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More evidence points toward the importance of vitamin B12 to protect against Alzheimer’s disease

AniKowal — Mon, 07 Feb 2011 05:00:31 +0000

In November I mentioned a study which found that supplemental B vitamins which lowered homocysteine levels in the body might be useful to help elderly individuals with mild cognitive [mental function] impairment. A recent study (1) has found that Vitamin B12 may help protect against Alzheimer’s disease. The results of the research suggests that elderly individuals with more of the active part of the vitamin B12 in their blood have a lower risk of developing the disease. However, the findings don’t necessarily mean that taking B vitamin supplements will stave off mental decline.

To recap on homocysteine:

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 heart disease and other 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 study (1)was set up in order to examine the relationship between blood serum levels of homocysteine and holotranscobalamin (holoTC), the active partof vitamin B12, and risk of incident Alzheimer disease in a sample of community-dwelling elderly. The research involved over 250 individuals aged between 65 and 79 years old who were free of dementia. The participants were followed-up for seven years and any cases of Alzheimer’s disease were recorded. The study scientists then looked to see if there was any association between the serum homocysteine levels, Vitamin B12 levels and Alzheimer’s disease. The study found that for each micromolar (1 µmol/L) increase in the concentration of homocysteine, the risk of Alzheimer’s disease increased by 16%, whereas each picomolar (1 pmol/L) increase in concentration of the active form of vitamin B12 reduced risk by 2%. The results stayed the same after taking into account other factors, such as age, gender, education, smoking status, blood pressure, stroke and body mass index. The addition of folate did not appear to raise or lower the risk of Alzheimer’s disease. From the results the authors conclude “This study suggests that both tHcy [homocysteine] and holoTC [vitamin B12] may be involvedin the development of AD [Alzheimer’s disease]. The tHcy–AD link may be partlyexplained by serum holoTC. The role of holoTC in AD should befurther investigated” (1)

In a press release Babak Hooshmand, one of the study scientists, said (2) ”Our findings show the need for further research on the role of vitamin B12 as a marker for identifying people who are at increased risk of Alzheimer’s disease,” “Low levels of vitamin B12 are surprisingly common in the elderly. However, the few studies that have investigated the usefulness of vitamin B12 supplements to reduce the risk of memory loss have had mixed results.”

The findings of this trial are very interesting but further large-scale research is needed in order to test whether vitamin B12 supplements can be recommended as a suitable treatment for the prevention of cognitive decline and dementia. Dr Hooshmand said in the press release “More research is needed to confirm these findings before vitamin B12 should be used solely as a supplement to help protect memory,”

Vitamin B12 is found mainly in meat, fish and poultry. Eggs and cheese also contain B12 as does brewer’s yeast. Many vegetarians and vegans have very low intakes of this vital nutrient and may wish to consider a multi-B vitamin supplement. Folic acid is found in beans, green vegetables and wholegrains. Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry. Supplements should never be seen as an alternative to a healthy diet. If you wish to investigate the option of taking B vitamins it is best to discuss this with your medical doctor first.

(1) B. Hooshmand B et al. 2010. Homocysteine and holotranscobalamin and the risk of Alzheimer disease. A longitudinal study. NEUROLOGY 2010;75:1408-1414

(2) Press Release. American Academy of Neurology (2010, October 19). Vitamin B12 may reduce risk of Alzheimer’s disease. ScienceDaily. Retrieved December 6, 2010, from http://www.sciencedaily.com /releases/2010/10/101018162922.htm

Written By Ani Kowal

Study links folic acid supplementation and DNA changes in newborn babies

AniKowal — Mon, 24 Jan 2011 05:00:13 +0000

A new groundbreaking study (1) conducted by a UK team of research scientists has linked changes in the DNA of newborn babies, folic acid supplementation during pregnancy and birth weight. This study was conducted at Keele and Nottingham Universities together with doctors at University Hospital of North Staffordshire and Derby Children’s Hospital and was funded by the World Cancer Research Fund (WCRF).

