I have mentioned folate a lot in my blog posts but mainly in relation to women, especially pregnant women.  However, recent research presented at the at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA(1) has found that high folate intakes in men may be associated with a 20% decreased risk of hearing loss.

The study(1) involved 3,559 cases of men with hearing loss.  The study authors found that men over the age of 60 who have a high intake of foods and supplement high in folate had a 20% decrease in risk of developing hearing loss.  The authors believe this is the largest study to delve into the relation between dietary intake and hearing loss. They also believe their findings could allow for greater education, prevention, and screening efforts in a bid to prevent hearing loss.  Further studies would certainly be necessary as this study only shows an association and not cause and effect. 

Ten years ago a small study in women (2) found that poor folate levels were associated with age-related decline in hearing.  The study was conducted in 55 healthy women aged 60-71.  The women were tested for hearing function and categorised into two groups – those with normal hearing and those with impaired hearing.  Women with impaired hearing had a 31% lower blood level of folate than women with normal hearing.  In addition to this study a couple of years ago a research team (3) found that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.  The objective of this study was to determine whether folic acid supplementation slows age-related hearing loss.  728 men and women were involved.  Subjects received daily oral folic acid (800 micro-grams) or placebo supplementation for 3 years.  Folic acid supplementation slowed the decline in hearing of the speech frequencies associated with aging in a population (but did not affect the decline in hearing high frequencies).  The authors note that the results need to be replicated in further larger studies but that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.

Folic acid may be playing a role in the prevention of age-related hearing loss by improving blood circulation to the artery that supplies blood to the cochlea of the ear.  In addition, folic acid is also related to lowering elevated homocysteine levels.  Elevated homocysteine could be related to age-related hearing loss.  Most people are aware that high levels of homocysteine in the blood have been linked to an increased risk of heart problems.  Recently high homocysteine levels have also been linked to poor bone health, poor eye health (such as age-related macular degeneration) and other health problems.  To recap from my past blog posts: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.  Vitamin B6 is mainly found in meat, fish and eggs.  Vitamin B12 is found in liver, meats, eggs, milk and yeast extract. 

Vegetarians and vegans and those who feel they are not eating a varied, balanced diet may wish to consider taking a multiple B vitamin supplement to ensure good levels of these important B vitamins

(1)American Academy of Otolaryngology -- Head and Neck Surgery (2009, October 6). Higher Folates, Not Antioxidants, Can Reduce Hearing Loss Risk In Men. ScienceDaily. Retrieved October 6, 2009, from http://www.sciencedaily.com/releases/2009/10/091005161116.htm
(2)Houston DK et al.  1999.  Age-related hearing loss, vitamin B-12, and folate in elderly women.  American Journal of Clinical Nutrition.  69(3):564-571.
(3) Durga J et al.  2007.  Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial.  Ann Intern Med.  146(1):1-9.
Written by Ani Kowal

On the 8th July this year I wrote a piece entitled “Are you tearing your hair out? Study finds nutritional supplement may help reduce compulsive behaviour”, the post was looking at a study which found that N-acetylcysteine (NAC) may be useful for sufferers of trichotillomania.  NAC is an amino acid that acts as an antioxidant in the body but also affects levels of glutamate in the brain.  Glutamate triggers excitement in the brain, lowering glutamate levels may help people who suffer with obsessive compulsive disorders.  Today I thought I would have another look at obsessive compulsive disorder (OCD) in general to assess whether any other nutritional/lifestyle advice could help.

One nutrient that seems to be coming up time and time again in the medical literature is inositol.  Insolitol is classified as a member of the vitamin B complex and is sometimes referred to as vitamin B8.  Naturally inositiol (in its myo-inositol form) is found in nuts, beans and fruit, especially cantaloupe melon, oranges, grapefruit and raisins.  It has many functions in the body, structurally it is important in some lipids (fats) and cell membranes but it also functions in insulin control pathways, nerve guidance, calcium control within cells, and serotonin activity.  Serotonin is often known as a feel-good brain chemical.  Low levels have been linked to many mood disturbances.  Low levels of insolitol in the body have also been linked with depression, bulimia, panic disorder, OCD, bipolar depression and agoraphobia.

So let’s have a closer look at the available medical studies with inositol in OCD and similar disorders.

