Complete Remission of Psychiatric Symptoms with Vitamin B12 -Case Study in Literature

B12 deficiency rates are high in people with gluten sensitivity. I list a number of mechanisms:

-low stomach acid ( achlorhydria) from an autoimmune process (Gluten sensitive people have 12 times the rate of autoimmune disorders) or from drugs like metformin and proton pump inhibitors

-antibodies to intrinsic factor, disabling the protein that carries B12 from the GI system into the bloodstream

- dietary restrictions

- higher B12 needs because of methylation gene abnormalities called MTHFR

- and brain fluid called cerebrospinal fluid (CSF) may have a much lower level of B12 because of an impaired blood brain barrier and so the brain function may be impaired.




All these factors also make it tricky to take oral B12 and expect it to increase the amount of B12 in the brain, where you want it.The blood level does not accurately reflect the level of B12 in the CSF. ( van Tiggelen CJM, Peperkamp JPC, Tertoolen JFW. Vitamin B12 levels of cerebrospinal fluid in patients with organic mental disorders. J Orthomolec Psych. 1983;12:305–311.)

I would like to report the case of a man in his early thirties who came into my practice a few months after he was admitted to a psychiatric facility for 6 weeks. He had refused all medication, and after being assess as a person with schizoaffective disorder he was discharged in much the same condition. I placed him on a gluten free diet while testing proceeded, but this was easy as he was living with his parents and his mother was on a gluten free diet already. It was difficult to get testing done but when it was done it was clear he was vitamin B12 deficient,( and his hospital notes revealed the same thing). And he had two genes for celiac disease.

He had suffered for years with mood swings, lethargy, and intermittent perceptual disturbances and had been prescribed psychotropic drugs on and off. He was never suicidal although this symptom is common in gluten sensitive individuals.

On the gluten free diet, he was having less negative symptoms, but there was a noticeable improvement when he self administered B12 shots. He has had periods of going off B12 shots, but his family members notice and remind him to give himself a shot. When taking shots regularly, he is alert, oriented, and has a stable romantic relationship. He is looking for work in his field.

In the literature we find a severe case where B12 was the only additional treatment. I don't find B12 deficiency unusual as a cause of mental symptoms. For testing I use homocysteine and urinary methylmalonic acid measurements as I find serum B12 measurements unreliable and it can miss methylation polymorphisms ( which has an prevalence in my practice of 76% for at least one SNP of c677T or a1298c). I will also do a trial of IM or Subcutaneous B12, and see what happens. If people feel better after the B12 the next step is to find the frequency. Some people need a shot a day but this is unusual.( this indicates multiple methylation polymorphisms, and/or heavy metal intoxication and/or active autoimmune disorders blocking B12 from going easily through the blood brain barrier, leading to low brain levels of B12.And needing more help). I recommend folate with B12 shots to avoid folate deficiency, in the form of a good B complex, with or without NAC. 

Here is what Dr. Kelly Brogan, a psychiatrist has to say about B12 and mental health:

If this is not a wake up call to the average psychiatric prescriber, I’m not sure what is. Much of what we attribute to serotonin and dopamine “deficiencies” melts away under the investigative eye of a more personalized style of medicine that seeks to identify hormonal, nutritional, and immune imbalances that can “look” psychiatric in nature.

How can B12 impact brain health?
B12 supports myelin (which allows nerve impulses to conduct) and when this vitamin is deficient, has been suspected to drive symptoms such as dementia, multiple sclerosis, impaired gait, and sensation. Clinically, B12 may be best-known for its role in red blood cell production. Deficiency states may result in pernicious anemia. But what about B12’s role in psychiatric symptoms such as depression, anxiety, fatigue, and even psychosis?


The one-carbon cycle refers to the body’s use of B vitamins as “methylators” in DNA synthesis and the management of gene expression. There are three concepts that relate to B12’s role in chronic, long-latency neuropsychiatric syndromes:
1. Methylation
This process of marking genes for expression, like little “read me!” signs, is also critical for detox and elimination of chemicals and hormones (estrogen), building and metabolizing neurotransmitters, and producing energy and cell membranes.