I have previously written about the importance of folic acid during pregnancy for the prevention of neural tube defects, low birth weight and congenital heart defects. This new study (1) showed that the levels of a critical metabolite of folic acid, homocysteine, in the blood of newborn babies is linked to modifications of their DNA (DNA methylation) in key genes and that such modifications might be used to predict birth weight (2).

To recap on homocysteine: 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 heart disease and other 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.

Supplementation with folic acid during pregnancy is known to reduce the risk of neural tube defects such as spina bifida. It also protects against low birth weight, which has numerous short- and long-term consequences. It has been suggested that folic acid, though its metabolism to chemicals such as homocysteine, might secure these clinical effects via DNA methylation (2). In this study the researchers examined the relationship between folic acid supplementation and its metabolites on DNA methylation in human blood from the umbilical cord, using a state-of-the-art ‘microarray’ techniques which simultaneously examines methylation at 27,578 sites in the DNA.

In a press release, Professor Farrell, lead study scientist said: “It has been known for many years that folic acid supplementation is essential for women during pregnancy to reduce the risk of neural tube defects and low birth weight delivery. However, we had little idea as to how this worked. This study is the first to suggest that methylation of particular genes in the baby’s DNA may be the key to unlocking the secret of the action of folic acid”. “Now we have identified which genes might be the link between folic acid and birth weight, we have opened the door to research that may allow doctors to predict the likelihood of low birth weight with greater certainty. Furthermore, it sheds light on the underlying causes of low birth weight and offers the potential to intervene earlier to prevent poor pregnancy outcomes such as premature delivery and pregnancy loss.”

The work being done by this group of scientists illustrates the potential of DNA methylation ‘microarray’ technology to identify a new generation of clinical markers that will have a major impact, not only on the development of new therapeutic agents, but also on the way we manage a wide range of medical scenarios (1,2)

Supplementation with folic acid during pregnancy is known to reduce the risk of neural tube defects and low birth weight. Folic acid supplements have long been recommended for all pregnant women, women planning on becoming pregnant and also women of childbearing age. The reason for this recommendation is that folic acid is crucial for optimal foetal development very early in pregnancy, at a time when many women do not realise they are even pregnant. At this early stage of pregnancy this nutrient of the B-vitamin group is known to prevent neural tube (brain and spinal cord) birth defects such as spina bifida.

If you are planning pregnancy or a woman of childbearing age who could fall pregnant it is certainly worth taking a multi-nutrient supplement which contains folic acid. Specific supplements are available for pregnant women and those planning pregnancy and it is always a good idea to check with your doctor or midwife before starting supplementation. 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.

(1) Fryer AA et al. 2011. Quantitative, high-resolution epigenetic profiling of CpG loci identifies associations with cord blood plasma homocysteine and birth weight in humans. Epigenetics. 6(1). [Epub ahead of print]

(2)Press release. Keele University. Posted 2^nd December 2010. Folic acid supplementation in pregnancy, DNA methylation and birth weight in newborn babies. http://www.keele.ac.uk/pressreleases/2010/title,34358,en.php

Written by Ani Kowal

B Vitamins may be important for people with memory problems

AniKowal — Mon, 22 Nov 2010 05:00:45 +0000

In older individuals, especially those who are suffering from cognitive (brain function) decline, there is often an increased rate of brain wastage/shrinking (atrophy). Previous studies have found that homocysteine is a risk factor for brain atrophy, cognitive impairment and dementia. It is also known that blood plasma concentrations of homocysteine can be lowered by dietary administration of B vitamins.

A recent, two year, study (1) was carried out in order to determine whether supplementation with B vitamins that lower levels of plasma total homocysteine can slow the rate of brain atrophy in subjects with mild cognitive impairment. High doses of folic acid (0.8mg/d), vitamins B₆ (20mg/d) and B₁₂ (0.5mg/d) were used in the study and participants, who were all over 70 years old, had brain MRI scans both at the start and end of the study in order to track brain shrinkage. The dose of B vitamins in the supplement pills was high, they contained around 300 times the recommended daily intake of B12, four times daily advised folate levels and 15 times the recommended amount of B6.