In 1996 (1) a small, but well designed, study published in the American Journal of Psychiatry found that 18g of inositol per day for six weeks was effective at significantly reducing OCD symptoms when compared to a placebo.  In 1997 (2) another small trial found that 18g of inositol for six weeks significantly reduced scores of OCD symptoms compared when compared with placebo treatment. 

A group of researchers in 2001 (3) undertook a study to compare the effect of inositol with that of fluvoxamine in individuals with panic disorder.  Fluvoxamine is a Selective Serotonin Reuptake Inhibitor (SSRI) pharmaceutical antidepressant drug often used in OCD.  The trial participants received up to 18g/day of inositol and up to 150mg/d of fluvoxamine for a month.  Improvements on Hamilton Rating Scale for Anxiety scores, agoraphobia scores, and Clinical Global Impressions Scale scores were similar for both treatments.   In the first month, inositol reduced the number of panic attacks per week by an average of 4.0 compared with a reduction of 2.4 with fluvoxamine.  Nausea and tiredness were more common with fluvoxamine.  The authors of the study conclude that “Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. Continuing reports of inositol's efficacy in the treatment of depression, panic disorder, and OCD should stimulate replication studies”.

Also published in 2001 was a paper (4) which reported three case studies to show that inositol may help in the treatment of trichotollomania.  The paper describes the cases of two women with trichotillomania and one with compulsive skin picking.  They were treated with 6g inositol (which was in a powder form and taken dissolved in water or juice three times per day). The treatment lasted 8-16 weeks and all of them found their condition improved with inositol treatment.  The authors of the paper conclude: "The three cases described here suggest that inositol might be a treatment option in some patients with hair pulling and skin picking and could be considered in patients who tolerate SRIs [selective reuptake inhibitors] poorly or who are unwilling to take them," 
 

These studies and case-studies certainly indicate that inositol is worth investigating further and I hope that larger trials are carried out soon.  Many OCD sufferers and sufferers of depression and other mood disturbances are unwilling to take anti-depressant drugs due to the many side-effects and a general unwillingness to take pharmaceutical mood-altering medications.  Side effects of inositol treatment are few and generally mild.  Possible side effects of high dose inositol treatment are mainly gastrointestinal symptoms such as gas, diarrhoea and abdominal cramps.  Headaches may also occur. 

How might inositol be working to help in OCD, trichotillomania and similar disorders?

As mentioned earlier inositol is involved with serotonin action in the brain. In 2001 (5) and 2002 (6) a group of researchers looked specifically at OCD and how inositol may be working to help sufferers of the condition.  There is, as yet, no conclusive answer but inositol certainly seems to be having an effect in brain cells at specific ‘receptor’ sites which are important in brain chemical signalling (dopamine and serotonin appear to be brain chemicals that are affected by inositol).  Inositol from the diet is incorporated into cell membranes of neurones, brain cells, where it serves a function in brain chemical signalling.  In addition to its role in cell signalling, inositol lipids also seem to alter receptor sensitivity, can direct membrane trafficking events, and have also been found to modulate an increasing array of complex signalling proteins in the brain (6).  Further research work is needed in order to gain firmer insights.

If you are a sufferer of OCD, trichotillomania or panic disorder and are looking for an alternative treatment to conventional antidepressants, or are interested in taking a natural substance in addition to conventional treatment it may well be worth talking to your medical doctor about inositol.  They may not be aware of the evidence, in which case you could show them this blog post and they can read the full study papers to gain a fuller perspective.  Never stop taking a conventional treatment without talking to your medical doctor first and do not start a high dose inositol treatment without first consulting a medical doctor. 

If you are suffering with trichotillomania you may also wish to contact the following online support network:  Trichotillomania Support Online.  For OCD sufferers the following charity, OCD-UK, may be a helpful point of contact.

(1) Fux, M et al.  1996.  Inositol treatment of obsessive-compulsive disorder.  American Journal of Psychiatry.  153(9):1219-1221
(2) Levine J.  1997.  Controlled trials of inositol in psychiatry.  Eur Neuropsychopharmacol.  7(2):147-155.
(3) Palatnik A et al.  2001.  Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 21(3):335-9
(4) Seedat S, Stein D, Harvey B (2001), Inositol in the treatment of trichotillomania and compulsive skin picking (letter). J Clin Psychiatry 62(1):60-61.
(5) Harvey BH et al.  2001.  Chronic inositol increases striatal D(2) receptors but does not modify dexamphetamine-induced motor behavior. Relevance to obsessive-compulsive disorder.  Pharmacol Biochem Behav.  68(2):245-253.
(6) Harvey BH et al.  2002.  Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder.  Prog Neuropsychopharmacol Biol Psychiatry.  26(1):21-32.
Written by Ani Kowal

Children everywhere are starting to get ready to go back to school after their long summer holidays.  Nutrition and diet can impact the body and health in many ways, the most apparent concerns for parents of school aged children are immune health and brain function/behaviour.

