(Jaan Suurküla [= big (suur) village (küla; cf. Sanskrit "kula")] is an M.D. of apparently Estonian ancestry.)
Date: Thu, 13 Apr 2006 14:51:32 +0200 (CEST) From: Jaan Suurkula <[EMAIL PROTECTED]> Subject: You may have vitamin B12-deficiency Introduction Dear Friends, B12 is very important for the normal functioning of the brain. For example, over half of people with Alzheimers dementia have been found to have B12 deficiency. Research has reported B12-deficiency among one third of vegetarians studied. This may be an underestimation as the tests are insensitive. The reason for the deficiency is that vegetarian food is poor in B12, unless one regularly eats mungbean and chickbean sprouts (a cup virtually every day is required to provide enough). So it is good to take some B12 if one has been a vegetarian for a long time. Even when there is a harmful deficiency in the Brain, it is not always very evident. Although the tests are unreliable, they should still be taken because, if positive you have a strong reason to be careful about taking B12 in the future. Wrong cooking may cause deficiency. This is, because all the B- vitamins are very heatsensitive so they are commonly destroyed with cooking. They are very watersoluble so they should not be boiled in water. B-vitamin rich vegetables should be steamed (not boiled in water), until they get a little soft. So unless this is done, there are not much B-vitamins left in the food. Then take B-vitamins - Brewers yeast is a good supplement. I have found pronounced deficiency in several vegetarian TM-people NOTE: Do forward this to your vegetarian friends especially as well as elderly relatives. Please mention that I intend, if time and resources allow, to create a website also informing about other important health issues. The idea is to sort out, among all the more or less well underpinned rumours in the health field, what are really important and common health issues in our modern society and to explain in a way laymen can understand. I will let you know when/if it is published. Jai Guru Dev Jaan As this text is quite long I have split it in a few parts. B12 part 1 Symptoms Silent vitamin B12 deficiency common among vegetarians By Jaan Suurküla, M.D. Recent research has shown that vitamin B12 deficiency is very common among vegetarians. In addition, at least 10-15 % of all people above 60 are deficient. Measuring the vitamin in blood is not reliable. Some can have a pronounced deficiency with normal B12 in blood. Therefore the extent of B12 deficiency has long been underestimated. Even young people may be deficient. The youngest vegetarian with a clearcut deficiency I know about was 17 years. I have found that many vegetarian meditators have B12 deficiency. Deficiency symptoms may be vague Vitamin B12 is very important for the normal functioning of the nervous system. Early and even fairly pronounced deficiency does not always cause distinct or specific symptoms. Common early symptoms are tiredness or a decreased mental work capacity. Decreased concentration and decreased memory (brain "Vata"). Irritability and depression. Sleep disturbances may occur, because B12 is important for the regulation of the sleep wake cycle by the pineal gland (through melatonin)[1]. Treatment with B12 normalizes the melatonin level, and thereby the sleep disturbance. Seasonal Affective Disorder (SAD), with severe seasonal depressions has a known connection with disturbed pineal (melatonin) functioning including disturbed sleep-wake rhythm[2]. But I have had cases with pronounced deficiency but still no subjective symptoms perhaps some sleep disturbance. It is my experience that many doctors miss the diagnosis. Severe deficiency may harm the brain. For example about 50 percent of Alzheimer's dementia cases had low B12 in a recent Swedish study. The damage is suspected to be caused by an increase of the neurotoxic amino acid homocystein which requires B12 for its breakdown. Also the peripheral nervous system is affected. The first symptoms are tingling, needle-prick or burning sensations in the toes and later in the fingertips. Later numbness in the hands and feet "like walking on clouds" and balance disturbances. The muscles get weak and shaky. The bladder and bowel control gets increasingly impaired. Impotence may occur. The sense of smell may decrease. Many other disturbances, not yet known to be connected to B12 may be there. But you can have pronounced brain deficiency without any of these peripheral symptoms. Vitamin B12-deficiency may also cause anemia and this was formerly thought to be a good indicator of B12-deficiency. But recent research has found that there may be pronounced brain affection without anemia. Especially in pernicious anemia (see below) there may also be symptoms from the Gastro-intestinal channel, including soreness of the tongue that may be smooth, at least on the sides, flatulence, heartburn, diarrhea or constipation. Treatment with B12 can reverse the disturbances caused by deficiency. The list of symptoms and disorders caused by B12-deficiency is steadily growing and no doubt much is left to be added. Here are some examples of disorders that have responded postively to B12- treatment: Aphtous stomatitis (whitish painful spots in the mouth) cured, erythema nodosum (a nodular skin disorder) cured, bursitis cured, sulfite sensitivity including asthma caused by it cured, chronic contact dermatitis cured, chronic urticaria, Bells palsy (facialis nerve paresis), breast cancer improved or cured, herpes zooster (bältros) improved. Macula degeneration of the eyes has been halted. --------------------------------- [1] The concentration of melatonin in SAD patients was on average 2.4 times as high as in the control group according to one study. See Karadottir R, Axelsson J. "Melatonin secretion in SAD patients and healthy patients matched with respect to age and sex." Int J Circumpolar Health. 