Vitamin B12 deficiency can cause long term nerve degeneration

Vitamin B12 (Cobalamin):

Vitamin B12, Cobalamin, foods sources and possible symptoms of deficiency.

Neurological symptoms of B12 deficiency may include:

  • numbness and tingling of the arms and legs; problems walking; disorientation; memory loss; mood changes that may resemble schizophrenia; and dementia.  Damage may occur to the myelin sheath which surrounds and insulates nerves like the plastic coating around an extension cord.  Nerve damage and mental health symptoms may become permanent with long term deficiency of vitamin B12.

Digestive symptoms may include:

  • loss of appetite, a painful tongue, and constipation.  The reason for there to be digestive symptoms associated with B12 deficiency is not well understood.  One theory suggests that undiagnosed digestive problems might have been an initial cause of the  B12 deficiency.

Symptoms of vitamin B12 deficiency may also include:

  • pernicious anemia and megaloblastic anemia which are hemoglobin deficiencies that have symptoms of tiredness.  Folate deficiency symptoms are also possible because B12 is necessary in folate metabolism.  Increased heart disease risk from elevated homocysteine levels may result from B6,  B12, or folate deficiency.

People who may be more at risk for vitamin B12 deficiency include:

Those with malabsorption problems, or people with chronic use of antacids and those who are over age 60.  A specific protein cofactor called the intrinsic factor and normal stomach acidity levels are necessary for B12 absorption to be able to occur.  Some individuals receive monthly injections of B12 after reaching older age and some people need to receive them monthly throughout life due to having chronically low vitamin B12 for other reasons than normal aging such as a genetic issue with their production of the intrinsic factor protein.

Sublingual tablets of the supplement are also available which are absorbed in the mouth, bypassing any problems with the rest of the digestive system.

A genetic difference may exist that causes some individuals to require the methylated active form of B12 rather than being able to benefit from the more commonly available supplement which is an unmethylated and therefore inactive form.  [More about methylcobalamin.] A genetic screening test would need to be ordered to find out if there were any differences in the gene that might cause an inability to methylate vitamin B12 or folate/(folic acid is the commonly used supplement which is also in the unmethylated form, and therefore inactive for someone with a genetic inability to perform the methylation reaction – meaning an enzyme is malfunctioning somewhere in the complex chemical chain of events.)

A problem with lower digestive acidity in the stomach could also be managed simply by adding a side dish or condiment to meals that contains vinegar or acidic ingredients. Examples from around the world include chutneys, pickles, lime or lemon juice/fresh wedges, vinegary salad dressing, salsa or Tabasco Sauce, and Worcestershire sauce.

  • What is Worcestershire Sauce? (thespruce) (and how do you spell it?)- It is an interesting story – featuring the chemists Lea and Perrins. (Lea & Perrins is still the best selling brand of Worcestershire Sauce). Who knew chemistry could be so delicious?

Schizophrenia may also be associated with an increased risk for low levels of vitamin B12. Read more: (askdrgonzalez.com/deficiency-of-vitamin-b12-and-schizophrenia/)

Low stomach acid may be an underlying issue with symptoms of schizophrenia and in other mental health disorders. The balance and variety of microbes living within the gastrointestinal tract also may be involved in symptoms resembling mental illness. (Digestion & schizophrenia /PMC4437570/)

Pickles that are made fresh and need to be refrigerated  can be a source of healthy intestinal microbes, in a similar way to the healthy bacteria found in yogurt with active probiotics or Kefir drinks.  A variety of traditional products with live cultures are listed here – and a new one, probiotics are being added to chocolate in some products: (health.com/probiotics & chocolate) Scientists studying the microbiome tend to recommend the live culture foods rather than supplements of probiotics – based on my overview impression of multiple sources. An overview regarding the current recommendations about probiotic supplements is available here: (washingtonpost/people-love-probiotics-but-do-they-really-help/2017/05/19)

Probiotics refers to products that contain actual good guy bacteria, while prebiotics refers to foods that contain fiber or other nutrients which the good guy bacteria need to eat in order to survive and flourish – in competition with the more negative strains of bacteria or with yeasts or other microbes which might be found within our gastro-intestinal tract.