The results of the study showed that individuals (1) receiving the B vitamins had a significantly reduced rate of brain atrophy per year when compared to those individuals taking the placebo. Brain atrophy was related to the homocysteine levels at the start of the study: the rate of atrophy in participants with homocysteine levels greater than >13 µmol/L was 53% lower in the group receiving the B vitamins. A greater rate of brain shrinkage was associated with a lower final cognitive test scores. The authors conclude that “The accelerated rate of brain atrophy in elderly with mild cognitive impairment can be slowed by treatment with homocysteine-lowering B vitamins. Sixteen percent of those over 70 y old have mild cognitive impairment and half of these develop Alzheimer’s disease. Since accelerated brain atrophy is a characteristic of subjects with mild cognitive impairment who convert to Alzheimer’s disease, trials are needed to see if the same treatment will delay the development of Alzheimer’s disease”.

For more on Alzheimer’s disease please read my previous posts on the topic. Individuals with mild cognitive impairment tend to experience problems with memory, language, or other mental functions, but not to a degree that interferes with daily life. Around half of people with mild cognitive impairment go on to develop dementia , mainly Alzheimer’s disease, within five years of diagnosis (2). Alzheimer’s is a mind-wasting disease for which there are few treatments and no cure, and which affects 26 million people around the world.

In a press release (2) one of the study authors, Professor David Smith of the Department of Pharmacology at Oxford University, said “It is our hope that this simple and safe treatment will delay the development of Alzheimer’s disease in many people who suffer from mild memory problems” “Today there are about 1.5 million elderly in UK, 5 million in USA and 14 million in Europe with such memory problems”. “These are immensely promising results but we do need to do more trials to conclude whether these particular B vitamins can slow or prevent development of Alzheimer’s. So I wouldn’t yet recommend that anyone getting a bit older and beginning to be worried about memory lapses should rush out and buy vitamin B supplements without seeing a doctor”

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust said (2): “These are very important results, with B vitamins now showing a prospect of protecting some people from Alzheimer’s in old age. The strong findings must inspire an expanded trial to follow people expected to develop Alzheimer’s, and we hope for further success. We desperately need to support research into dementia, to help avoid the massive increases of people living with the condition as the population ages. Research is the only answer to what remains the greatest medical challenge of our time”

The findings of this trial are indeed very encouraging, further large-scale research is needed in order to test whether B vitamins can be recommended as a suitable treatment for the prevention of cognitive decline and dementia.

Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry. Vitamin B12 is found mainly in meat, fish and poultry. Eggs and cheese also contain B12 as does brewer’s yeast. Many vegetarians and vegans have very low intakes of this vital nutrient and may wish to consider a multi-B vitamin supplement. Folic acid is found in beans, green vegetables and wholegrains. Supplements should never be seen as an alternative to a healthy diet and as Professor Smith said in the press release, if you wish to investigate the option of taking B vitamins it is best to discuss this with your medical doctor first.

(1)Smith AD et al. 2010. Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. PLoS ONE, 2010; 5 (9): e12244 DOI: 10.1371/journal.pone.0012244

(2)Press Release. University of Oxford (2010, September 12). B vitamins slow brain atrophy in people with memory problems. ScienceDaily. Retrieved September 13, 2010, from http://www.sciencedaily.com /releases/2010/09/100912213050.htm

Written by Ani Kowal

Folate might impact cholesterol levels

AniKowal — Mon, 30 Aug 2010 05:00:10 +0000

Folate (the naturally occurring form of folic acid), a B vitamin, is one that I have written a lot about, it has been linked to heart health, mood, pregnancy outcomes and much more. In July I wrote about the B vitamins, folate and vitamin B12, being linked to heart disease .