In July I wrote about probiotics and prevention/treatment of childhood colds and last year I wrote about boosting immune health in children going back to school.  Today I wanted to have another look at behaviour and the brain.  Previously I have written about ADHD, particularly with regards the importance of omega 3 fatty acids for brain function.  The brain is a highly complex organ.  In infancy and childhood the brain is growing rapidly and it requires a lot of energy.  There is a mounting body of evidence to suggest that diet can influence the development and functioning of the brain (1).  This influence may well start with the diet of the mother during pregnancy and then in the infant in early life, however later in childhood nutritional intervention may well make a difference to brain function and cannot be discounted.

There is increasing evidence that the missing of breakfast has negative behavioural and attention consequences later in the morning and it is also thought that meals of a low rather than high glycaemic load are beneficial with regards child behaviour.  There are also findings of an association between a tendency to develop low blood sugar (glucose) and aggression in children(2). 

Glycaemic index and glycaemic load are terms used to characterise foods and diets based on their effects on blood glucose levels.  Foods that release sugar quickly into the bloodstream have what is known as a high Glycaemic Index (GI), meals that favour a spike in blood sugar levels are said to have a high Glycaemic Load (GL).  White bread, potatoes, processed/refined carbohydrates have a high glycaemic index i.e. they tend to cause a rapid surge in blood sugar.  Vegetables, whole-grain high-fibre carbohydrates, create a more gradual change in blood sugar levels and are considered to have a low glycaemic index.  For the classification of more food examples please visit the website 'The Glycemic Index', there you will find a database where you can search for specific foods and find out more about GI and health.

Certain nutrients have greater effects on brain development than do others and hence may have more of an impact on childhood behaviour and brain function. The important nutrients include protein (which is so important for proper growth in childhood), certain fats (especially omega 3 fats), iron, zinc, copper, iodine, selenium, vitamin A, choline, and folate (3).  There is evidence that sub-clinical deficiencies of vitamins and minerals may influence anti-social behaviour and intelligence but the evidence is still controversial(4).The B vitamins, Folate and B12 (cobalamin), are vital for the brain.  Deficiencies have negative consequences on the developing brain, and behaviour, during infancy; and deficits of both vitamins are associated with a greater risk of depression during adulthood (5).  Recently vitamin D has also received attention with regards brain functioning.  As you can see a myriad of nutrients are important for the brain and they probably work and act synergistically, this makes clinical trials difficult to carry out.  However, there have been three well-designed studies which have reported that vitamin/mineral supplementation in children can reduce anti-social behaviour (2).

It is difficult to conclusively say which vitamins/minerals are most important and whether or not supplementation can help children – this is because behaviour is difficult to standardise and measure in a trial-setting.  Also psychological and environmental influences will be having an effect.  Needless to say our bodies are complex, we require various nutrients in correct proportions in order to stay optimally healthy.  Many children in the UK fall short of achieving recommended 5 portions of fruit and vegetable daily which is worrying for health and many children do not eat oily fish (the best source of omega 3 fatty acids) at all.  If you are concerned that your child is not eating a consistently healthy diet you may wish to consider a food-state multivitamin and mineral supplement that has been formulated specifically for children together with an omega 3 fatty acid supplement – easy to take liquid fish oils are now available for children which are naturally flavoured (usually lemon or orange).  Flaxseed oil and omega 3 supplements produced from algae are available for vegetarian/vegan children.

