So, what’s all the conversation about B vitamins?
Why are they so important? What impact do they have on brain health and cognition? Well, let’s just talk about it.
So there are lots of different vitamins, they are classified as either fat-soluble or water-soluble. The B vitamins happened to be water-soluble. So what does that mean exactly? Well, let’s first talk about a fat-soluble vitamin. So, the fat-soluble vitamins would be your vitamin A, vitamin D, your E, and your K and, fat-soluble vitamins are stored in the tissue in the fat, and they can hang out there until you need them for weeks, months actually up to six months. Water-soluble vitamins, such as the B vitamins, are quickly excreted, so whatever you don’t use, you eliminate.
So, of the B vitamins, there’s actually eight of them, but I want to focus on three. The three that I want to focus on are B6, also known as Pyridoxine, B9, also known as Folic Acid, and B 12, which is also known as Cobalamin. These three, in particular, play a significant role in cognitive function. And when you have appropriate levels of them in your system, then what we know about it is that it helps prevent (it cannot guarantee that you will completely avoid, but it definitely helps prevent) cognitive decline, and it promotes brain health.
And as I said, they play an important role, and the role that they play is that they aid and promote the production of three very important neurotransmitters, and a neurotransmitter is a chemical that our brain utilizes to communicate and the three that I’m specifically talking about are serotonin, dopamine, and then the final one is called GABA.
So let’s first go back to these three B vitamins and understand them a little bit more. B6 is necessary in order to convert amino acids, which are also the building blocks of proteins, into neurotransmitters, such as serotonin. Now the recommended daily dose of B6 six is somewhere between 30 and 500 milligrams per day. Again, this is just the recommendation. B6 can be found in several foods, particularly avocados, bananas, nuts, whole grains, beef, poultry, and pork. So things that you would find in a well-balanced diet.
Another one is B9, as I mentioned, it’s also known as folic acid. Now in the US, many foods are artificially fortified with folic acid, and the reason that that’s done is to help avoid neural tube defects in the fetus. So, what they found was that there were a lot of neural tube defects in infants newborns, And it was due to B9 or folic acid deficiency. So they went ahead, and they fortified many foods that we consume on a daily basis so that the pregnant woman would naturally get enough of this B vitamin.
B9 or folic acid plays many roles. It also plays a very important role in the immune system, as well as energy production. There are many natural sources of B9, particularly you can find them in your green leafy vegetables, your citrus fruits, and legumes, the recommended daily dose for B9 is 400 micrograms per day, Not milligrams. This is micrograms, and the abbreviation is mcg.
Finally, let’s talk about B12, also known as Cobalamin, plays a vital role in nerve health. Oftentimes when people are deficient in B12, you start to notice brain fog or some memory issues. So when someone is in my clinic, and they’re being evaluated for memory impairment, one of the very first things I’ll check is a B12 level. And what we know about B12 is that it aids in, as I said, nerve health, neuron health, which is the cells in the brain. And also in red blood cell production, and what red blood cells do, is they carry oxygen throughout the body. There’s a lot of different conditions that can cause you to have deficiencies in B12; you can possibly have pernicious anemia, and fail to absorb B12 through the gut. So, even though you’re eating a balanced diet, Your B12 level may be low. And as a result, taking a B supplement orally is not going to do you any good. You actually would need to have B12 injections.
So, again when your B12 is low, what you might experience is some fatigue, some weakness, possibly even some shortness of breath again that’s attributed to the anemia. You also might experience some odd sensations in your hands or feet. It could be anything from numbness to burning and tingling. What I’ve noticed is most often, it’s the numbness, and they’re not aware of it, because it’s such a gradual process of losing sensation that they don’t even realize it’s happened, but you can observe how they walk and typically someone who is not having appropriate sensation in their feet will walk, almost as if they’re walking on clouds. And the reason for that is because they don’t actually feel the ground below the way that they should, their stance tends to be a little bit more widespread, normal stance would be the span of your shoulders. But with somebody who has a sensory alteration, whether it’s due to B12 deficiency or some other cause, they tend to stand a little bit wider. And I think that’s instinctual to give them a better base so that they don’t fall over. Because oftentimes, what they will complain about is a balanced disturbance. And so, although we can go ahead and get those B12 numbers up rather quickly by either injection or recommending oral supplementation, the numbers go up much faster than the improvement clinically, and so for someone who has a B12 deficiency that’s affected their sensation in their feet in particular, I oftentimes will recommend that they walk with a walking stick, Not a cane, because they’re not weak per se, a walking stick. And the difference would be every time they place that stick on the ground, and the sensory input is going to their hand. Instead of their feet, because they’re not receiving it there as they should. So every time as you can imagine that pace and they’re putting the stick on the ground, they’re getting that sensation in the palm of their hand and that helps them to know what the surface below is really like.
