B12 Deficiency, a Growning Concern in Children and Adults

By Dr. Iva Lloyd, ND

Vitamin B12 is a water-soluble vitamin that is naturally present in foods that come from animals, including fish and shellfish, meat (especially liver), eggs and milk products, as well as fortified cereals and other fortified foods. With changes in dietary patterns and other factors, vitamin B12 deficiency is becoming a major concern.

Symptoms of Vitamin B12 deficiency

Vitamin B12 is required for proper red blood cell formation, neurological function and DNA synthesis.

Signs of B12 deficiency in adults include:

• altered or decreased growth of cells and poor oxygen-carrying capacity of blood
• impaired neurological function including diabetic neuropathy, peripheral neuropathy and vertigo
• increased susceptibility to infection and/or gastric mucosal atrophy including disturbed digestion, nausea, anorexia, diarrhea or constipation and urinary incontinence. 
• The mental symptoms of Vitamin B12 deficiency are extremely variable and include disorders of mood, mental slowness, memory defect, confusion, severe agitation and depression, personality disorders, delusions and even paranoid behaviour or hallucinations. 
• There is a very strong correlation between Alzheimer's disease and vitamin B12 deficiency.

Signs of B12 deficiency in children include:

• developmental delays or regression in behaviour and impaired neurological development including seizures, mental retardation and even Autism.
• irritability, apathy, as well as, ADD and ADHD type behaviour. 
• Treating B12 deficiencies in children is critical for their development, both physically and mentally.

What causes a deficiency?

A deficiency of B12 can be caused by:

• food intolerances can result in blow B12 levels
• digestive issues, especially hypochlorhydria (low stomach acid) or any condition that impairs the mucosal lining of the gastrointestinal track
• decreased consumption of dietary red meat, fish or eggs
• vegetarian diets increase the risk of deficiency for both an individual and for any breastfed children
• increased consumption of folate-fortified foods and supplements
• some parasites and bacteria compete for the available B12 which can result in a deficiency
• there are some conditions such as Multiple Sclerosis, endocrine disorders, hemorrhage and other conditions that deplete B12 levels
• surgeries that involve the removal of part of the colon often results in B12 deficiency
• exposure to medication which depletes B12 status or block Intrinsic-Factor-mediated B12 absorption (birth control, antacids, heartburn medications, anti-epileptics, etc.) 

The Link between folate and Vitamin B12

Over the last twenty years specific foods have been fortified with folate. Folate fortification and maternal supplementation were a public health initiative aimed at reducing folate-deficiency neural tube defects at a time when populations were eating large amounts of red meat (B12 rich) but few fruits and vegetables (folate-rich).

Part of the rise in Vitamin B12 deficiency rates is due to the high amounts of folate-fortified foods that individuals have consumed over an extended period of time. High levels of folate block Vitamin B12 and can both mask and exacerbate B12 deficiency symptoms.

Testing for Vitamin B12 deficiency

The normal blood testing for Vitamin B12 levels is often not diagnostic and normal values do not exclude B12 deficiency. If you experience any of the symptoms above, I encourage you to ask your naturopathic or medical doctor to run a blood test for both Vitamin B12 levels and for RBC folate.  A high level of folate will result in a Vitamin B12 deficiency, even if your blood level of Vitamin B12 is normal.

Because of the strong link between Vitamin B12 levels and decreased cognitive function, it is often recommended that anyone with signs of memory loss be tested for Vitamin B12 deficiency.

Another way to gauge Vitamin B12 deficiency is to request an intra-muscular injection of Vitamin B12 and see if you notice any symptoms.  Generally speaking, a positive result to a Vitamin B12 injection will be noticed within 48 hours.

Treating Vitamin B12 deficiency

Monthly intra-muscular injections of B12 are the most efficient way of building up low levels of B12 in the body. Often after the first injection there is a notable improvement in either energy, cognitive function or sleep. Vitamin B12 injects are generally regarded as very safe.

Depending on your levels, it can take between 3 and 6 months, or more, to re-establish normal B12 levels. For mild symptoms or once levels have been re-established with intra-muscular infections, sublingual Vitamin B12 may be indicated, especially if there is also a decreased consumption of B12 rich foods.

There are three types of B12:

1. cynocobalamin is the most common and least expensive form of B12. It is the form that is often used in the United States for intra-muscular injections.
2. hydroxycobalamin lasts longer in the body and requires less frequent injections. It is often considered more potent than cynocobalamin.
3. methylcobalamin is the most expensive form of B12. It is more effective when B12 injections are being used for cognitive concerns or for peripheral or diabetic neuropathy.

If you suspect that you have a B12 deficiency and you have been taking B12 injections without much improvement, I encourage you to request a different form of B12.

Vitamin B12 deficiency is very common and is very easy to treat.  If you are suspect that you may be deficient I encourage you to get tested.  For more information talk to your naturopathic doctor.