60, 4:548-51, 2001. [2] See e.g. Ikeda M, Asai M, Moriya T, Sagara M, Inoue S, Shibata S. "Methylcobalamin amplifies melatonin-induced circadian phase shifts by facilitation of melatonin synthesis in the rat pineal gland." Brain Res. 1998 Jun 8;795(1-2):98-104. B12 part 2 - Testing and causes Testing Vitamin B12 in blood serum is not a reliable indicator. One reason is simply that the commonly used normal values wrong, allowing much to low B12 levels as normal (115-800 pg/l). Recent research indicates the lower normal limit should be raised to at least 500 pg/l (In Japan 550 is now established as minimum level). Homocystein is an amino acid that requires B12 for its decomposition. So an increased level of Homocystein is an indirect and fairly good indicator of B12 deficiency that seems to be more sensitive than vitamin B12 in blood. Not seldom only Homocystein in the cerebrospinal liquor is increased in vitamin B12 deficiency in the brain. So all the blood tests can be normal and yet an important deficiency can be there. Homocystein in cerebrospinal liquor is not a standard test yet. So the generally available test methods are not fully reliable. But it is important to test anyway, because if one of the tests is positive you will have a strong reason to correct the deficiency. Homocystein causes other serious trouble, so it is good to check it anyway. If you treat with high dose B12 without testing it will influence the tests for several years. So you will not know for sure if you had a B12 deficiency. Even if the test values are normal, I recommend you to take vitamin B12 for safety, if you suspect you have a defiency, as B12 is totally untoxic. If you feel clearly better, you had deficiency (this diagnosis method is used by physicians when the tests are negative, but a deficiency is suspected - it is called "exjuvantibus diagnosis"). Causes 1. The most common cause is deficient intake. This is why a considerable proportion of vegetarians have deficiency. The number may still be underestimated as the testing methods are not sensitive enough and the incidence of deficiency has therefore been underestimated, perhaps to a great extent. 2. Stomach disturbances may cause deficiency, because B12 is taken up in the stomach: An increasingly common such cause is the use of the very popular stomach acid reducing agents, so called "proton pump inhibitors" like for example Nexium, Losec, Omeprazol, Pariet and Rifun and "Histamin receptor antagonists" like Cimitidin, Zantac and Tagamet. One study found that Omeprazol decrased uptake by 80%. Stomach operations where part of it has been removed (Bilroth) "Perniciosa" a condition that causes an atrophia of the stomach mucosa, preventing the uptake. The symptoms are not very dramatic, other than heartburn, gases and bad digestion. So if you have some stomach disorder and are vegetarian, there are especially good reasons to check B12. 3. A number of drugs disturb the uptake or destroy the vitamine. This includes among others, Oral contraceptives, certain Antidiabetic drugs, the antibiotics Flagyl, Chloramphenicol and Neomycine. Smoking also decreases B12. 4. Gastrointestinal disorders may also disturb the digestion or uptake of the vitamin. This includes disturbances of the gastrointestinal flora, for example after antibiotics (already one tablet of antibiotics can sometimes upset the flora importantly), Chron's disease, Gluten intolerance caused intestinal disorder, pancreatic insufficiency. 5. Age. Above about 50 the ability to take up B12 decreases to an increasing exent. /Jaan Suurküla, M.D. B12 part 3, Complications, food sources, treatment Complications Homocystein damage: In the absence of vitamin B12 the homocystein level increases. Homocystein is a toxic amino acid that damages the cells in various tissues. This includes the arteries. Recent research has established that homocystein is a major cause of arteriosclerotic diseases including stroke and myocardial infarction. For example, one study found a greater than 60% decrease in vascular disease among users of the major nutrients required to lower homocysteine, namely vitamin B12, folic acid and vitamin B6. When one of them is deficient, the homocystein increases to harmful levels. So vitamin B12 deficiency can cause severe cardiovascular disease. Especially if you have cardiovascular diseases in your family there are strong reasons to check B12, folic acid and Homocystein in serum. Also it appears that the neurtoxic effect of homocystein is a common cause of the brain damage in Alzheimers dementia. There is also evidence that homocystein also causes other age-related degenerative diseases and cancer. The knowledge of the complications of