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

Today I was asked by a 70 year old friend if there is anything he could do to feel better as he was being treated for depression and he is feeling unwell and tired on some of the medicine he is prescribed. 

I told him to talk to his doctor if he hasn't already done so, not to stop any medication until he has talked it over with his doctor and to learn more about B12. 

The subject is so important as we age that I thought that I would re-published this blog entry. Do take the time to open the link at the end with Dr. Prousky's award winning article on B12 and why it is important to at least try a few doses of B12 by injection as a trial to see if this makes a positive difference to your symptoms, especially mental health symptoms like fatigue, depression, or others. 

B12 deficiency rates are high in all people especially 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 of psychiatric symptoms where B12 was the only additional treatment that gave complete remission. 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 oxide (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 (TM)

Celiacbrain.blogspot.com  (TM)

WHO- 85% of Adult Cancers are Preventable: Beyond Celiac

We are so busy every day we often forget that we are what we eat and other lifestyle habits. Simple ( but not necessarily easy) changes make a very large difference in our future health.

If you eat inflammatory foods like grains, and you have inflammatory lifestyle habits like smoking or a sedentary life, you will encourage inflammatory responses in your body which include, but is not exclusive of, cancer. 

The Cytokine Research Laboratory published an article entitled "Cancer is a preventable disease that requires major lifestyle changes" which can be summarized by saying reduce inflammation/cytokines with lifestyle changes.  

The WHO has put out a paper declaring 85% of adult cancers of preventable and known risk factors are overweight, obesity, malnutrition and infection, all of which are higher in gluten sensitive persons. Here is an excerpt. 

The role of diet in the etiology of the major cancers

Cancers of the oral cavity, pharynx and oesophagus. In developed countries the main risk factors for cancers of the oral cavity, pharynx and oesophagus are alcohol and tobacco, and up to 75% of such cancers are

attributable to these two lifestyle factors (5). Overweight and obesity are established risk factors specifically for adenocarcinoma (but not squamous cell carcinoma) of the oesophagus (6--8). In developing countries, around 60% of cancers of the oral cavity, pharynx and oesophagus are thought to be a result of micronutrient deficiencies related to a restricted diet that is low in fruits and vegetables and animal products (5, 9). 

A colleague and a health advocate writes Beyond Celiac and she has some real pearls in it. 

The World Health Organization (WHO) has revealed that 85 per cent of adult cancers are entirely avoidable and, of these, around half are related to nutritional deficiencies in the Western diet. A recent government report showed how nearly 70,000 premature deaths could be prevented each year by simply improving the UK's diet.

Another study carried out by Brigham Young University professor Steven Aldana, published in the Journal of the American Dietetic Association, March, 2005, found that a combination of 30 minutes of cardio exercise a day along with a switch to a healthier diet dropped the participants’ health risks for diabetes, cancer, and heart disease dramatically in just 6 weeks.

Let us all be mindful when we choose our food for the day. Planning our lunches that we take to work or making food on Sunday in preparation for the week goes a long way to being healthier.

Walking is great exercise and with a few sprints added in for the cardio and you will help keep the blood flowing rather than stagnating.

Choose your food wisely. More to come on this topic.

Besides eliminating inflammatory foods and lifestyle habits, how can reverse inflammation and encourage anti inflammation?

-Keeping our microbiota healthy by eating and drinking fermented foods (like water Kefir) and supplementing with good probiotics. 

-Eating fish three times a week, and supplementing with fish oils to keep our omega 3 levels as high as possible. 

-avoiding grains and seed oils and other sources of omega 6's, because the average persons levels are too high. 

-Keeping serum homocysteine levels below 8 with B vitamins and Betaine

-Keeping ones serum high sensitivity CRP ( a blood test ordered by your doctor) below 2. 

-flossing your teeth and seeing a biological dentist for assessment and care.

-moderate exercise, slightly more if you need to lose weight.