A UK based study concludes: “Whilst the importance of diet in educational attainment remains under investigation, the evidence for promotion of lower-fat, -salt and -sugar diets, high in fruits, vegetables and complex carbohydrates, as well as promotion of physical activity remains unequivocal in terms of health outcomes for all schoolchildren”(6)

(1)Benton D.  2008.  Eur J Nutr.  The influence of children's diet on their cognition and behavior. Eur J Nutr.  47 Suppl 3:25-37.
(2) Benton D.  2007.  The impact of diet on anti-social, violent and criminal behaviour. Neurosci Biobehav Rev. 31(5):752-74.
(3)Georgieff MK.  2007.  Nutrition and the developing brain: nutrient priorities and measurement.  Am J Clin Nutr.  85(2):614S-620S.
(4)Benton D.  2008.  Micronutrient status, cognition and behavioral problems in childhood.  Eur J Nutr. 47 Suppl 3:38-50.
(5)Black MM.  2008.  Effects of vitamin B12 and folate deficiency on brain development in children.  Food Nutr Bull.  29(2 Suppl):S126-31.
(6)Ells LJ et al.  2008.  A systematic review of the effect of dietary exposure that could be achieved through normal dietary intake on learning and performance of school-aged children of relevance to UK schools. Br J Nutr.  100(5):927-36.

Written by Ani Kowal

In March I wrote about the link between following a Mediterranean style diet and the risk of having a baby affected by spina bifida.  The study (1) that I mentioned found that mothers following a Mediterranean style diet seemed to have a reduced risk of having a baby affected by the condition.  Spina bifida is a birth defect, known as a neural tube defect, that occurs when the spinal cord fails to close completely. The research seemed to show that folate (folic acid) and vitamin B12 may be of particular importance to expectant mothers.  Folic acid supplementation is now recommended to all women planning to get pregnant and during the early stages of pregnancy since supplementation has been shown to prevent the condition.  However, folate is not the only protective nutrient to consider, a healthy diet as a whole is very important for all individuals especially pregnant women, folate is simply one major factor.

Neural tube defects are birth defects that affect the brain and spinal cord.  They can lead to a lifelong disability or in some cases death. The two most common ones are spina bifida and anencephaly, a fatal condition in which the brain and skull do not develop normally.

In a recently published study (2) the relationship between vitamin B12 and neural tube defects was investigated.  Vitamin B12 works with folate in the body and these vitamins are important for several biochemical reactions as well as with the synthesis and formation of healthy DNA.  Vitamin B12 is particularly important for red blood cell and nerve cell formation.  The study looked at a group of Irish women since Ireland has a high rate of neural tube defects.

The study involved around 1,200 women (2) who gave blood samples during early pregnancy, these were analysed to determine vitamin B12 levels.  Mothers of children affected by a neural tube defect had significantly lower blood levels of vitamin B12 than those women who had children not affected.  Women with the lowest levels of vitamin B12, compared with the highest, were on average 2-3 times more likely to be the mother of a child affected by neural tube defect.  Women with the very lowest levels of vitamin B12, those who showed clinical deficiency of the vitamin, were five times more likely to have a baby with a neural tube defect than those women with the highest levels of vitamin B12

The authors conclude that deficient or inadequate maternal vitamin B12 status is associated with a significantly increased risk for having a child affected by neural tube defects.  The results were independent of the maternal levels of folic acid, showing that B12 was important in it’s own right (2).

Most women are already aware of the importance of folic acid (folate) for the prevention of spinal bifida, the authors of this new study hope that awareness of the importance of vitamin B12 for the further reduction of the risk of neural tube defects also increases among women of childbearing age. 

Although the researchers noted that their results needed to be confirmed by other studies among other populations of women they suggest that women of childbearing age ensure they get enough vitamin B12 in order to prevent deficiency or inadequate levels at the start of pregnancy.  It is critical that women consider their nutritional status before they become pregnant since the developmental events that are involved with neural tube defects occur in the first four weeks of pregnancy, once a women realises that she has become pregnant it is often after this crucial 4 week timeframe.

Vitamin B12 is found in virtually all meat products, dairy products, eggs, fish, shellfish and fortified breakfast cereals.  It can also be found in certain algae and seaweeds.  The recommended nutrient intake (RNI) in the UK for adults aged 19-64 is 1.5 micrograms (µg) per day (or 0.0015mg per day).