Key to a Strong Mind

A strong healthy mind is something that everyone seems to desire. For many it is taken for granted until there are signs of decline. Memory loss and cognitive decline is not inevitable. It is not a natural part of aging. Achieving and maintaining a strong mind requires work and constant attention.

Mental health and cognitive function is strongly determined by the strength of the blood-brain barrier (BBB). The BBB is a tight barrier that surrounds the brain and ensures that only the nutrients, water and other elements that are meant to get into the brain, do. When the BBB becomes damaged or weakened, signs of mental decline, decreased sensory and cognitive function start to appear. The factors that impact the integrity of the blood brain barrier include:

• Dehydration, especially chronic dehydration is strongly correlated with decreased mental and cognitive function.  The body is primarily water. As a person becomes dehydrated, the tight junctions in the brain become more permeable and the brain is not as effective at blocking the entry of toxins.
• Nutritional imbalances, especially as it relates to vitamins, minerals and oils are strongly associated with decreased cognitive function. The most vitamin deficiency associated with dementia and Alzheimer Disease is Vitamin B12. 
• Head injuries and trauma, such as whiplash, contact sport injuries, falls and motor vehicle accidents can weaken the integrity of the BBB, especially if the injury is not properly addressed and results in chronic inflammation.  
• Poor posture, especially forward-head posture, puts additional stress on the head and the brain.
• Pathogens such as viruses, bacteria, parasites and mold can contribute to decreased cognitive function.
• Environmental toxins, such as heavy metals (aluminum, mercury and lead) and chemicals contribute to cognitive decline and many other chronic health problems.
• There are a number of prescription medications that contribute to decreased cognitive function. Check with your naturopathic doctor to see if any of the medications that you are taking are associated with decreased cognitive function.
• Sleep is when the body heals and recovers from the stress of the day. Lack of sleep, especially chronic insomnia, is strongly associated with decreased cognitive function.

Other factors that are associated with decreased integrity of the BBB include:

• high ferritin levels which often indicate high inflammation levels in the body
• high insulin levels which often indicate diabetes
• high sodium levels which are often associated with increased salt intake
• high triglyceride levels which are linked to both high cholesterol and high fruit or fructose intake
• decreased blood flow to the brain which is often seen in atherosclerosis or peripheral artery disease
• and increased oxidative stress on the body.

The key to a strong mind is to:

Address the factors that impact the integrity of the BBB, such as:

• Ensure that you continue to drink adequate water on a daily basis. Generally speaking you want to drink half your body weight in ounces a day.
• Your diet is one of the key contributing factors to your ongoing cognitive function. It is also the one that you have the most direct control of. Ensuring that food sensitivities are addressed is a great place to start. It is also important to ensure that your diet is balanced with adequate lean protein, vegetables and healthy fats.
• Ensure that you take the steps necessary to ensure that your blood sugar and cholesterol concerns are addressed with natural solutions. Simply taking medications, without addressing the underlying causes may actually increase your risk of cognitive decline.
• Ensure head injuries are adequately addressed. The main threat to the BBB is unresolved head trauma and chronic inflammation. There are a number of natural therapies that can effectively decrease chronic inflammation and that can minimize the impact of sport injuries.
• Work with your naturopathic doctor to determine if heavy metals are a factor. Heavy metals disrupt the normal functioning of the brain, they decrease the body's ability to absorb nutrients and they cause a more dramatic decline than other lifestyle factors.

Other factors that are essential to a strong mind include:

1. Use it or lose it. The mind, in many ways, is like a muscle. If you want a strong mind you have to work every aspect of it.  To the mind, memory, speed, problem solving, attention, flexibility (multi-tasking) are all different aspects. Numbers, words and names are all processed in different aspects of the mind. Working the mind on an ongoing basis is key to health. Some options include:
• Ensure that you continue to read, preferably not on a computer or e-book (too much computer time can actually contribute to weakening the BBB.
• Work whatever aspect of the mind is a concern.  If you have problems finding words then do word searches and cross word puzzles. If you have problems remembering names then practice by going through old pictures and saying the names of people out loud when you meet them.
• Check out www.lumosity.com  It is a website geared to working all aspects of the mind.
2. Decrease anxiety. Chronic anxiety is exhausting. It is also dehydrating. There is a strong link between chronic anxiety and decreased overall cognitive function.
3. Be positive. A positive mind is associated with increased cognitive function and decreased memory loss. 
4. Take care of your senses. There is a strong link between hearing, seeing and cognitive function, as well as mental health.

Most importantly, don't wait until you have a problem. Like most health issue, your best chance of being healthy is to prevent disease. It is about being proactive and recognizing that most health issues, especially as you get older are simply an accumulation of your life. It is like a life-long balance sheet that weighs the impact of the positive and negative factors.

If you would like to learn more about what you can specifically do to achieve a strong mind book an appointment with Dr. Iva Lloyd, ND.  To learn more about how the breakdown of filters in the body contributes to disease check out the presentation that Dr. Lloyd, ND gave at Health Fusion in June 2013.