-keeping your waist/hip ratio below .75 for women and below 1.0 for men and 

-keeping the waist measurement below 30 inches for women and below 35 inches for men.

-keeping your vitamin D blood level between 100-200 nmol/l, (40 - 60 ng/ml)

To Year Health

Dr. Barbara

How Genes Can Influence Our Mood-And How They Can Be By-Passed For Better Mental Health-Huffpost

Here is an article by Dr. Michael Stanclift ND in Huffpost Healthy Living on how adding gene studies to assess MTHFR status can be used to help people with mood issues, as part of a systemized approach. I've spoken a little bit about how these genes influence enzymes by the same name, MTHFR, that are important in the production of neurochemicals among other things, and can be by-passed with B12, folate and other supplements. As you know, when I first work with someone with mood issues, I do comprehensive testing for gluten sensitivity, serum vitamin D status, nutritional status, infections, hormone and thyroid status.

Thanks to Dr. Stanclift for sharing.
Here is an excerpt, but I suggest you read the whole thing.
Michael Stanclift, N.D. Naturopathic Doctor


How Genes Can Influence Our Mood
Posted: 07/06/2014 2:24 pm EDT Updated: 07/06/2014 2:59 pm EDT Print Article


When Susan* first came to see me, she was feeling pretty low. She had debilitating fatigue, and her body ached all over. Susan had been prescribed an antidepressant, and it helped with her depression a little, but she was still constantly anxious and had difficulty concentrating. Everything seemed "life or death," her performance at work was declining, and she was afraid she would lose her job if things didn't change soon.

..... I agreed and ordered comprehensive thyroid testing, a test to rule out anemia, and some "functional genetic" testing. Her thyroid and anemia tests came back right away: Everything looked normal. The genetic testing came back about two weeks later with some significant findings. Susan had variations in both copies (one from her mother and one from her father) of a gene that converts folate/folic acid into its active form. The gene, called "MTHFR" (think "Mon. THur. FRi.") helps an important biochemical reaction in our body called "methylation." Because of her variations, her body couldn't use folate very efficiently. So how did this factor into her condition?

Folate, in its activated form (5 MTHF), is needed for many important processes in our bodies. In Susan's case it was particularly important with relation to her neurotransmitters. Neurotransmitters are the chemicals our brains make to communicate messages to each other, and they have to be available in high enough amounts for us to successfully communicate those messages. Many of us have heard of serotonin, dopamine, and adrenaline (epinephrine), and may even be familiar with their effects on our emotions and mood. In order to make these neurotransmitters, that crucial step called "methylation" must occur. This step can be particularly difficult for someone with MTHFR variations like Susan had................

A few weeks into her treatment she came back reporting her coworkers had noticed a change. In my office I immediately saw the change in her mood, and even our front desk staff reported Susan sounded happier when she called. I know moods can change periodically, so I asked about something that had been consistent with her: exercise. She had exercised at least 50 percent more per week, and wasn't exhausted from it like before. Her sleep had improved, she reported her concentration was no longer an issue, and her libido was starting to return.We're now many months into her treatment and Susan has continued to do well.

Finding the variations in Susan's MTHFR gene was not the end-all be-all of her symptoms and treatment, but it was a significant factor. It opened up a window into why her depression and fatigue were so significant and why her medications weren't giving her satisfactory results. New and inexpensive "functional genetic" tests like this have opened up whole new areas of medicine and offer patients interventions that are personalized and nutritionally based. These tests have taken a significant amount of guess work into what interventions might work and explain why some people require drastically different dosages of nutrients to achieve the same outcomes. To find out if functional genetic testing could be important to you and your health, ask your doctor if these tests could be relevant for you.