Eating vegetables and other foods that are good sources of some types of fiber also helps support healthier intestinal microbes, a few foods that provide the types of fiber that our intestinal microbes need to eat in order to flourish and protect us from more negative types of microbes, are listed here: (pcrm.org/seven-foods-to-supercharge-your-gut-bacteria)

It is a very good idea to get adequate fiber in the daily diet – because starving microbes will start breaking down and consuming edible portions of the intestinal cells for nourishment – if forced, and it may leave the body more at risk for infection (labblog.uofmhealth.org/gut-bacteria-eat-colon-lining-when-starved-for-fiber) – but why starve your good guy microbes? Our intestinal microbes may also help prevent anxiety. (neuroscienceresearch.wustl.edu.pdf)

Food Sources of Vitamin B12 include: 

  • shellfish, fish, meat, poultry, eggs, milk, cheese, dairy products, Nutritional or Brewer’s yeast.  Vegetarians who don’t eat dairy, eggs, fish or other meat products may need a supplement or nutritional yeast, a vegan food source of vitamin B12. (nutritional yeast/pubmed/11146329)
  • See the post on Vitamin B6 for more information about how the group of B vitamins work together in energy metabolism and cell growth.

Reference for more information:

An Evidence-based Approach to Vitamins and Minerals:  Health Benefits and Intake Recommendations, 2nd Ed., by J. Higdon & V. Drake, (Thieme, Stuttgart / New York, 2012)

  • A description and source for purchasing the text: (thieme.com)
  • A review of the text: (ajcn.nutrition.org/content/79/5/892.full)
  • The text is produced in cooperation with the Linus Pauling Institute. He is a researcher who used large doses of vitamin C to cure cancer tumors. His work was met with skepticism. More recently research supports his work in that a specific type of cancer cells is very susceptible to vitamin C – while to the rest of the body it is water soluble and non-toxic at the level that was toxic to the cancer cells. (sciencedirect.com/science/article/pii/S2213231716302634)

Last reviewed and revised on 9/30/2017, graphic added, 5/23/2018.

Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

Folate is essential and Folic Acid is commonly available

Folate (L-methylfolate or vitamin B9) and Folic Acid:

Food Sources of Folate, the bioactive natural form, include:
  • beans, black eyed peas, green peas,
  • peanuts and other nuts and seeds,
  • whole grains,
  • asparagus, most dark green vegetables,
  • orange juice, citrus fruits.
  • Fortified cereal and rice are sources of folic acid, the supplemental form.
Folate is the natural form; Folic Acid is in supplements & fortified foods.

Folate is the form of the vitamin found in food and is more bioactive.  Folic acid is the form that is commonly available as a supplement and in fortified foods, however it is less bioactive, less able to function until methyl groups are added which requires adequate supplies of vitamin B12. A genetic difference may exist in some individuals that prevent the body from being able to convert the inactive folic acid form into folate, the methylated bioactive form of the vitamin. [More about methylation.]

Symptoms of Folate deficiency include:
  • Deficiency of folate can cause megaloblastic / macrocytic anemia which is characterized by red blood cells that are over-sized and ineffective.  Anemia symptoms include being short of breath and feeling tired and weak.  The symptoms are due to a shortage of normal red blood cells and reduced ability to transport oxygen with each breath.
  • Folate is needed for DNA synthesis and for DNA methylation which may be important for preventing cancerous changes from occurring in the DNA.
  • Lack of folate may increase heart disease risks due to less breakdown of homocysteine. Vitamin B6 and B12 are also necessary, a deficiency of any one of the three might cause an accumulation of homocysteine.
  • Folate is important during pregnancy for fetal development.  Spina bifida and cleft palate are birth defects that may be caused by folate deficiency.
  • Deficiency of several of the B vitamin group can cause changes in the appearance and surface texture of the tongue. B vitamins that can cause changes in the tongue are mentioned in the following excerpt and include “niacin (B3), riboflavin (B2), pyridoxine (B6), folic acid (folate/B9), and vitamin B12”:
  • “Deficiencies of niacin, riboflavin, pyridoxine, folic acid, or vitamin B12,  resulting from poor diet or from the administration of antagonists, may cause a sore, beefy-red tongue without a coat. In the chronic vitamin deficiency state, the tongue may become atrophic and smooth.”                   – “The Tongue – Clinical Methods – NCBI bookshelf  https://www.ncbi.nlm.nih.gov/books/NBK236/

  • See the post on Vitamin B6 for more information about how the group of B vitamins work together in energy metabolism and cell growth.
Reference used for food sources & symptoms of Folate deficiency:
Other References used for the food sources of Folate and Folic Acid:

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Vitamin B6

Vitamin B6 (pyridoxal, pyridoxal-5-phosphate, (P5P), pyridoxine, and pyridoxamine):