2. Homocysteine recycling
B12 is a primary player in the one-carbon cycle and a co-factor for the methylation, by activated folate, of homocysteine, to recycle it back to methionine. From there, SAMe is produced, the body’s busiest methyl donor.
3. Genetic override
Sufficient supply of an activated/bioavailable form of a vitamin (ie methylfolate vs folic acid) is even more necessary in the setting of gene variants such as transcobalamin II, MTHFR, and MTRR which may function less optimally in certain individuals and result in pathology under stress. An example of this is a report of death in a B12-deficient patient with genetic variants who underwent anesthesia with nitrous (which causes stress to the system). Notably the B12 blood level was normal, so this fatal case was attributed to functional deficiency, suggesting that access to B vitamins may not always guarantee proper utilization. For this reason, supplementing with activated forms of B vitamins enhances their likelihood of effectively supporting cellular processes.

Read her take on testing and causes of vitamin B12 deficiencies.

If you are interested in the scientific studies, see Dr. Prousky's award winning article on the rational of using B12 therapeutically for psychiatric conditions, even in the absence of "classical" deficiency. 

In conclusion: if you are not feeling 100%, it could be B12.

To Your Health

Dr. Barbara

Glyphosate Implicated as Driver of Modern Diseases including Celiac Disease.

In recent months, I have learned some very disturbing truths about glyphosate the active ingredient in Monsanto's broad-spectrum herbicide called Roundup, which  generally applied to genetically modified (GMO) Roundup Ready crops like wheat, corn ,soy and alfalfa. 

GMO crops are engineered to withstand extremely high levels of Roundup or BT toxin so as to not perish with the weeds. And so these crops are usually more contaminated with glyphosate or BT toxin than regular crops. Wheat crops sometimes get an extra dose after harvest but before shipping, called desiccation or ripening.

In November of 2013, a peer-reviewed report authored by Anthony Samsel, and Dr. Stephanie Seneff,  a research scientist at the Massachusetts Institute of Technology (MIT), reveals how glyphosate starts a sequence of events in humans that is so destructive to health that it has been called the "driver of modern diseases". 

I urge you to read the whole report called Glyphosate, pathways to modern diseases ll: Celiac Sprue and Gluten Intolerance. It shows how all the features of celiac disease can be explained by glyphosates known properties.

These include:

1. the disruption of Shikimate pathways. 

2. Altering the balance between pathogens and beneficial biota in the gut. 

3.Chelating transition metals  as well as sulphur and selenium and 

4. Inhibiting cytochrome P450 enzymes

The authors argue that a key system wide pathology in celiac disease is impaired sulphate supply to the tissues and that this is a key component of glyphosate toxicity to humans.

Dr. Seneff states in an interview with Dr. Mercola: (my bold)

“Glyphosate’s claimed mechanism of action in plants is the disruption of the shikimate pathway… The currently accepted dogma is that glyphosate is not harmful to humans or to any mammals because the shikimate pathway is absent in all animals.

However, this pathway is present in gut bacteria, which play an important and heretofore largely overlooked role in human physiology through an integrated biosemiotic relationship with the human host. In addition to aiding digestion, the gut microbiota synthesize vitamins, detoxify xenobiotics, and participate in immune system homeostasis and gastrointestinal tract permeability. Furthermore, dietary factors modulate the microbial composition of the gut.”


And describing the connection to the bowel, where the most damage occurs, and may even trigger gluten sensitivity, Dr. Mercola continues:

Remember, the bacteria in your body outnumber your cells by 10 to 1. For every cell in your body, you have 10 microbes of various kinds, and all of them have the shikimate pathway, so they will all respond to the presence of glyphosate! It causes extreme disruption of the microbe’s function and lifecycle; worse yet, glyphosate preferentially affects beneficial bacteria, allowing pathogens to overgrow. At that point, your body also has to contend with the toxins produced by the pathogens. Once the chronic inflammation sets in, you're well on your way toward chronic and potentially debilitating disease. 

In a nutshell, Dr. Seneff has summarized the two key problems caused by glyphosate in the diet as:

Nutritional deficiencies
Systemic toxicity

She believes glyphosate is possibly the most important factor in the development of multiple chronic diseases and conditions that have become prevalent in Westernized societies, including but not limited to:

Autism                                              

Gastrointestinal diseases such as inflammatory bowel disease, chronic diarrhea, colitis and Crohn’s disease 

Obesity
Allergies 

Cardiovascular disease 

Depression
Cancer 

Infertility 

Alzheimer’s disease
Parkinson’s disease  and other neurological disorders such as Multiple sclerosis, and  ALS

And more.

