Great follow-up to our webinar “Plant-based Eating: Enhancing Health Benefits, Minimizing Nutritional Risks” Learn more about vitamin B12 deficiency, assessment methods, and the role of B12 in the prevention and treatment of certain health conditions.
Learning Objectives:
1. List populations and groups at risk of vitamin B12 deficiency/inadequate vitamin B12 status?
2. Understand what constitutes adequate vitamin B12 intake
3. Distinguish between reliability of different vitamin B12 assessment methods
What constitutes adequate vitamin B12 status?
Indirect indicators of vitamin B12 deficiency
4. Assess the role of vitamin B12 in prevention and treatment of selected health conditions
CVD
Osteoporosis/Bone fractures
Brain Atrophy
B12 and EPA & DHA
5. Evaluate the efficacy of different vitamin B12 deficiency treatment options
PRESENTER
Roman Pawlak, Ph.D., RD
Associate Professor
Department of Nutrition Science
East Carolina University
Author of several books, Dr. Pawlak has lectured internationally about diet and nutrition.
The presentation provided an overview of the ketogenic diet, including:
- Defining the ketogenic diet and how it works to produce ketone bodies and treat epilepsy.
- Discussing various ketogenic diet protocols like the classic ketogenic diet, MCT oil diet, Modified Atkins Diet, and Low Glycemic Index Treatment Diet.
- Outlining the clinical pathway for initiating and monitoring the ketogenic diet therapy for epilepsy.
- Noting potential side effects, challenges, and nutritional inadequacies of maintaining the restrictive ketogenic diet long-term.
The presentation aimed to educate on the science and evidence behind using ketogenic diets to treat chronic diseases like obesity and type 2
This document summarizes key considerations for nutrition in intensive care patients. It addresses questions like which patients should be fed, when feeding should start, what route is best, how much to feed, and what the feed should contain. The document discusses evidence that early enteral feeding within 48 hours is preferable to delaying feeding. It also notes that enteral feeding is generally better than parenteral feeding when possible due to lower risks, though parenteral may be necessary in some cases. The optimal amount of feeding is also addressed.
Cnw170 heyland nutrition risk assessment.v3 feb 19 17 revisedbejo10
This document summarizes a presentation on nutrition risk assessment in critically ill patients. It discusses various tools and factors that can help identify patients who may benefit most from nutrition therapy, including the NUTRIC score. The NUTRIC score was developed using several variables to predict outcomes like mortality and ventilator days. Studies have since validated the NUTRIC score in different populations and databases. However, not all low NUTRIC score patients may be the same, and certain subgroups like those with low BMI or longer ICU stays may still benefit from optimal nutrition intake.
The ketogenic diet (or keto diet, for short) is a low carb, high fat diet that offers many health benefits.
In fact, many studies show that this type of diet can help you lose weight and improve your health.
Ketogenic diets may even have benefits against diabetes, cancer, epilepsy, and Alzheimer’s disease.
This document summarizes new randomized controlled trials in critical care nutrition published between 2009-2011 and their impact on existing clinical practice guidelines. It discusses several new RCTs on probiotics, fish oils, arginine, glutamine, and lipid emulsions. For probiotics and fish oils, the new evidence strengthens recommendations for their use. However, for arginine and glutamine, the new RCTs did not clearly support benefits. Overall, the new data impacts some recommendations and highlights areas requiring further research.
This is a presentation I done with 3 days in a rush for a presentation in a workshop. I hope it brings certain information to my blog users. From www.littlediet.info.
This document discusses the role of nutrition in wound healing. It outlines the four phases of wound healing and key nutrients involved in each phase such as vitamins C, A, and K, protein, zinc, and arginine. Poor nutrition status can compromise wound healing by limiting the nutrients available. The document recommends assessing patients' nutrition risk, referring to a dietitian, optimizing protein and calories through oral supplements if needed, and considering arginine or zinc supplementation depending on serum levels. Nursing staff are responsible for nutrition screening, communication, and ensuring dietary recommendations are followed to support wound healing.
