{"id":12750,"date":"2019-02-06T16:30:18","date_gmt":"2019-02-07T00:30:18","guid":{"rendered":"https:\/\/lightbearers.org\/blog\/?p=12750"},"modified":"2020-01-29T09:57:05","modified_gmt":"2020-01-29T17:57:05","slug":"b-sure-part-1","status":"publish","type":"post","link":"https:\/\/lightbearers.org\/blog\/b-sure-part-1\/","title":{"rendered":"B Sure, Part 1"},"content":{"rendered":"\n<p>The early 1930s was a time of great uncertainty. Prior to President Roosevelt, our nation was uncertain of its leadership. Investment uncertainty existed after economic collapse. Among the working class there was uncertain employment and therefore financial insecurity and doubt about whether daily necessities would be met. The nation gravitated to public figures such as sports heroes who provided inspiration as they struggled to persevere through the depression.<\/p>\n\n\n\n<p>Baseball was the most popular sport in America during this time. Both New York Yankees, Lou Gehrig rose in Babe Ruth\u2019s shadow. Gehrig became more than a baseball hero of the nation though. Unlike Babe Ruth, Gehrig approached baseball as a workman rather than a sport\u2019s star, though he set several major league records. He was nicknamed \u201cThe Iron Horse\u201d as a result of his reliability as a player and his steadfast work ethic. In 1939, however, Gehrig\u2019s reliability gave way to a diagnosis of a rare disease, amyotrophic lateral sclerosis (ALS), an incurable neuromuscular illness now commonly referred to as Lou Gehrig&#8217;s disease. The unthinkable had occurred. He had been confidently walking on to ball fields for 16 years. Now his future was uncertain.<\/p>\n\n\n\n<p>Though not a cure, vitamin B<sub>12<\/sub> has been found to have a protective effect on neurons, giving it the potential ability to lengthen the lifespan of those with Lou Gehrig&#8217;s disease.<sup>1<\/sup> Vitamin B<sub>12<\/sub> plays a crucial role in the nervous system. It is needed in the formation of the protective sheath around nerve fibers that allow for successful nerve transmission. It plays an important role in cell division and the production of red blood cells. It is involved in the metabolism of fat and protein. Deficiency can impact risk of cardiovascular disease by impairing the function of the lining of arteries, which can lead to atherosclerosis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Sufficient or Deficient?<\/h2>\n\n\n\n<p>While we do not require an abundance of B<sub>12<\/sub>, we do need to ensure adequate amounts. Deficiency can be disastrous to nerve, brain, and eye function. Generic symptoms like feeling tired, weak, constipation, loss of appetite, memory difficulties, numbness, and tingling in the hands or feet can all be associated with B<sub>12 <\/sub>deficiency.<\/p>\n\n\n\n<p>Vitamin B<sub>12<\/sub> is produced by some strains of bacteria. Absorption of B<sub>12<\/sub> from our own intestinal bacteria is unsure as it occurs higher in the intestinal tract than where it is produced. Vitamin B<sub>12 <\/sub>is present in animal foods, such as meat, eggs, and dairy, but for those who are choosing to reduce these foods in their diet, adequacy is a concern. There is some evidence that dried green and purple laver (nori) contains vitamin B<sub>12<\/sub>.<sup>2<\/sup> However, people who have relied on edible algae have been found to be deficient. Many foods thought to contain B12 contain either none, only trace amounts, or contain a form that is inactive in humans. It is commonly believed that fermented food is another source. Fermented food, however, is not a reliable source.<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Those with gastrointestinal disorders, like celiac disease or Crohn\u2019s, or those who have had weight loss surgery, may not be properly absorbing B<sub>12<\/sub>\u2026<\/p><\/blockquote>\n\n\n\n<p>Vitamin B<sub>12<\/sub> deficiency is experienced even in those who consume animal-based diets, especially with age. One reason for this could be impaired absorption. Several factors could potentially affect absorption, but one is a lack of sufficient acid in the stomach. Medications that decrease stomach acid include proton pump inhibitors (PPIs) such as Prilosec, Nexium, and H2 blockers, such as Zantac and Pepcid, which are taken to relieve symptoms of acid reflux and stomach ulcers. One study found that individuals who took PPIs for more than 2 years had a 65 percent higher risk of B<sub>12<\/sub> deficiency.<sup>3<\/sup> Approximately 80 percent of PPIs in the United States are purchased without a prescription or physician evaluation of upper gastrointestinal symptoms.<sup>4<\/sup> This is compounded by the fact that one out of three adults over age 50 have decreased stomach acid secretion. Bacterial overgrowth in unwanted regions of the gastrointestinal tract, such as the stomach and upper small intestine, can result from decreased stomach acid levels. Bacterial overgrowth was found in 53 percent of 47 outpatients taking omeprazole (20 mg\/day) in a prospective study.