The authors argue that glyphosate residues, found in most commonly consumed foods in the US, “enhance the damaging effects of other food-borne chemical residues and toxins in the environment to disrupt normal body functions and induce disease.”

Perfect Storm

The average person in North America has seen their vitamin D3 serum levels decline to deficiency states since the 40's. And vitamin D3 protects the bowel but also 2,000 genes and their expression. We have a perfect storm with the combination of low vitamin D3 which makes a phenotype susceptible to many "diseases", alien modern wheat , and chemicals with unknown and known horrifying properties. No wonder we have so many health problems. 

The good news is that we can make some choices that improve our health. One would be to eat only organic foods as a way to avoid glyphosate and BT toxin. (eliminate corn from your supplements and drugs, except for non- GMO corn).

Drink clean water: reverse osmosis or distilled.

Get some exercise: 30 minutes to 1 hour 3- 6 times a week.

Another is to find out what your serum level of vitamin D3 is and take enough vitamin D3 to have the level about 100 nmol/l (over 120 is best) or 40 ng/ml.

And get some "RAYS",  UV B of course. 

To Your Health

Dr. Barbara

Omega-3-Rich Fish Intake During Pregnancy May Boost Birth Weight for Babies: European Data

As people with celiac disease or gluten sensitivity have poor absorption of fats, it is important to make up to difference by increasing the amounts of fats in the diet. Including the best source of omega 3's, fish. And if an expectant mother is undiagnosed and untreated, she is more likely to experience recurring miscarriages, premature births and low birth weights. And a gluten free diet reverses the higher risk to normal, but I aim for an even lower rate of risk.

Here is a report in the American Journal of Clinical Nutrition, that shows that eating fish at least one serving a week helped to reduce the risk of preterm birth by between 11%-13%. And eating fish three times a week allowed the baby to have a small but significant increase in birth weight, according to data from 19 European birth cohort studies. 

Preterm birth is a public health issue. If you want to know more about this subject link here. This report also mentions the benefits of omega 3's.

It is especially important to follow this advice if you are celiac or gluten sensitive and pregnant or planning to get pregnant. This advice helps to reduce the risk of premature birth and to reduce the risk of "intrauterine growth retardation" (a condition where the baby being born at term, but the baby has a low weight). Low weight at full term is much more dangerous to the future health of the baby than being born at a low weight when premature.

It is prudent to do whatever it takes to avoid having a baby with either low weight at term or pre-maturity. Start with a completely clean diet without grains, gluten, oats, or sugar. No cheating.

And look for the list of safe fish to eat from your countries health recommendations,but you can see Canada's recommendations here.

To Your Health

Dr. Barbara

CLEARING CONTROVERSY ON SATURATED FAT, CHOLESTEROL & HEART HEALTH

Around 2009, I could only watch the first 45 minutes of the movie Oiling of America, by Dr. Mary Enig, presented by Sally Fallon- Morell, because of severe physical symptoms of betrayal. By then I had been in practice 32 years and had done a low fat diet most of my life, suffering its consequences. For the last ten years or so, I now get as much saturated fat as I can get. And I feel the most well in decades.

The truth is we need saturated fats to thrive. The movie is 2 hours and the information is vital.

Over at Jules' Fuel, there is a well written summary of the story of fats. Part 1: The Skinny on Fat Phobia, is here. Many of you will recognize yourself in this narrative. 

This is an excerpt from Part 2.

Assuming Ancel Keys’ research and the government food recommendations are right, a decrease in butter consumption would equate to a decrease in heart disease, right?

Similarly, an increase in government recommended vegetable oil consumption would equate to a decrease in heart disease.

Let’s see how the facts pan out.

1900: Heart disease rare
Butter Consumption: 18 lbs./person/yr
Vegetable Oil Consumption: 11 lbs./person/yr

2012: Heart disease leading cause of death
Butter Consumption: 4 lbs./person/yr
Vegetable Oil Consumption: 59 lbs./person/yr

And heart disease?



Though death resulting from a heart attack has decreased, thanks to medical advancements, it appears that decreasing butter consumption and increasing vegetable oil consumption has resulted in a resounding FAIL for heart disease prevention.

This makes sense, since we learned of the importance of a low Omega-6: Omega-3 fatty acid ratio in Part 1, and how vegetable oils high in Omega-6 fatty acids can contribute to systemic inflammation.

There is an interesting comment on Jules' Fuel, from a lady who discovered the importance of eating saturated fats when she was researching the cures for infertility. Yes, low fat intake leads to increased risk of infertility.