Women who eat meat, fish or dairy foods regularly should be able to get enough vitamin B12 from their diet.  However, because vitamin B12 isn't found in vegetable foods vegans and vegetarians who do not regularly consume dairy foods might not get enough of this important vitamin.  For more information vegans and vegetarians may wish to visit the vegetarian and vegan foundation website and read the fact sheet on vitamin B12.  Individuals suffering from intestinal disorders such as inflammatory bowel disease may also have inadequate levels of vitamin B12 since these kinds of conditions often prevent the absorption of sufficient amounts of the vitamin.  In such cases it may be wise to visit a doctor to discuss the use of regular vitamin B12 supplements.

Any woman who is planning a pregnancy and who is concerned that she is not eating a consistently healthy diet rich in vegetables, fruits and healthy fats may wish to consider taking a broad-spectrum food-state supplement specifically designed for pregnancy in order to main good levels of all nutrients, this kind of supplement should contain a good level of vitamin B12.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take a supplement please discuss your thoughts with a GP, nurse or midwife.

(1) Vujkovic M et al.  2009.  The maternal Mediterranean dietary pattern is associated with a reduced risk of spina bifida in the offspring. BJOG.  116(3):408-15
(2)Molloy AM et al.  2009.  Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification. 
Pediatrics. 123(3):917-23.

Written by Ani Kowal

Currently it is Save Your Vision Month in America, a campaign run by the American Optometric Association (1).  The role that diet plays in preserving our eyesight is highly important and certainly worth a loud mention.  In August last year I wrote about cataracts and age related macular degeneration (AMD) and mentioned how diet, particularly omega 3 fatty acids from oily fish and antioxidants from vegetables and fruits, was important in preventing these conditions and preserving good eyesight.   In the UK Age-related Macular Degeneration (AMD) is the leading cause of blindness, with 45% of those registered as blind suffering from the disease.  For more info on AMD please read my previous blog post.

Very recently a paper was published (2) suggesting that B vitamins, particularly folic acid, vitamin B6 (also known as pyridoxine hydrochloride) and vitamin B12 (cyanocobalamin) may be particularly important for good eye health.  The study was conducted since previous research had indicated the links between homocysteine concentrations in the blood and the risk of age related macular degeneration (AMD).

I have previously written about homocysteine.  Most people are aware that high levels of homocysteine in the blood have been linked to an increased risk of heart problems.  Recently high homocystein levels have also been linked to poor bone health and other health problems.  To recap from my past blog posts: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

The researchers of the eye health study (2) wanted to examine the incidence of AMD in a trial of combined folic acid, vitamin B6 and vitamin B12 therapy.  The trial was well designed and involved over 5000 women aged 40 or older with no diagnosis of AMD at the start of the trial.  These women received either a daily placebo supplement or a supplement containing 2.5mg folic acid, 50 mg vitamin B6, and 1g vitamin B12.  After around 7 years of treatment and follow-up it was found that the women receiving the supplement had a significantly reduced risk of AMD.   The women taking the multi-B vitamin supplement were around 35% less likely to develop AMD than those taking the placebo.

The research seems to support the idea that taking a multiple B vitamin supplements is useful for sight preservation.  It is not entirely clear whether the B vitamins worked to protect eyesight simply via lowering homocysteine levels.  These vitamins may have also been working via exerting antioxidant effects or by improving blood vessel function.  Further studies would be necessary to evaluate these ideas and strengthen data before strong recommendation for B vitamin supplementation can occur.

In the diet the B vitamins may be found in the following sources (vegetarians and vegans may wish to consider a multiple B vitamin supplement):
Vitamin B6 – Mainly found in meat, fish and eggs
Vitamin B12 – liver, meat, eggs, milk, yeast extract
Folic acid – liver, orange juice, green vegetables, nuts

Continuing with the theme of eye health.  Scientists at the University of Liverpool (3) have recently announced that the degeneration of sight caused by AMD could be reduced by up to 20% through dietary changes alone, specifically through the increase of vegetables, fruits and nuts in the diet.  Professor Ian Grierson, Head of Ophthalmology at the University of Liverpool, has produced a comprehensive cooking guide called 'Fruit for Vision', designed to add fruit and vegetables into everyday meals.  The recipes were formulated in order to help AMD sufferers slow down the degeneration process by increasing micronutrient, vitamin and antioxidant intake in the diet. Non-sufferers can also use the book to add fruit, nuts and vegetables into each meal to protect against the disease.