A recently published study(1) has found that folate may also be linked to cholesterol levels (another potential risk factor for heart disease). The study looked at data for blood vitamin B12 and folate levels in over 1700 individuals. They found that higher folate levels were associated with lower levels of low density lipoprotein cholesterol (LDL-cholesterol, the so called ‘bad’ cholesterol which has been linked to an increased risk of heart disease). They also found that higher levels of folate were linked to higher levels of ‘good’ cholesterol, high density lipoprotein cholesterol (HDL-cholesterol). The study authors also compared the individuals of the highest with those of the lowest levels of folate. They found that individuals with the highest folate had higher levels of HDL-cholesterol, lower levels of LDL-cholesterol and a lower LDL-C: HDL-C- ratio, this is indicative of a favourable cholesterol profile. In this study Vitamin B12 was not associated with the cholesterol profile.

The study authors call for more research to further investigate the link between folate and cholesterol levels. The current study only provides a potential link, it does not prove that low folate levels are linked to raised LDL cholesterol levels. The study does provide further evidence to suggest that there may also be a link between cholesterol and homocysteine levels, other studies have also suggested such a link. These are very complex interactions and further research to elucidate links could provide really useful information on how diet can be used to reduce the risks of heart disease.

At the present time there is no conclusive evidence to suggest that B vitamins can reduce the risk of heart disease and supplements cannot be recommended as a preventative measure. Having a good level of B vitamins in the diet is, however, important for health. Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry. Vitamin B12 is found mainly in meat, fish and poultry. Eggs and cheese also contain B12 as does brewer’s yeast. Folic acid is found in beans, green vegetables and wholegrains.

Supplements should never be seen as an alternative to a healthy diet and it is wise to check with you doctor before starting any new supplement regiment. If you are thinking about taking a vitamin B supplement I would always suggest a broad spectrum supplement that supplies adequate, but not megadose, levels of all of the B vitamins (not single nutrient supplements), these vitamins work best together as a team

(1)Semmler A et al. 2010. Plasma folate levels are associated with the lipoprotein profile: a retrospective database analysis. Nutrition Journal. 9:31E-pub prior to print. doi:10.1186/1475-2891-9-31 Published 28 July 2010

Written by Ani Kowal

A diet high in B vitamins might be linked to a lower risk of heart disease and stroke

AniKowal — Wed, 28 Jul 2010 05:00:31 +0000

A recent Japanese study (1) has found that eating more foods which contain the B-vitamins B6 and folate may reduce the risk of death from stroke and heart disease in women and may reduce the risk of heart failure in men.

There has been a lot of research interest in the links between B vitamins and risk of cardiovascular disease (stroke and heart disease) over the last decade. The rationale behind this is that there is evidence to suggest that elevated homocysteine levels are a risk factor for heart disease. As mentioned in previous 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 heart disease and other 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 evidence, however is controversial and not yet solid.

In this study(1) over 23,000 men and 35,000 women, age 40 to 79 years, completeda specialised food frequency questionnaire. During an average of 14-years follow-up, there were 986 deathsfrom stroke, 424 from coronary heart disease, and 2087 fromcardiovascular disease. The researchers analysed the results and found that higher dietary folate and vitaminB₆ intakes were associated with a reduced risk of death from heartfailure for men and with a reduced risk of death from stroke, coronary heartdisease, and total cardiovascular disease for women. In this particular study no association was found betweenvitamin B₁₂ intake and mortality risk.

The findings on the value of B vitamins were consistent with studies in Europe and North America. The study only shows association, a direct causal link hasn’t been established, but evidence has shown that too much homocysteine may damage the inner lining of arteries and can promote the formation of blood clots (2).

Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry. Vitamin B12 is found mainly in meat, fish and poultry. Eggs and cheese also contain B12 as does brewer’s yeast. Many vegetarians and vegans have very low intakes of this vital nutrient and may wish to consider a multi-B vitamin supplement. Folic acid is found in beans, green vegetables and wholegrains. Supplements should never be seen as an alternative to a healthy diet and it is wise to check with you doctor before starting any new supplement regiment. If you are thinking about taking a vitamin B supplement I would always suggest a broad spectrum supplement that supplies adequate, but not megadose, levels of all of the B vitamins (not single nutrient supplements), these vitamins work best together as a team

(1)Renzhe Cui et al. 2010. Japan Collaborative Cohort Study Group. Dietary Folate and Vitamin B6 and B12 Intake in Relation to Mortality From Cardiovascular Diseases. Japan Collaborative Cohort Study. Stroke, 2010; DOI: 10.1161/STROKEAHA.110.578906