Enjoy your eggs and butter and coconut oil in abundance, and avoid trans fats and oxidized cholesterol in processed fats. It will lower your cholesterol levels and help you thrive.

To Your Health

Dr. Barbara

Gluten and Health with Dr Tom O'Bryan. Video Interview Not to be Missed

Dr. Tom O'Bryan

From theDr.com on Facebook, Ben Coomber of Gut Health interviews Dr. Tom O'Bryan DC Podcast 72  where he goes into gut health and his personal story of his discovery of the importance of gluten sensitivity.

Very moving. And if you have trouble understanding the diverse manifestations of gluten sensitivity, here is more evidence that the whole body is influenced.

To Your Health

Dr. B

12 Part GAPS Diet Course by Melanie Starts Soon.

I do recommend  the version of the specific carbohydrate diet designed by Dr. Natasha Campbell- McBride, called Gut and Psychology Syndrome diet and protocol. So many people have said to me how they would like a GAPS course. 

If you are one of those people who would like to know more about how to do a GAPS diet and protocol or you want to fine tune or expand your expertise in GAPS, there is an online course,  for less than $20.00 a part, that may interest you. Plus you will get a free 30 day PREP GUIDE for GAPS.

Here is the link.
To Your Health
Dr. Barbara

Dr. Bill Davis On Autoimmunity and Wheat! Evidence Wheat Affects All, Even Those Not Gluten Sensitive!

Here is a great article on autoimmunity disorders and wheat by Dr. Bill Davis!

First consumed in desperation 10,000 years ago, after not consuming grains for the preceding 2.5 million years, then altered by the efforts of geneticists and agribusiness, increased wheat consumption accounts for the increasing landscape of multiple autoimmune conditions, especially type 1 diabetes in children (and, now, adults), Hashimoto’s, and inflammatory bowel diseases.

So what is it about modern wheat that can cause such misguided immune responses? There are several reasons:

Increased intestinal permeability–Dr. Alessio Fasano and his team, working at the University of Maryland (now at Harvard) have worked out the complex path by which gliadin, when remaining intact, opens the “tight junction” barriers between intestinal cells, allowing foreign substances entry into the bloodstream and thereby organs. Among the substances that can enter: intact gliadin, gliadin-derived peptides, wheat germ agglutinin (a large and highly inflammatory protein), lipopolysaccharide from bacterial cell walls, and others.

Gliadin peptide toxicity–While some gliadin remains intact, some also gets degraded to peptides. Some of these peptides can enter the bloodstream to exert opiate effects on the brain, while other fractions are toxic to the intestinal lining.

Wheat germ agglutinin–Humans cannot digest the roots, stalk, leaves, or husk of wheat because it is a grass. For that reason, humans only consume the flour ground from the seed of wheat. We can only efficiently digest the amylopectin and amylose of the seed endosperm, the carbohydrates. Wheat germ agglutinin of the seed, a component of all wheat flour, is an example of another indigestible component of this grass. This large 4-part structure is highly toxic to the intestinal lining, causing complete denuding of the villi in experimental models. If it gains entry to the bloodstream, it is a potent activator of the immune system.

Molecular mimicry–As if this wasn't already strange enough, there are amino acid sequences in the gliadin protein of wheat (and thereby the secalin of rye, the hordein of barley, perhaps the zein of corn) that look just like sequences in some human proteins. To date, human proteins that resemble gliadin include transglutaminase (in muscle, liver, many other tissues), synapsin (in nervous tissue), and calreticulin (ubiquitous). The gliadin sequence activates an immune response, which can then launch an attack on the organs containing these cross-reacting proteins.

Dysbiosis–Wheat changes bowel flora, not uncommonly causing dysbiosis, or changes in bowel flora characterized by decreases in healthy species, such as Lactobacillus and Bifidobacteria, and increases in pathogenic bacteria, such as E. coli and Clostridium difficile. Dysbiosis increases intestinal permeability, especially to the lipopolysaccharide component of bacterial cell walls, a powerful activator of inflammation.

Note that NONE of these phenomena leading to autoimmunity require the presence of celiac disease or gluten sensitivity. The abnormal intestinal permeability induced by gliadin, for instance, develops in 80-90% of people; the toxic effects of wheat germ agglutinin affect everybody.

Read the whole article here.

To Your Health

Dr. Barbara