This document discusses parenteral nutrition for neonates. It covers the goals of fluid and electrolyte management, indications for parenteral nutrition, nutritional goals, composition of infusates including carbohydrates, proteins, lipids, electrolytes and vitamins. It also discusses the steps for calculating a total parenteral nutrition solution, preparation and administration, and potential complications that can arise with parenteral nutrition. The conclusion emphasizes that parenteral nutrition remains essential for preterm and sick neonates, but optimal inputs are still unknown, and some neonates experience extrauterine growth restriction due to excessive caution with nutrition in the NICU.
The presentation provided an overview of the ketogenic diet, including:
- Defining the ketogenic diet and how it works to produce ketone bodies and treat epilepsy.
- Discussing various ketogenic diet protocols like the classic ketogenic diet, MCT oil diet, Modified Atkins Diet, and Low Glycemic Index Treatment Diet.
- Outlining the clinical pathway for initiating and monitoring the ketogenic diet therapy for epilepsy.
- Noting potential side effects, challenges, and nutritional inadequacies of maintaining the restrictive ketogenic diet long-term.
The presentation aimed to educate on the science and evidence behind using ketogenic diets to treat chronic diseases like obesity and type 2
This document summarizes key considerations for nutrition in intensive care patients. It addresses questions like which patients should be fed, when feeding should start, what route is best, how much to feed, and what the feed should contain. The document discusses evidence that early enteral feeding within 48 hours is preferable to delaying feeding. It also notes that enteral feeding is generally better than parenteral feeding when possible due to lower risks, though parenteral may be necessary in some cases. The optimal amount of feeding is also addressed.
Cnw170 heyland nutrition risk assessment.v3 feb 19 17 revisedbejo10
This document summarizes a presentation on nutrition risk assessment in critically ill patients. It discusses various tools and factors that can help identify patients who may benefit most from nutrition therapy, including the NUTRIC score. The NUTRIC score was developed using several variables to predict outcomes like mortality and ventilator days. Studies have since validated the NUTRIC score in different populations and databases. However, not all low NUTRIC score patients may be the same, and certain subgroups like those with low BMI or longer ICU stays may still benefit from optimal nutrition intake.
The ketogenic diet (or keto diet, for short) is a low carb, high fat diet that offers many health benefits.
In fact, many studies show that this type of diet can help you lose weight and improve your health.
Ketogenic diets may even have benefits against diabetes, cancer, epilepsy, and Alzheimer’s disease.
This document summarizes new randomized controlled trials in critical care nutrition published between 2009-2011 and their impact on existing clinical practice guidelines. It discusses several new RCTs on probiotics, fish oils, arginine, glutamine, and lipid emulsions. For probiotics and fish oils, the new evidence strengthens recommendations for their use. However, for arginine and glutamine, the new RCTs did not clearly support benefits. Overall, the new data impacts some recommendations and highlights areas requiring further research.
This is a presentation I done with 3 days in a rush for a presentation in a workshop. I hope it brings certain information to my blog users. From www.littlediet.info.
This document discusses the role of nutrition in wound healing. It outlines the four phases of wound healing and key nutrients involved in each phase such as vitamins C, A, and K, protein, zinc, and arginine. Poor nutrition status can compromise wound healing by limiting the nutrients available. The document recommends assessing patients' nutrition risk, referring to a dietitian, optimizing protein and calories through oral supplements if needed, and considering arginine or zinc supplementation depending on serum levels. Nursing staff are responsible for nutrition screening, communication, and ensuring dietary recommendations are followed to support wound healing.
This document discusses parenteral nutrition for neonates. It covers the goals of fluid and electrolyte management, indications for parenteral nutrition, nutritional goals, composition of infusates including carbohydrates, proteins, lipids, electrolytes and vitamins. It also discusses the steps for calculating a total parenteral nutrition solution, preparation and administration, and potential complications that can arise with parenteral nutrition. The conclusion emphasizes that parenteral nutrition remains essential for preterm and sick neonates, but optimal inputs are still unknown, and some neonates experience extrauterine growth restriction due to excessive caution with nutrition in the NICU.
Nutrition is important for patients undergoing peritoneal dialysis due to high risk of protein-energy malnutrition. The kidney regulates various body functions and end stage renal disease results in metabolic and nutritional abnormalities. Protein-energy malnutrition is highly prevalent in peritoneal dialysis and associated with increased mortality. Early nutritional assessment is important to diagnose and treat malnutrition through dietary modifications. Assessment involves measurements of serum albumin, weight changes, dietary intake and anthropometric measurements. The nutritional management focuses on adequate protein, energy, fluid and electrolyte intake tailored to the individual needs.