So, B12 deficiency is a simple blood test. Now, when most people go for their annual visits in particular seniors. B12 is not always on the bloodwork panel that’s ordered. Unless you report some things that raise the suspicion to your healthcare provider that they need to check it. And so again if you start talking about some confusion or brain fog, or increased fatigue. That would go ahead and raise the concern. And at that point, they probably would go ahead and order a B12 level.
Now, there’s another test that they might order instead, called a homocysteine level. Homocysteine is a byproduct of digestion, and B12 helps to clear it. So when the B12 is low, the homocysteine levels will increase, it has an inverse relationship. So, if they go ahead and they check homocysteine and they find that it’s quite high, that would give them a clue that your B12 by default is low and would need further investigation and replacement, the recommended daily dose of B12 is anywhere between, 400 micrograms and 2000 micrograms per day.
This is something you’d want to talk to your healthcare provider about. There are many different forms that it comes in, there’s liquid, there are pills that you swallow, there are sublingual the ones that go into your tongue and melt, they tend to be fairly well absorbed. But again, I would go ahead, and I would talk to your healthcare provider.
Another group of people that tend to be at risk of B12 deficiency are individuals who are on special diets. For example, vegetarians, vegans are at a particularly increased risk of a B12 deficiency, and the reason for that is, is because we know that B12 is consumed by consuming animal products, hence why vegans and vegetarians tend to have a B12 deficiency, you would find B12 in meat, poultry, seafood, as well as fortified cereals.
Someone who’s had gastric bypass does not have the ability to absorb B12 through their gut, and they tend to require B12 injections for the rest of their life. Another group at risk, seniors. Seniors tend to have absorption problems. And so, it is really truly indicated, in my opinion, to go ahead and check a B12 level periodically for seniors. Would it surprise you to know that certain medications can also reduce your B12 level?
Now I want to caution you. These medications only slightly decrease your B12, nothing that’s significant and certainly nothing that cannot be addressed by taking B12 supplements, regardless of oral or injected. But some of those medications include excessive amounts of ibuprofen, oral contraceptives for birth control, colchicine, which is a medication that many people take for the treatment of gout.
Some people go ahead and take Cimetidine, which is Tagamet, or Prilosec, also known as Omeprazole, and those medications also can reduce your B12 level.
There are some seizure medications that also can reduce B12, and they include Phenobarbital, Pregabalin, which is also known as Lyrica, and many people take Lyrica for some type of neuropathy or abnormal sensation, regardless of the cause it can be due to chronic low back pain diabetes, small nerve fiber neuropathy, there are many different causes.
Primidone, also known as Mysoline, is a medication that we use to treat essential tremors. And finally, Topiramate or Topamax, this medication is used for the control of seizure disorders, but it’s also frequently prescribed for migraine prevention.
Finally, the last one on this list is Metformin, again; remember what I said, They only minimally decrease your B12 level, I do not recommend that you stop any prescribed medications, but I do think if you’re on these medications, it certainly warrants a conversation with your healthcare provider, and maybe you need to go ahead and get your B12 level checked.
Now, is it possible to go ahead and have too much B12 in your system? Well, yes, it is. Unfortunately, there’s not a lot of research currently available in terms of how much is too much. What is suggested in the research that’s available, is that if someone has impaired kidney function, it certainly can be detrimental if they take in too much vitamin B12.
Additionally, there’s a suggestion that excessive amounts of B12 can promote heart attacks, stroke, and even death. So, yes, it’s appropriate to make sure that your B vitamins are at the recommended levels, and if you take a little bit too much, it’s okay because you will excrete them in your urine, but this is definitely a case where, if a little bit is good. More is definitely better, so no, it is not.
Now let’s go ahead and talk about those three neurotransmitters that vitamin B6, B9, and B 12 help promote. The first one is serotonin, when a lot of people hear Serotone, and what they think about is depression, and that’s true serotonin is a neurotransmitter that helps decrease anxiety. It helps to balance mood, and when it’s low, yes, in fact, depression often is present. Low levels are also believed to be related to poor memory function, and possibly, promote Alzheimer’s disease development.
So what can we do to increase our serotonin levels? Well, you can exercise. Exercise promotes serotonin production. It has your feel-good chemical; it’s the endorphin release also, so exercise is good for so many reasons, including serotonin production.
The next one is dopamine.