Professor Grierson said (3): "Poor eating habits have a huge impact on health in general and the health of your eyes is no exception. Eye problems such as AMD, cataract and even glaucoma can all be affected by what we eat. But a relatively minor change in diet - adding a little more fruit into our meals - can make a profound difference and can keep eye diseases like AMD at bay for up to 20% longer.  There are of course other risk factors related to AMD such as age, light exposure, smoking and being overweight. But if we can improve the kind of food that we eat, we could dramatically reduce the number of people who may suffer from eye diseases in the future."

Fruit for Vision is published by Indigo Creative Marketing and the Macular Disease Society. It provides easy recipes that incorporate fruit and nuts in to the diet. The recipes suggest minor additions to what we already eat, rather than major dietary changes.

Over in America, the AOA has also released information (4) in order to highlight the importance that diet and nutrition play in eye health.  The AOA highlights six nutrients important for eyesight:
Lutein, Zeaxanthin, Essential fatty acids, Vitamins C, Vitamin E, Zinc  
 
In their press release the AOA mention the following food sources of these specific nutrients:
Lutein and zeaxanthin: Colorful fruits and vegetables such as broccoli, spinach, kale, corn, green beans, peas, oranges and tangerines
Essential fatty acids: Oily fish like trout, salmon, sardines, or herring, nuts and seeds, whole grain foods, chicken and eggs
Vitamin C: Fruits and vegetables, including oranges, grapefruit, strawberries, papaya, green peppers and tomatoes
Vitamin E: Vegetable oils, such as safflower or corn oil, almonds, pecans, sweet potatoes, and sunflower seeds
Zinc: Lean red meat, poultry, liver, shellfish, milk, baked beans, and whole grains

(1)American Optometric Association (AOA)
(2)William G. Christen, ScD et al.  2009.  Folic Acid, Pyridoxine, and Cyanocobalamin Combination Treatment and Age-Related Macular Degeneration in Women.   The Women's Antioxidant and Folic Acid Cardiovascular Study.  Arch Intern Med.169(4):335-341.
(3)University of Liverpool – press release
(4) Open Your Eyes To Healthy Eating Habits – press release by the AOA

Written by Ani Kowal

In August last year I wrote about natural ways to prevent and treat mouth ulcers, medically known as Aphthous Stomatitis.  A recently published medical study (1) has found that nightly doses of a vitamin B12 supplement are useful for individuals who suffer from recurrent mouth ulcers.  The study is very relevant since it is estimated that up to 25% of the general population may suffer from mouth ulcers with up to 50% of these individuals having recurrent ulcers within 3 months.  Recurrent mouth ulcers are especially common during times of stress as this is a known contributor in susceptible individuals.

Before starting their scientific research, the authors of this new paper conducted a comprehensive search of published medical studies related to the treatment of recurrent mouth ulcers.  They found that many treatments have been tested ranging from local antiseptics to antibiotics and even certain steroid creams and immunosuppresant drugs!  Most of these treatments were seen as short term ways to alleviate pain, number of ulcers, their size and duration of effect.  The treatments were not so good at achieving long-term reduction in the frequency of mouth ulcer attacks or maintenance of remission.

Previously (2,3) the same authors have shown that treatment of recurrent mouth ulcers with vitamin B12 was successful but they wanted to confirm and expand upon their findings.  Their latest study was small but well designed.  It included 58 patients who suffered with recurrent mouth ulcers.  A sublingual, under the tongue, high dose (1000mcg) of vitamin B12 was given to 31 of the patients nightly for 6 months.  The other 27 patients acted as the control group and received no vitamin B12 supplement. 

It was found that the duration of outbreaks, the number of mouth ulcers, and the level of pain were reduced significantly at 5 and 6 months of treatment with vitamin B12, regardless of initial vitamin B12 levels in the blood. During the last month of treatment a significant number, 74%, of participants in the intervention group reached "no aphthous ulcers status" i.e. they no longer had mouth ulcer attacks.  The authors conclude that Vitamin B12 treatment is simple, inexpensive, and low-risk and seems to be effective for patients suffering from recurrent mouth ulcers regardless of their initial blood serum vitamin B12 levels.

Although the study was small the results are adding to previous evidence and therefore seem highly relevant.  The reason that effect may have been seen even in patients without a B12 deficiency could be because the identification and measurement of ‘functional’ vitamin B12 deficiency is controversial, it is difficult to accurately measure the status of B12 in the body.  The authors comment that another explanation for the possible effectiveness of vitamin B12 in treating recurrent mouth ulcers is that vitamin B12 has some unique but still unrecognized functions and needs may be higher than once thought.