In Health,

Michael Stanclift, N.D.Naturopathic Doctor in Practice in Carlsbad, California

"Functional genetic" testing is done in a number of laboratories in Canada, USA, Europe and Asia. Most require a requisition from your doctor. A normal homocysteine can not be used to assess your MTHFR status (because the "short route" may be working overtime). A high homocysteine level means you probably have a MTHFR issue (lower function of the MTHFR enzymes) and a requirement for more B12, folate,zinc, magnesium, vitamin C and other supplements. If you should decide to add genetic testing, it is best to be guided by a doctor who has some experience with MTHFR issues, as there is the rare person who, to avoid unpleasant effects, needs an individualized programme before starting folate in higher doses.

To Your Health

Dr. Barbara 

Methyl Folate for depression

A new research study showed that taking l-methylfolate 
 which is sometimes called folate with an anti-depressant, increased the rate of resolution of depression symptoms with no side effects. They showed that 15 mg of l-5 MTHF or folate a day worked. And how does folate work? Folate helps to make methyl groups, a biochemical entity, which in turn helps to make neurochemicals. If you are the person who has a genetic abnormality called MTHFR single nucleotide polymorphism (SNP's), you will require supplementation with folate ( also called l- 5-MTHF) because you can't get enough folate from food to help run your metabolism to the maximum. Which means you could become depressed. 

Also, two colleagues of mine, evaluated neurochemical status of a group of gluten sensitive people a few years back. Their verbal report to me was that all had low neurochemicals. Pervasive nutritional deficiencies and SNP's could account for this finding in gluten sensitive people. Heal the gut and provide nutrients and digestive enzymes and probiotics. 

Other illnesses  from MTHFR SNP's, that occur when a person is functionally dependent on more folate, and other B vitamins include:
heart disease
high homocysteine
thrombophilia or clotting easily
hypertension
gout
neurological disorders
psychiatric disorders
osteoporosis
infertility, miscarriages, and loss of pregnancy
offspring with congenital abnormalities such as neural tube defects 
pain conditions

The incidence of methylation polymorphism for two common ones c677t and a1298c, in the general population is found to be around 30%. When I looked at the prevalence in a group of  74 people, all with at least one chronic illness,  I found the prevalence to be 76%. 
I use folate to reverse many symptoms and problems.

When people are not well, they can use more folate, balanced with B12. 
Woman of childbearing age should take folate to insure their future choices when it comes to having a family or not, and the health of their future child. 

Folate is safe, there is no known toxicity, and is effective. Avoid folic acid. 

To Your Health
Dr. Barbara

Dr. Christiane Northrup’s Top Tips for Women’s Breast Health

Undiagnosed persons with celiac disease or gluten sensitivity have a four times increased risk of cancer than than the regular population. The good news is, that 5 years of a gluten free diet seems to bring the risk of cancer down to the normal rate in the population. 

This rate is still pretty high: 1 in 2 men and 1 in 3 women can expect to get this diagnosis.

But with a few simple lifestyle habits, that risk can be lowered. Eat a grain free diet (low glycemic), maximize your magnesium intake, meditate, sleep in total darkness 7-9 hours a night, exercise moderately, find out what your vitamin D level is and keep it in the 100-150 nmol/l range, find out what your homocysteine level is and keep it below 8 with supplemental methylators ( which are mainly B vitamins), have less than 10 alcoholic drinks a week for men, and less than 6 alcoholic drinks a week for women, have good mental and emotional coping strategies and don't smoke.


Below is an excerpt of an interview with Dr. Christiane Northrup, done by Dr. Mercola.She is a practicing physician, an OB-GYN who has dedicated a good portion of her life to helping women take control of their life and health. Dr. Northrup is also a New York Times best selling author and important educator and public speaker on natural health issues for women.

You really must view the video and read the transcripts for it's brilliant wisdom. 

Many Cancers Heal on Their Own...


Another important study was published in November 2008 in the Archives of Internal Medicine.2 This study followed more than 200,000 Norwegian women between the ages of 50 and 64 over two consecutive six-year periods. Half received regular periodic breast exams or regular mammograms, while the others had no regular breast cancer screenings. The study reported that those women receiving regular screenings had 22 percent more incidence of breast cancer.