Food Sources of Vitamin B6 include:
  • fortified cereal, barley, buckwheat;
  • avocados, baked potato with the skin;
  • beef, poultry, salmon;
  • bananas, green leafy vegetables;
  • beans, nuts, sunflower and pumpkin seed kernels.
Symptoms of a B6 deficiency may include:
  • A severe deficiency of vitamin B6 may cause seizures;
  • other neurological (nervous system or brain) symptoms affecting mental health may include irritability, confusion, and/or depression;
  • the earliest signs of a B6 deficiency might be observed first in the mouth where the tongue may be swollen and painful and become smooth looking and have a bright magenta color; mouth ulcers and cracks or fissures at the corners of the mouth may also occur;
  • and a weakened immune system may occur with a deficiency of vitamin B6.
  • Three B vitamins, B6, B12 and folate, are all necessary for the breakdown of homocysteine, which at elevated levels may increase risk of heart disease. So deficiency of any one of the three B vitamins, B6, B12 and folate, may be involved with symptoms or a diagnosis of heart disease.

  • Symptoms of PMS (Pre-menstrual Syndrome) and symptoms of prenatal nausea and vomiting may be helped by supplemental B6 intake. This suggests a deficiency may be involved in the underlying cause of the symptoms or that an increased need for the nutrient occurs before menstruation and during pregnancy. All B vitamins are important during pregnancy as they are involved in the growth of new cells and are needed for converting sugar into usable energy.

The skin & GI tract have a rapid cell growth rate which requires energy.
B vitamins are involved in both cell growth & energy metabolism.

B vitamins work together as a group to help breakdown the sugar glucose into a usable form of energy.

Areas of the body that have a short life cycle for cells are the first areas affected by deficiency of B vitamins because new cells need energy to grow and the B vitamin group are also involved in other chemical reactions that are necessary for the growth of new cells. The lining of the intestinal tract can have a cell turnover rate of just one week and the tongue is part of the gastro-intestinal (GI) tract and has a similar quick rate of cell growth.

The skin at the corners of the mouth and the lips in general may also have a slightly quicker rate of cell turnover than other areas of the surface skin. Our outer skin and the lining of the GI-tract are similar and considered part of the same organ system.

“Deficiencies of niacin, riboflavin, pyridoxine, folic acid, or vitamin B12,  resulting from poor diet or from the administration of antagonists, may cause a sore, beefy-red tongue without a coat. In the chronic vitamin deficiency state, the tongue may become atrophic and smooth.”                   – “The Tongue – Clinical Methods – NCBI bookshelf  https://www.ncbi.nlm.nih.gov/books/NBK236/

Pyroluria:

Pyroluria may be a genetic problem that causes increased urinary loss of B6 and zinc for some people. For patients with the condition adequate amounts of the nutrient cannot be readily obtained from food sources and large dose supplements are needed on a daily basis of both vitamin B6 and the mineral zinc. The condition is generally not assessed for or treated by the current medical system as it is not easy to diagnose. Anxiety is a primary symptom, migraine headaches and reduced tolerance for stress may also be symptoms. This post of mine has links and sources for more information: https://effectiveselfcare.info/2014/09/22/pyroluria-anxiety-and-deficiency-of-b6-and-zinc

This post by a medical doctor discusses the mental health and other symptoms in more detail. Emily Dickinson and Charles Darwin had similar symptoms. Daily supplements of zinc and B6 and/or the more bioactive form, pyridoxal-5-phosphate, (P5P), can quickly restore more normal health:  http://www.judytsafrirmd.com/pyroluria-mental-health-and-the-immune-system/

Lack of dreaming at night is a symptom of pyroluria likely due to a long term deficiency of vitamin B6. Once treatment with the large dose supplements has been underway for a while it is common for patients to report remembering dreaming at night again. Whether the deficiency of B6 is causing less time to be spent at night in the stage of sleep when dreaming is more likely to occur, or whether it interferes with the ability to remember dreams the next morning, is not known.

