th ed.). (pp. 402-422). Philadelphia, PA: Lea & Febiger.
- Marz, R.B. (1999). Medical Nutrition from Marz. (2nd ed.). Portland, OR: Omin-Press