This document discusses nutrition and energy balance. It states that energy intake and output must be balanced for stable body weight over time. When energy intake exceeds output, weight increases, and when intake is less than output, weight decreases. It also covers body energetics, listing the average calories provided by carbohydrates, fats, and proteins. Additional topics include daily nutrient requirements, protein deficiency diseases like kwashiorkor and marasmus, and factors that regulate food intake such as hormones and the hypothalamus.
This document discusses the role of diet and nutrition in inflammatory diseases like arthritis. It explains that inflammation is the body's immune response, and chronic inflammation can lead to autoimmune diseases. Western diets high in processed foods, sugar, and unhealthy fats may promote inflammation and be a risk factor for diseases. Anti-inflammatory diets rich in omega-3 fatty acids, antioxidants, and probiotics from foods like fatty fish, fruits and vegetables may help reduce inflammation and arthritis symptoms. Proper nutrition is an important complementary approach for managing inflammatory conditions alongside medical treatment.
This document discusses the role of medical nutrition therapy in wound healing, specifically for pressure ulcers. It identifies key nutrients needed to support wound repair like protein, calories, vitamins, and minerals. The goals of nutrition intervention for wound healing are to provide adequate nutrients and prevent or promote healing of pressure ulcers. Medical nutrition therapy for wound healing should include increasing energy and protein intake and fluid intake. It also discusses the role of registered dietitian nutritionists in assessing nutritional status, identifying risks, developing nutrition care plans, and monitoring progress.
I created and presented a PowerPoint to those attending the CHIP program at the Walla Walla General Hospital. It was about anti-inflammatory diets and was based on current scholarly research articles
This document discusses various topics related to nutrition including:
1. Three subtypes of malnutrition associated with starvation, chronic disease, or acute disease/injury.
2. Formulas for calculating ideal body weight and interpreting BMI.
3. Methods for assessing nutritional status like serum albumin levels and energy expenditure equations.
4. The metabolic response to starvation involving the breakdown of glycogen, amino acids, and fat stores over time.
In a randomized trial comparing low-carbohydrate and low-fat diets in patients with type 2 diabetes, both diets produced similar weight loss over 2 years but glycemic control improved more with low-carbohydrate. Low-carbohydrate increased HDL cholesterol levels but had no other effects on lipids or blood pressure. While glycemic control benefits were transient, low-carbohydrate was not shown to have metabolic risks even with higher saturated fat intake.
The document provides nutrition guidelines for pressure ulcer management based on a patient's Braden scale score and presence of ulcers or wounds. It recommends protein and calorie intake levels, fluid goals, vitamin/mineral supplements, and conditionally essential amino acids like arginine and glutamine to support wound healing. It also discusses use of oxandrolone to reduce catabolism and promote tissue repair in patients experiencing weight loss or skin breakdown. Regular monitoring of intake, weight, and wound status is advised to evaluate response to the nutrition interventions.
Did you know that food storage and preparation can hugely affect its nutritional value? For example, the antioxidant capacity of blueberries actually increases with freezing, and letting crushed garlic rest for 10 minutes before cooking allows for the development of compounds with amazing health benefits.
Learn the tricks of the trade for getting the most out of your food in this short webinar with nutritionist Dr Danielle Crida.
This clinical trial compared the efficacy and safety of two doses of ferrous bisglycinate chelate (60mg once daily and 60mg twice daily) to ferrous ascorbate (100mg once daily) in treating iron deficiency anemia in women. Over 8 weeks, all three treatments significantly increased hemoglobin levels from baseline with no significant differences between groups. Adverse events occurred in 9-13% of subjects across the groups, mostly gastrointestinal disorders, with no serious adverse events reported. The study demonstrated that ferrous bisglycinate chelate at both doses and ferrous ascorbate were effective and well-tolerated treatments for iron deficiency anemia.
This document provides guidelines on nutrition in the intensive care unit (ICU). It defines patients at risk of malnutrition in the ICU, how to assess nutritional status, determine energy needs, choose feeding routes, and adapt nutrition based on clinical conditions. It discusses initiating and progressing nutrition administration, determining macronutrient needs, and paying special attention to glutamine and omega-3 fatty acids. The guidelines also address nutrition for patients with conditions like dysphagia, trauma, surgery, sepsis, and obesity that are common in the ICU.