Since this kind of treatment is simple and inexpensive and has no known significant toxic effects it may well be worth a try.  Taking 500-1000mcg Vitamin B12 at night if you suffer from recurrent mouth ulcers could prove very useful.  Many sublingual B12 supplements and vitamin drops are now available to buy. 

(1)Volkov I et al.  2009.  Effectiveness of Vitamin B12 in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial.The Journal of the American Board of Family Medicine.  22: 9-16
(2) Volkov I et al.  2005. Recurrent apthous stomatitis responsive to vitamin B12 treatment. Can Fam Phys.  51: 844–5
(3) Volkov I et al.  2007. Successful treatment of recurrent aphthous stomatitis of any origin with vitamni B12 (irrespective of its blood level). The Internet Journal of Family Practice 2007;5.

Written by Ani Kowal

On 15th October I wrote about the connection between B vitamins and healthy bones and I also mentioned how elevated homocysteine levels may be implicated in bone deterioration and heart disease.  Today I want to look at the link between elevated homocysteine levels, low vitamin B12 levels and cognitive (mental) decline.

To recap: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

A new study (1) was recently published which showed that older adults who have vitamin B12 levels that are low, but still within the normal range, may exhibit a quicker rate of brain shrinkage (brain volume loss) as they age compared to those who have good levels.  The authors wanted to investigate the association between vitamin B12 status and brain volume loss in a population of adults aged 61-87 over a 5 year period.  The participants were free of cognitive impairment (they were free of dementia) at the start of the study.  Those with lower vitamin B12 levels at the start of the study experienced the greatest decrease in brain volume over the 5 year period.  This was only a small preliminary study involving 107 individuals, the authors suggest that low vitamin B12 status should be further investigated and that trials with vitamin B supplements would be useful.

A loss in brain volume has been linked to a faster rate of mental decline and progression to diseases such as Alzheimer’s disease and dementia.  Vitamin B12 is extremely important in order to keep nerve cells healthy.  The study mentioned above (1) suggests, but does not prove, that modifying vitamin B12 status could be important in protecting the brain and preventing cognitive decline.  The results of the study do suggest that it is important to keep our vitamin B12 levels higher than just the minimum.

A study last year (2) looked at the association between cognitive decline and vitamin B12.  The study included 1684 individuals who were followed for 10 years.  Mental state (cognition) was examined a minimum of 3 times over the 10 years as were serum vitamin B12 concentrations.  Analysis of the results found that reduced vitamin B12 status was associated to cognitive decline.  The investigators also found that a high homocysteine level was associated with a greater rate of cognitive decline.  Again the authors indicate the need for further studies and supplementation trials for the prevention of dementia.

A review (3) paper published this year discussed the importance of vitamin B12 for brain health throughout life from infancy to adulthood.  In childhood low vitamin B12 levels may be related to behavioural problems and in adults it seems to be related to social development, depression and cognitive problems.  It seems as though this nutrient really is vital throughout our lifespan. 

Many older adults in the UK have lowered vitamin B12 levels.  In the diet, B12 comes from meat, fish, dairy, other animal products, and fortified breakfast cereals. Strict vegetarians, who avoid meat, and vegans, who avoid all animal products, are also at risk of B12 deficiency.  Studies seem to suggest that anything in the stomach that affects the normal acidity and digestive processes, ranging from infections to acid reflux medications to aging, may also interfere with the absorption of vitamin B12. 

The vitamin B group work very well as a team and interact in many processess, if you decide to take a supplement it may well be worth considering a multi-B vitamin supplement rather than single B vitamin supplement, or a broad spectrum multi-nutrient supplement (I prefer food state supplements which appear to be more easily absorbed by the body).

(1) Vogiatzoglou A et al.  2008.  Vitamin B12 status and rate of brain volume loss in community-dwelling elderly.  Neurology.  71:826-832
(2)Clarke R et al.  2007.  Low vitamin B-12 status and risk of cognitive decline in older adults.  Am J Clin Nutr.  86:1384-1391
(3)Black MM.  2008.  Effects of vitamin B12 and folate deficiency on brain development in children.  Food Nutr Bull.  29:S126-131

Written by Ani Kowal