(2)Press release American Heart Association (2010, April 15). Diet high in B vitamins lowers heart risks in Japanese study. ScienceDaily. Retrieved April 17, 2010, from http://www.sciencedaily.com /releases/2010/04/100415161933.htm

Written by Ani Kowal

Low B vitamin intake linked to depression in older adults

AniKowal — Mon, 19 Jul 2010 05:00:38 +0000

As mentioned in many past posts, depression and mood have links to nutrition. In past studies deficiencies and low levels of B vitamins have been associated with depression. Vitamin B12 is important for efficient brain function and cognition (mental function). A recent study (1) published in the American Journal of Clinical Nutrition has found that “high totalintakes of vitamins B-6 and B-12 are protective of depressivesymptoms over time in community-residing older adults”.

The study(1) examined whether dietary intakes of vitamin B6, folate and vitamin B12 were linked to depressive symptoms over a period of over 7 years in a population of older adults. The study included over 3500 adults aged 65 and older. The diet of the individuals was assessed using a special food frequency questionnaire and depression was measured using a well regarded depression scale. The results showed that high intakes, which included intakes from supplements, of vitamin B6 and B12 were associated with a decreased likelihood of depression of up to 12 years of follow up. The authors of the study note that “each10 additional milligrams of vitamin B-6 and 10 additional microgramsof vitamin B-12 were associated with 2% lower odds of depressivesymptoms per year” “Theseassociations remained after adjustment for smoking, alcoholuse, widowhood, caregiving status, cognitive function, physicaldisability, and medical conditions”.

In this study,unlike many other studies, folate intake was not linked to depression risk. A potential explanation is that folate deficiency is rare in the U.S., where this study look place, since grain products are routinely fortified with the vitamin.

The study is interesting and adds to the evidence that B vitamins are important for brain function and may help to prevent depression. The results, however, do not prove that the B vitamins protect against depression – the study simply shows there is an association between high B vitamin intake and reduced likelihood of developing depression. The main strength of the current study was that it followed a large group of people over 12 years, measuring depression symptoms at several time points. The results should be interpreted with caution, because study participants’ consumption of the vitamins might be a marker for other factors, like a generally healthy diet.

Both vitamin B6 and vitamin B12 are involved in the efficient functioning of the nervous system, and low vitamin B12 levels are associated with cognitive decline. Vitamin B6 is involved in the manufacture of chemical ‘messengers’ in the brain such as including serotonin. Serotonin dysfunction is believed to play a key role in depression. The role for Bvitamins in the treatment and prevention of depression is still unclear and further evidence is certainly required before any firm conclusions can be drawn and recommendations made.

Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry. Vitamin B12 is found mainly in meat, fish and poultry. Eggs and cheese also contain B12 as does brewer’s yeast. Many vegetarians and vegans have very low intakes of this vital nutrient and may wish to consider a multi-B vitamin supplement. Folic acid is found in beans, green vegetables and wholegrains If you decide you would like to take a vitamin B supplement I would always suggest a broad spectrum supplement that supplies adequate, but not megadose, levels of all of the B vitamins (not single nutrient supplements), these vitamins work best together as a team!

(1) Kimberly A Skarupski KA et al. 2010. Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time. American Journal of Clinical Nutrition, online June 2, 2010.

Written by Ani Kowal

Commonly prescribed diabetes drug linked to vitamin deficiency

AniKowal — Mon, 12 Jul 2010 05:00:41 +0000

Individuals with type 2 diabetes are often prescribed a drug called metformin. It is considered a cornerstone in the treatment of type 2 diabetes. A new study (1), published in the British Medical Journal has found that patients who are treated over long periods of time with metformin are at risk of developing vitamin B12 deficiency, which is likely to get worse over time. One of the reasons that metformin is frequently prescribed is that it is one of the few type 2 diabetes drugs that is associated with improvements in heart disease which is a major cause of death in individuals with type 2 diabetes. However, the fact that the drug seems to cause vitamin B12 deficiency is a serious issue. In the research paper the scientists state (1) “Our data provide a strong case for routineassessment of vitamin B-12 levels during long term treatmentwith metformin” Checking vitamin B-12 levels regularly could help to prevent deficiency and the effects associated with that.