Fat as a Health Food: Benefits & Course Corrections During a Year of Tracking...James McCarter
Ketosis, where the body burns fats in preference to carbohydrates, is being promoted as an approach to weight loss and treatment for chronic diseases. I’ve taken a Quantified Self approach to tracking my experience with ketosis seeing a number of benefits and challenges along the way. One of the conclusions, which I’m testing further, is that the types of fats used to replace carbohydrates may be critical to optimal health in response to a ketogenic diet. These slides are from my March 17, 2015 presentation to the Quantified Self St. Louis Group (www.quantifiedstl.com) at the Cambridge Innovation Center.
This document presents a study on the correlation between vitamin D levels and diabetic retinopathy. It begins with an introduction stating that diabetes prevalence is increasing globally and that longer duration of diabetes increases risk of retinopathy. It then discusses the aims and objectives of studying the association between vitamin D levels and retinopathy severity. The methodology section outlines how cases and controls will be selected from patients with and without diabetes and retinopathy and the inclusion/exclusion criteria. The document reviews several previous studies that found inverse relationships between vitamin D levels and retinopathy severity or progression.
This document discusses nutritional support for ICU patients. It begins with a brief history of ICU nutrition and outlines the basis for nutritional support. Providing nutrition is important to prevent the physiologic effects of malnutrition, which can lead to organ dysfunction and poor outcomes. The nutritional requirements of ICU patients, including calories, protein, fluids and micronutrients are described. Enteral and parenteral routes of feeding administration are covered, along with their indications. Guidelines for initiating feeding, monitoring for complications, and calculating nutritional needs are provided. The goal of nutritional support is to improve patient outcomes by preventing and treating critical illness-related malnutrition.
This document discusses various nutritional disorders including malnutrition, undernutrition, micronutrient deficiencies, overweight, obesity, and metabolic syndrome. It defines each condition and provides details on signs, causes, and health effects. Malnutrition refers to deficiencies or imbalances in energy and nutrient intake and includes undernutrition, micronutrient deficiencies, overweight, and obesity. Undernutrition is insufficient food intake over time and includes wasting, stunting, and being underweight. Micronutrient deficiencies involve inadequate intake of vitamins and minerals. Overweight and obesity result from excessive calorie intake over time and not enough physical activity.
Annals of Nutritional Disorders & Therapy is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients leading to various Nutritional diseases including obesity, eating disorders, malnutrition, developmental abnormalities that could be prevented by diet, hereditary metabolic disorders that retort to dietary treatment, food allergies and intolerances, and potential hazards in the food supply. It also focuses upon the chronic diseases caused due to improper nutrition such as cardiovascular disease, hypertension, cancer, and diabetes mellitus.
Presented at Johns Hopkins Bayview Medical Center. Evidence-based research surrounding the potential association between vitamin D deficiency and risk for developing gestational diabetes among pregnant women and women of reproductive age.
Many clients take bone health for granted until they’re presented with a diagnosis of osteoporosis, often following a fracture. Whether your client is nutrient deficient, concerned about bone health, or diagnosed with a metabolic bone disease, adding the right nutrients to a protocol is paramount.
In her latest webinar, Dr Danielle Crida discusses:
- The importance of bone health
- Consequences of low bone mineral density
- The most important nutrients for bone health and their synergistic roles
- Exercise and lifestyle choices for bone strength
- Supplement and dosing recommendations, introducing our new Ca/Mg/D3/K2/Boron product
Vitamin B12 deficiency is a common cause of megaloblastic anemia and neuropsychiatric symptoms, especially in older persons. There are several risk factors for vitamin B12 deficiency including prolonged metformin use. While major organizations do not recommend routine screening, high-risk patients such as those with malabsorptive disorders may warrant screening through CBC, serum B12, methylmalonic acid, and homocysteine levels. Treatment involves intramuscular B12 injections or high dose oral B12 supplementation.