Homocystein toxicity and B12 deficiency is yet incomplete as this problem has long been underdiagnosed and underestimated. Food sources of vitamin B12 The best sources for vegetarians are mung bean and chick bean sprouts. Vegetables in general are very low in B12. There are small amounts in milk and in cottage cheese (Frischkäse), but far from enough to cure a deficiency and it has not to be pasteurized as B12 is damaged by heat (over 80 degrees). It was formerly believed that Alge including Spirulina and Chlorella contained B12. But this is a form that cannot be used by humans. The best sources are non-vegetarian: Organ foods including liver, kidney, heart, brain. Egg yolk. Clams (Muscheln/, musslor), Oysters, crabs, sardines, salmon. None of the sources are sufficent to effectively and rapidly cure a deficiency. In such a case there is no option but to take Vitamin B12. Treatment When a deficiency has been diagnosed or is suspected the only safe way is to take a Vitamin B12 preparation. Take Methylcobalamin. Not yet available in Apotheken. But it is easily found in the Internet. Use tablets to dissolve in the mouth (sublingual resoriblets). Dosage: Methylcobalamin 5 mg (5000 microgram) a day until all symptoms are gone. Don't stop as long as you note any improvement. Let the tablet dissolve under the tongue. Avoid swallowing and keep it for a good while in the mouth not eating afterward so that all is taken up through the mouth mucosa. This is because some have decreased or low uptake ability through the stomach. Don't take Cyanocobalamin, which is the predominant form. It is an unnatural variety that has no or very weak effect on the brain (see http://www.strokedoctor.com/vitamin_b12.htm). Don't take injections, which is commonly offered, when there is a pronounced deficiency or neurological symptoms. This is because these can cause allergy to vitamin B12. It has been scientifically confirmed that B12 is as well absorbed through the mouth. If you have amalgam disorder or have much amalgam in your teeth, it is desirable to take the treatment under the supervision of an expert on this problem (unfortunately very few doctors are). You may need to take 10 mg Methylcobalamin per day for ½-1 year or more, because it seems that mercury may make brain uptake more difficult. Conclusion Do check your B12 and homocystein if you have been a vegetarian for a few years. If you have taken antibiotics any time in your life without actively correcting the gastrointestinal flora, or have been taking contraceptives or antacidic drugs you have especially strong reasons to check B12. Even if you have normal test values but have some tiredness, or depression tendencies, or sleep disturbances or irritability or other symptoms mentioned above, do take Methylcobalamin 5 mg anyway until the symptoms decrease or disappear (you don't need to have all symptoms they appear to a different extent in different persons). And thereafter either be careful to take mungbean sprouts and milk products regularly and/or take 5 mg Methylcobalamin a few times a month. That is usually enough as it is stored in the liver. It is my experience that B12 deficiency has been greatly underdiagnosed so far. It appears to be a much more common cause of health problems, especially in vegetarians and elderly, than doctors have realized. It may cause serious damage to the nervous system. So be vigilant about it. Copyright 2006/ Jaan Suurküla, M.D. Ayurveda Physician at the Maharishi Ayurveda Clinic at Bad Ems, Germany PS. I think it is only in our modern world with our unnaturally and insufficiently nourished crops together with food processing that destroys important nutrients, that major deficiencies can develop. In ideal food - Maharishi Vedic Agriculture food, I think there is such a richness of all necessary nutrients that deficiencies dont occur, especially if the food is richly varied as Ayurveda recommends. Is is said in Ayurveda that nature provides all nutrients that we need - provided we live and culture our food in tune with nature. So I think B12-deficiency may not have been an issue in those times. The natural treatment is just to eat enough of the best natural sources. But with the pronounced deficiencies that occur in modern conditions, even in meditating vegetarians following the rules of ayurveda, it is necessary to take supplements to prevent permanent damage in the nervous system. Regarding diagnosis, when there is a B12 deficiency you may see pulse changes in the dhatu level - B12 involves rakta- blood and majja - brain. So a good pulse reader may be able to find indicataions of deficiency or some kind of weakness in these tissues. He needs then to know what may cause such weakness. I think the great fathers of ayurveda were able to connect it with special qualities and kinds of food. In modern times we can just check the B12 and Homocystein. ---------------- kula n. herd, flock, swarm, multitude, race, family, esp. good family, nobility; guild, corporation, community, association, caste, tribe; land for one family, abode, residence, house; chief of a corporation (v. {kulabhUta}). --- often = chief, noble. ------------------------ Yahoo! Groups Sponsor --------------------~--> Check out the new improvements in Yahoo! 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