Vitamin B12, Psychiatry & Physical Health | A Healthy State of Mind

Posted by Mary R. Fry, N.D. on Friday, July 26, 2013

In last month’s blog post on iron’s role in mental (and physical) health, we covered one of a trio of ferromagnetic metals found in nature. Cobalt is another such metal that has a prominent role in our mental (and physical) health. Cobalt is seldom found in its free form, needing to exist in compounds with other element(s) to be stable.  Cyanocobalamin is one such compound, which is also known as Vitamin B12.  This nutrient is critical in proper mental functioning and overall health.  Here is one  woman’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:

-Anxiety -Depression -Agitation -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 -Constipation -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,….)

Diagnosing deficiency

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, B & B ) 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.

 Methylation Quiz1

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.

Food Sources

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!

If you would like to be notified of when a new blog entry is posted and/or would like to receive the clinic’s quarterly newsletter, be sure to sign up!

References:

  1. Hyman, M. (2009). The UltraMind Solution Companion Guide. Retrieved from http://drhyman.com/wp-content/uploads/2012/03/UltraMindCompanionGuidewithCover1.pdf – page 10
  2.  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.
  3. Marz, R.B. (1999). Medical Nutrition from Marz. (2nd ed.). Portland, OR: Omin-Press.

Categories: Anxiety Disorders, Depression, Diet & Nutrition, Schizophrenia & Psychosis, Supplements Tags: celiac disease, Cyanocobalamin, memory, nutrient deficiencies, vegan, vegetarian, Vitamin B12, vitamins

Folate, Genetics & Mental Health | A Healthy State of Mind

Posted by Mary R. Fry, N.D. on Friday, January 31, 2014

Folic acid has been widely researched for the treatment of depression. In this post we will continue our Micronutrients in Mental Health Series, covering the 3rd nutrient implicated in depression and anemia with our discussion of folate. The name ‘folate’ is derived from the Latin ‘folium’ which means foliage, as it is abundant in leafy green vegetables and was first isolated from spinach.  A deficiency of folate (also known as folic acid and vitamin B9) has been associated with depression, with regular supplementation of the nutrient returning one to euthymia (or a normal mood). Prescription forms of active folic acid (Deplin, Metanx and others) are readily prescribed to augment the effects of antidepressant medications (improve the efficacy of antidepressant medications) and to treat ‘treatment resistant’ depression.

Symptoms of a deficiency

A holistic evaluation of a patient with depression often includes a nutritional history and may include genetic testing to determine if there are genetic polymorphisms that limit absorption and metabolism of this nutrient. A set of genetic polymorphisms that can affect folic acid absorption include those coding for an enzyme required for folate metabolism, Methylenetetrahydrofolate reductase (MTHFR). If an individual has such a polymorphism,  reduced enzyme activity results and they are increasingly likely to suffer from depression (and are also at higher risk of heart disease, gastrointestinal tract issues, megaloblastic anemia, birth defects, infertility, cervical dysplasia, cognitive difficulties and a number of other symptoms/conditions associated with folate deficiency). Other signs and symptoms of folate deficiency include weakness, fatigue, shortness of breath, irritability, forgetfulness, dizziness, headaches, palpitations, a sore tongue, gum disease, diarrhea, loss of appetite, weight loss and abnormal liver enzyme results on labs.

The following questionnaire, produced by Mark Hyman, MD is a helpful tool to determine if your methylation pathways (which require vitamins B12, B (folate)& B to function optimally) are impaired due to a deficiency of one or more of these nutrients. 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.

Diagnosing deficiencies

Naturopathic physicians often evaluate patients for genetic polymorphisms and can also investigate other causes of poor folate status (including food allergies, a variety of medical conditions and medications). Those suffering from Ulcerative Colitis, Celiac disease and any condition with gastrointestinal inflammation are at increased risk of deficiency due to malabsorption.  Smokers and those with high alcohol consumption also have lower folate status. Those with liver disease and on dialysis also have lower folate status and are thus potentially more prone to deficiency and depression. Medications that adversely affect folate status include oral contraceptives (or birth control pills), anticonvulsants (which are prescribed in some cases of bipolar disorder), methotrexate, diuretics and proton pump inhibitors.

Laboratory evaluations are highly recommended prior to supplementing folic acid as folic acid supplementation can mask a vitamin B12 deficiency, causing potentially severe neurological effects. Serum folate is often measured, but this test is not a good indicator of folate status over time (it is sensitive to short-term changes in folate intake).  To get a more reliable sense of folate stores, erythrocyte (or red blood cell) folate is preferred. Other laboratory tests that may be performed to assess folate status include Homocysteine, Methyl Malonic Acid and serum B12. Ruling out iron-deficiency anemia is often a part of the work-up as well.

Treating folate deficiency & MTHFR polymorphisms

Supplements with the active form of folate (L-methylfolate, 5-MTHF or Metafolin) are preferred over most prescription forms as they do not contain potentially harmful colorings, flow agents and fillers commonly found in the prescription preparations.

Foods rich in folate include liver, asparagus, legumes, dark green leafy vegetables and whole grains. Folate is lost as vegetables are stored at room temperature and with excessive cooking. While many grains and cereals are fortified with folate, most gluten-free grains/grain products are not. Fortification is potentially harmful for those with the MTHFR polymorphism and may need to be avoided as part of their treatment regimen.

Finally, lest I get too reductionistic in discussing folate metabolism, it is helpful to take a step back and appreciate that human physiology and biochemistry is anything but simple. In its complexity we see that there is much interdependence between nutrients and synergy in absorption and metabolism in some cases. To properly process and utilize folate in our diet, we need to have a balance between dietary protein, vitamin B12 and folic acid levels. Those with deficiencies of any of these nutrients will also have imbalances in the other nutrients,.

Addressing Mental Health Concerns with Folate

If you or someone you know suffers from depression (and/or some of the deficiency symptoms listed herein), a comprehensive evaluation by a physician skilled in nutrition is advised to determine the cause(s) or factor(s) contributing to this mood disorder. Supplementation in the absence of such evaluation and testing may lack efficacy or even pose harm.

If you would like to be notified of when a new blog entry is posted and/or would like to receive the clinic’s quarterly newsletter,  sign up here to be added to the mailing list.

References:

  1. Hyman, M. (2009). The UltraMind Solution Companion Guide. Retrieved from http://drhyman.com/wp-content/uploads/2012/03/UltraMindCompanionGuidewithCover1.pdf – page 10
  2.  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. 402-423). Philadelphia, PA: Lea & Febiger.
  3. Marz, R.B. (1999). Medical Nutrition from Marz. (2nd ed.). Portland, OR: Omni-Press.
  4. Masterjohn, C. (2012). Beyond Good and Evil: Synergy and Context with Dietary Nutrients. Wise Traditions, 13 (3), 15-26.

Categories: Depression, Diet & Nutrition, Supplements Tags: 5-MTHF, Anemia, anticonvulsants, Deplin, genetic polymorphism, medication, Metafolin, Mood, MTHFR, oral contraceptives, proton pump inhibitors, vegetables, vitamins