It is estimated that over 240 million people around the world have type 2 diabetes and these rates are expected to rise as the number of people who are overweight or obese also rises. Overweight is a major risk factor for type 2 diabetes.

Vitamin B12 is essential to keep all nerves healthy, therefore it is essential for brain function. Vitamin B12 also maintains healthy red blood cells. In the diet, vitamin B12 comes from meat, fish, dairy, eggs, 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.

Symptoms of vitamin B12 deficiency may include fatigue, mental changes, anaemia and nerve damage known as neuropathy. Unfortunately all of these symptoms may be missed and misdiagnosed as a consequence of the type 2 diabetes or aging rather than vitamin B12 deficiency (1).

The research (1) involved 390 individuals with type 2 diabetes who were receiving insulin treatment. 196 were given metformin three times daily for over four years, 194 were given an inactive placebo. Blood was taken at the start of the study and again at 4, 17, 30, 43 and 52 months to test the vitamin B12 levels. Those who had taken the metformin had a significant reduction in their vitamin B12 levels compared to the group receiving placebo, who has almost no change in their vitamin B12 levels. In the group receiving metformin the reduced levels of vitamin B12 persisted and became even lower over time. The authors write (1) “Our study shows that it is reasonable to assume harm will eventually occur in some patients with metformin-induced low vitamin B12 levels”

Compared with placebo metformin treatment was also associated with a reduction in folate levels and an increase in homocysteine levels. The authors of the study conclude that (1) “Long term treatment with metformin increases therisk of vitamin B-12 deficiency, which results in raised homocysteineconcentrations. Vitamin B-12 deficiency is preventable; therefore,our findings suggest that regular measurement of vitamin B-12concentrations during long term metformin treatment should bestrongly considered”.

I have written about homocysteine previously, it is important because there is mounting research which suggests that elevated homocysteine levels are a risk factor for heart disease, especially among individuals with type 2 diabetes. 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 heart disease and other 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 authors also note “it is likely that, if anything,we underestimated the impact of metformin treatment on the riskof clinically important vitamin B-12 deficiency. A further reason that we may have somewhat underestimatedthe adverse effects of metformin is that all participants inour trial received frequent dietary counselling, which may haveattenuated the impact of metformin treatment on vitamin statusand may not be available in routine clinical practice”.Further studies are needed to confirm the results and to see if giving patients specific dietary advice on vitamin B12 would solve the problem. It might be that regular screening of vitamin B12 would be necessary and also possibly supplementation.
“The reduction in vitaminB-12 concentration associated with metformin increased withtime. Current guidelines indicate that metformin is a cornerstonein the treatment of type 2 diabetes, but make no recommendationson the detection and prevention of vitamin B-12 deficiency duringtreatment. Our data provide a strong case for routine assessmentof vitamin B-12 levels during long term treatment with metformin” (1).

If you are currently taking metformin you may wish to speak to your doctor about screening for vitamin B12 and homocysteine levels. If you have been diagnosed with type 2 diabetes do not take a vitamin B12 supplement prior to checking with your medical doctor first. The vitamins of the B group work very well as a team and interact synergistically in many processess, if you decide to take a supplement it would be worth considering a multi-B vitamin supplement rather than single B vitamin supplement, or a broad spectrum multi-nutrient supplement.

(1) de Jager J et al. 2010. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ 2010;340:c2181

Written by Ani Kowal

Higher folate levels recently linked to reduced risk of hearing loss

admin — Mon, 19 Oct 2009 16:03:08 +0000

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

Can nutrition be helpful for sufferers of obsessive compulsive disorder (OCD)?

admin — Mon, 28 Sep 2009 11:35:11 +0000

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

Diet, the brain and behaviour in children

admin — Wed, 26 Aug 2009 17:03:27 +0000

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