Reference used for food sources & symptoms of Vitamin B6 deficiency:
Other References used for the food sources of Vitamin B6:

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Niacin

Niacin (vitamin B3, niacinamide, and nicotinic acid):

Food Sources of Niacin include:
  • nutritional yeast;
  • meats, salmon and tuna;
  • beans, green peas, peanuts, and seeds;
  • avocado, mushrooms, green leafy vegetables;
  • grains, nixtamal flour, & fortified cereals;
  • milk, coffee and tea.
Symptoms of Niacin (Vitamin B3) Deficiency:

Digestive symptoms of less severe niacin deficiency may include nausea and vomiting and may also be able to be seen visibly as an unusually bright red tongue. Several B vitamins can cause changes in the appearance of the tongue as the cells all along the digestive tract need to be replaced frequently with new cells. The B vitamins work together as a group and many are essential for the growth of new cells. See the excerpt in the reference section for other B vitamins necessary for maintaining a healthy tongue.

Headache, apathy, memory loss, disorientation, and/or depression may be neurological symptoms that occur if niacin deficiency continues long term. Fatigue may also be a symptom of niacin deficiency.

Severe niacin deficiency is called pellagra. Symptoms of pellagra include skin rashes, (dermatitis), diarrhea, dementia, and eventually death if adequate niacin isn’t provided to the patient.

The condition was discovered in groups of people who lived primarily on a diet of corn or sorghum.  However the condition was not common in Mexico, in Central America, or for some groups of Native Americans. Corn in those areas was first soaked in an alkaline solution of lime or wood ash before being made into a type of flour called nixtamal.  The alkaline soaking method makes more of the grain’s niacin content available for absorption in the human digestive system.

Nixtamal flour is available to the home shopper and might be called tortilla or tamale flour. The ingredient list would include lime or wood ash if the product was made with the alkaline presoaking step.

The amino acid, tryptophan, can be converted to niacin within the body if adequate B6, folate and heme are available (an iron rich enzyme cofactor).

Background history regarding nicotinic acid, niacin, and nicotine:

Nicotinic acid and nicotine from tobacco cigarettes have similar names because they are similar chemicals but are not the same chemical and don’t have the same function within the body. This is a content marketing issue, read more – including the comments in the following link.

A summary: Nicotinic acid is a chemically reasonable name for the form of the nutrient that was initially discovered, but the similarity of the word to nicotine made people fearful when it was first added to foods and food labels as a new nutrient fortification being added to help prevent and treat pellagra. The use of a different form with a name change to “niacin” may have been a move at that time towards a form with a more commercially successful name even though it is not as descriptive of the way the chemical is formed as the name “nicotinic acid.”

Warning – non-harmful “Niacin flush” may occur with Nicotinic acid:

For some people, excessive supplementation with the nicotinic acid form of vitamin B3, but not the niacin form, may cause a temporary non-life-threatening reaction that may include symptoms of itching, a temporary flushing or reddening of the skin, nausea and vomiting. The reaction may be referred to as a “niacin flush.” A holistic practitioner describes the reaction in the following article and mentions that it usually goes away after a week of taking the supplement and that drinking some extra water during the sensation might help ease symptoms. The practitioner suggests that the reaction may be helpful for multiple sclerosis.

Niacinamide is a form of niacin that does not help reduce cholesterol

Niacin can be converted to niacinamide in the body and both forms are available as supplements which could help prevent deficiency symptoms. However niacin may also be helpful with blood lipid (fats) levels. It may help reduce elevated levels of triglycerides which can help prevent high cholesterol levels. Niacinamide is a form that does not affect blood lipid levels and wouldn’t be recommended over the niacin form if the goal is protecting cardiovascular (heart & blood vessel) health. http://www.webmd.com/vitamins-supplements/ingredientmono-924-niacin%20and%20niacinamide%20vitamin%20b3.aspx?activeingredientid=924&

B vitamins essential for health of the tongue (and Gastrointestinal tract):

Deficiency of several of the B vitamin group can cause changes in the appearance and surface texture of the tongue. B vitamins that can cause changes in the tongue are mentioned in the following excerpt and include “niacin (B3), riboflavin (B2), pyridoxine (B6), folic acid (folate/B9), and vitamin B12”:

  • “Deficiencies of niacin, riboflavin, pyridoxine, folic acid, or vitamin B12,  resulting from poor diet or from the administration of antagonists, may cause a sore, beefy-red tongue without a coat. In the chronic vitamin deficiency state, the tongue may become atrophic and smooth.”                   – “The Tongue – Clinical Methods – NCBI bookshelf  https://www.ncbi.nlm.nih.gov/books/NBK236/

  • See the post on Vitamin B6 for more information about how the group of B vitamins work together in energy metabolism and cell growth.
Reference used for food sources & symptoms of Niacin deficiency:
Other References used for the food sources of Niacin:

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.