The researchers, as well as another team of doctors who did not take part in the study but who analyzed the data, concluded that the women who didn’t have regular breast cancer screenings probably had the same number of occurrences of breast cancer, but that their bodies had somehow corrected the abnormalities on their own.


“Of course, this makes complete sense, because your immune system is set up to recognize and destroy cancers in the right environment,” Dr. Northrup says. “The right environment, of course, is enough sleep, a low-glycemic diet, enough vitamin D, and also regular handling of resentments, anger, grief, and loss.


I think what I want women to know is that your breasts are not two potentially pre-malignant lesions sitting on your chest. The problem with our paradigm – whether it’s tomosynthesis or mammograms – is that it will find things that were never going to go anywhere. And then you’re out there wearing a pink ribbon and running for the cure, thinking that you were going to die of breast cancer when you never will, and never would.”

Your immune system is setup to recognize and destroy cancers given the right environment. And the right environment includes a grain free, low glycemic diet, sometimes called a GAPS diet and the lifestyle habits mentioned above. 

Read the whole article especially if you've been contemplating getting a screening mammogram.

To your health.
Dr. Barbara

What is Homocysteine and Why You Should Know About It?

What is homocysteine and why you should know about it?

I think knowing your homocysteine level is paramount to preventing and treating cardiac, neurological, psychiatric conditions as well as cancer. 

Why take a Homocysteine Test? - watch this

In summary, a homocysteine (H) test is suitable for anyone that is concerned about their heart health,strokes or abnormal clotting. A recent review of the research on H suggested that each 3 umol/L point decrease in the H levels might, on average reduce the risk of:

-heart attacks by 16%

-strokes by 24%

-DVT (deep vein thrombosis) by 25%

Here you can read what Dr. McIntyre says about taking supplements to normalize the metabolism of homocysteine, if you should find it above 8. They are safe, effective and without side effects. What more can you want, to easily add years of healthy life.

I've highlighted some areas and added the bold.

POSTED BY: DR_CAMERONMCINTYRE ON: OCTOBER 12 2012 •




This week’s blog will focus on the subject of homocysteine. You can see from below that I have included the same methylation diagram from last week. In the middle of this diagram you can see homocysteine. So what is it and why is it important?



Homocysteine is an amino acid formed by the removal of a methyl group from methionine. Unfortunately, it has been shown that homocysteine is toxic at high levels. It has been implicated in a number of inflammatory processes in the body including increasing risk of cardiovascular, diabetes, bone and neurocognitive diseases. A physician’s health study revealed that men with higher homocysteine levels had a threefold higher risk of coronary events.

Levels of homocysteine can be measured via blood test. Optimal ranges do vary depending on age and gender but a goal of having a level of 6 µmol/L or less is considered optimal. If you are at all concerned about preventative medicine and an anti-aging approach, knowing your homocysteine level is a must in my opinion.
Homocysteine can be methylated back into methionine via trimethylglycine (betaine) and an enzyme called BHMT. In addition, homocysteine can also be re-methylated via the enzyme MS (methionine synthase), which is very dependent on methyl B12 for its reaction. For homocysteine to be converted downstream to cysteine, vitamin B6 is a required cofactor.



You can see the importance of all of these vitamin cofactors to make sure that homocysteine is dealt with in an efficient and effective manner. I want to again feature the AOR product MaxMethyl as a product to help you achieve healthy homocysteine levels. With therapeutic levels of TMG (Betaine) ,B6, folate and B12,it has been formulated to include the necessary ingredients for the proper methlyation of homocysteine.

One study using the combination of ingredients in MaxMethyl was shown to significantly reduce levels of homocysteine after just 6 weeks of supplementation. Happy methylating!

Sources:

http://www.nature.com/cdd/journal/v11/n1s/images/4401451f1.jpg

Galway, J.G. Metabolism at a Glance. 2nd Ed. 1999. P.54.

www.MTHFR.net

Thanks to the folks at AOR for the use of this blog entry.

To your health.

Dr. Barbara