Dopamine regulates mood, as well as muscle movement. Now, when a lot of people think about dopamine, they may think of either Parkinson’s disease, which is a deficiency in dopamine. There you go to the muscle movement or schizophrenia; schizophrenia is on the other extreme of the dopamine spectrum. Too much dopamine, if you will. But what we know about dopamine is that it plays a vital role in the brain’s pleasure reward center. And so you want to make sure that you have appropriate levels of dopamine in your body. How do we promote the production of dopamine? Here we go again. It’s exercise. Exercise definitely promotes the production of dopamine. While slowing down (And this is really important) brain cell death rate. So for so many reasons, dopamine is a vital neurotransmitter to our overall brain health. Dopamine also plays a very important part in working memory; working memory is part of the short term memory system. And it plays a role in our ability to have appropriate reasoning, as well as aid us in decision making. Dopamine is mostly produced in the prefrontal cortex of the brain. And so, thought process, and again, decision making, are closely linked with dopamine.
Finally, I want to talk about GABA.
GABA is also a neurotransmitter, and neurotransmitters are either classified as excitatory or inhibitory. And as the words suggest, it either calms you or excites you, and GABA happens to be an inhibitory neurotransmitter. And the reason that GABA is so important, with respect to memory, is because it helps to promote cognitive focus. It helps you to relax and attend to what you are learning what you’re listening to, what memories you’re trying to create. It can actually even have a somewhat sedating effect when it’s in excess. So, how do we increase our GABA? Consumption of whole grains fava, nuts, including walnuts, and almonds and sunflower seeds, and even shrimp and halibut, that’ll help increase your GABA. You can also go ahead and try berries and cocoa, just to name a few other items. But what I want you to remember is that none of this operates in a vacuum. They’re all interconnected. And so it’s important that you maintain a healthy lifestyle that you have your wellness checks. And if you’re concerned that possibly your B12 is low, ask for your health care provider to go ahead and check it. Like I said in the beginning, unless there’s something that your healthcare providers are picking up on, it’s probably not going to be part of your wellness labs.
My dad is almost 80, and he doesn’t live in the same state that I do. And the last time I saw him was almost a year ago. But I talked to him frequently. And for any of you who have listened to my previous podcasts, know different dementias are rampant in my family on both sides.
I’ve noticed that my dad is taking a little bit longer to comprehend some things that I’m saying, he tends to be a bit repetitive. But I attribute that to just that he’s not getting new experiences to share with me, and so he’s telling the same story more than once, but to the credit of his health care provider. They picked up on something, and they went ahead, and they checked his B12, and in my opinion, I’d call it critically low, primary care and specialists tend to view lab ranges, a little bit differently, a primary care provider would be okay with a B12 getting as low as well I’ve seen 200 to 300, but from a neuro standpoint, I don’t like to see it any less than 400. His came back at 230, and when we talked, he reported a little bit short of breath, yes, in fact, his gait is a little bit different, he feels like he’s a little off-balance. And he does struggle a little bit from memory, oftentimes what I find is that primary care doesn’t dip their toe in the water of memory issues. Some do, don’t get me wrong, but most, or at least the ones I have had some interaction with, don’t.
And again, I give his, his doctor a lot of credit for going there, because he had the difficult conversation with my dad, and said, You can turn this around now, but if you don’t jump on it, this can certainly be the first step towards dementia. And he’s 100% correct. What surprised me is my dad was always a meat and potatoes eater. Every morning for my entire life, I remember him getting up early, making two fried eggs. So what changed. I don’t know I asked him, and I said, are you not eating your eggs? Are you not eating steak? What’s going on. And what he told me. Is that he was trying to lose some weight, just felt like he had a little bit of a gut. And so he’s been eating more salads, more of a plant-based diet if you will. And here is the unfortunate consequence of that. So I’m very grateful that they found that his B12 was low. And now he’s getting injections. And at some point, they’ll probably challenge him to see if oral supplements will be enough. But for now, he definitely needs the B12 injections, and I’m glad he’s getting them.
So if you have concern for either yourself or your loved one, please, don’t just go ahead and take a B12 supplement. Talk to your health care provider. And while we’re talking about supplements, let me just say this. There is something called a B-Complex vitamin, and the B-Complex vitamin contains all eight B vitamins. And so what I’ve started doing in my practice is, I have started transitioning people from B12 supplements to B-Complex. Now sometimes they need a little bit more B12 than the B-Complex will offer, but if it’s just for overall health.
I’m suggesting the B complex vitamin, something to consider.
You’ll also notice, under the My mind challenge tab on my website. Every week we post five questions that are just to challenge your brain and get you thinking, check it out. Anyway, I hope you decide to subscribe to my podcast. Every Tuesday. New episodes are released. Thanks again for listening, and have a great day.