<sup>5<\/sup> As a result, the bacterial colony may actually use vitamin B<sub>12<\/sub> rather than produce it, \u201cfurther reducing the amount of vitamin B<sub>12 <\/sub>available.\u201d<sup>6<\/sup> Those with gastrointestinal disorders, like celiac disease or Crohn\u2019s, or those who have had weight loss surgery, may not be properly absorbing B<sub>12<\/sub> as well.<\/p>\n\n\n\n<p>Certain medications such as Metformin, a common medication used for type 2 diabetes, can also impair absorption. It is estimated that chronic use of Metformin results in B<sub>12<\/sub> deficiency in 30 percent of patients and could be a potential cause of neuropathy.<sup>7<\/sup> The elderly may be more susceptible, as one study found that 53 percent of elderly in long-term care institutions with diabetes experienced B<sub>12<\/sub> deficiency compared to 31 percent in diabetic patients not taking Metformin and 33 percent in the elderly without diabetes.<sup>8<\/sup><\/p>\n\n\n\n<p>What is considered to be the most reliable way of detecting deficiency or measuring B<sub>12<\/sub> levels is to test methylmalonic acid (MMA). MMA accumulates in the blood with B<sub>12<\/sub> deficiency, and consuming foods that contain active vitamin B<sub>12<\/sub> causes those levels to drop. Many foods commonly believed to be good sources of vitamin B<sub>12<\/sub> actually have no effect on MMA levels, which means those foods contain primarily inactive analogues.<\/p>\n\n\n\n<p>Next month we will conclude our discussion of Lou Gehrig, vitamin B<sub>12<\/sub>, and supplementation so that we can B sure.<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Y. Izumi &amp; R. Kaji, \u201cClinical trials of ultra-high-dose methylcobalamin in ALS,\u201d <em>Brain Nerve<\/em>, 10\/2007. 59(10):1141-7. (2007),&nbsp; https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17969354.<\/li><li>F. Wanatabe, \u201cVitamin B12 sources and bioavailability,\u201d <em>Exp Biol Med<\/em>, 11\/2007, 232(10):1266-74, https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17959839.<\/li><li>J. Lam et al, \u201cProton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency,\u201d <em>JAMA<\/em>, 12\/11\/13, 310(22):2435-42.<\/li><li>J. Heidelbaugh, \u201cProton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications,\u201d <em>Therapeutic advances in drug safety<\/em>, vol. 4, 3 (2013): 125-33.&nbsp;<\/li><li>Andrew C. Dukowicz, MD&nbsp; et al, \u201cSmall Intestinal Bacterial Overgrowth: A Comprehensive Review,\u201d <em>Gastroenterology &amp; hepatology<\/em>, vol. 3, 2 (2007): 112-22, https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3099351\/.<\/li><li>Vitamin B12, <em>National Institute of Health<\/em>, https:\/\/ods.od.nih.gov\/factsheets\/VitaminB12-HealthProfessional\/.<\/li><li>D. Bell, \u201cMetformin-Induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy,\u201d <em>South Med J<\/em>, 103(3):265-7 (2010),&nbsp; https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20134380.<\/li><li>Can\u2019t access the website. C. Wong, , C.S. Leung, C.P. Leung,&nbsp; &amp; J. Cheng, , (2018). &#8220;Association of metformin use with vitamin B<sub>12<\/sub> deficiency in the institutionalized elderly,&#8221; <em>Arch Gerontol Geriatr<\/em>, 79:57-62,.<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"<p>The early 1930s was a time of great uncertainty. Prior to President Roosevelt, our nation was uncertain of its leadership. Investment uncertainty&#8230;<\/p>\n","protected":false},"author":2,"featured_media":12752,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[2],"tags":[232,237],"class_list":["post-12750","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-report","tag-newsletter","tag-vitamin-b"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/lightbearers.org\/blog\/wp-content\/uploads\/2019\/02\/B_Sure.jpg?fit=2560%2C1440&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/paAh8r-3jE","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/posts\/12750","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/comments?post=12750"}],"version-history":[{"count":2,"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/posts\/12750\/revisions"}],"predecessor-version":[{"id":12860,"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/posts\/12750\/revisions\/12860"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/media\/12752"}],"wp:attachment":[{"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/media?parent=12750"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/categories?post=12750"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lightbearers.org\/blog\/wp-json\/wp\/v2\/tags?post=12750"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}