Vitamin B12 deficiency is a common cause of megaloblastic anemia and neuropsychiatric symptoms, especially in older persons. There are several risk factors for vitamin B12 deficiency including prolonged metformin use. While major organizations do not recommend routine screening, high-risk patients such as those with malabsorptive disorders may warrant screening through CBC, serum B12, methylmalonic acid, and homocysteine levels. Treatment involves intramuscular B12 injections or high dose oral B12 supplementation.
Nutrition is important for patients undergoing peritoneal dialysis due to high risk of protein-energy malnutrition. The kidney regulates various body functions and end stage renal disease results in metabolic and nutritional abnormalities. Protein-energy malnutrition is highly prevalent in peritoneal dialysis and associated with increased mortality. Early nutritional assessment is important to diagnose and treat malnutrition through dietary modifications. Assessment involves measurements of serum albumin, weight changes, dietary intake and anthropometric measurements. The nutritional management focuses on adequate protein, energy, fluid and electrolyte intake tailored to the individual needs.
This document discusses nutrition and energy balance. It states that energy intake and output must be balanced for stable body weight over time. When energy intake exceeds output, weight increases, and when intake is less than output, weight decreases. It also covers body energetics, listing the average calories provided by carbohydrates, fats, and proteins. Additional topics include daily nutrient requirements, protein deficiency diseases like kwashiorkor and marasmus, and factors that regulate food intake such as hormones and the hypothalamus.
This document discusses the role of diet and nutrition in inflammatory diseases like arthritis. It explains that inflammation is the body's immune response, and chronic inflammation can lead to autoimmune diseases. Western diets high in processed foods, sugar, and unhealthy fats may promote inflammation and be a risk factor for diseases. Anti-inflammatory diets rich in omega-3 fatty acids, antioxidants, and probiotics from foods like fatty fish, fruits and vegetables may help reduce inflammation and arthritis symptoms. Proper nutrition is an important complementary approach for managing inflammatory conditions alongside medical treatment.
This document discusses the role of medical nutrition therapy in wound healing, specifically for pressure ulcers. It identifies key nutrients needed to support wound repair like protein, calories, vitamins, and minerals. The goals of nutrition intervention for wound healing are to provide adequate nutrients and prevent or promote healing of pressure ulcers. Medical nutrition therapy for wound healing should include increasing energy and protein intake and fluid intake. It also discusses the role of registered dietitian nutritionists in assessing nutritional status, identifying risks, developing nutrition care plans, and monitoring progress.
I created and presented a PowerPoint to those attending the CHIP program at the Walla Walla General Hospital. It was about anti-inflammatory diets and was based on current scholarly research articles
This document discusses various topics related to nutrition including:
1. Three subtypes of malnutrition associated with starvation, chronic disease, or acute disease/injury.
2. Formulas for calculating ideal body weight and interpreting BMI.
3. Methods for assessing nutritional status like serum albumin levels and energy expenditure equations.
4. The metabolic response to starvation involving the breakdown of glycogen, amino acids, and fat stores over time.
In a randomized trial comparing low-carbohydrate and low-fat diets in patients with type 2 diabetes, both diets produced similar weight loss over 2 years but glycemic control improved more with low-carbohydrate. Low-carbohydrate increased HDL cholesterol levels but had no other effects on lipids or blood pressure. While glycemic control benefits were transient, low-carbohydrate was not shown to have metabolic risks even with higher saturated fat intake.
The document provides nutrition guidelines for pressure ulcer management based on a patient's Braden scale score and presence of ulcers or wounds. It recommends protein and calorie intake levels, fluid goals, vitamin/mineral supplements, and conditionally essential amino acids like arginine and glutamine to support wound healing. It also discusses use of oxandrolone to reduce catabolism and promote tissue repair in patients experiencing weight loss or skin breakdown. Regular monitoring of intake, weight, and wound status is advised to evaluate response to the nutrition interventions.
Did you know that food storage and preparation can hugely affect its nutritional value? For example, the antioxidant capacity of blueberries actually increases with freezing, and letting crushed garlic rest for 10 minutes before cooking allows for the development of compounds with amazing health benefits.
Learn the tricks of the trade for getting the most out of your food in this short webinar with nutritionist Dr Danielle Crida.
This clinical trial compared the efficacy and safety of two doses of ferrous bisglycinate chelate (60mg once daily and 60mg twice daily) to ferrous ascorbate (100mg once daily) in treating iron deficiency anemia in women. Over 8 weeks, all three treatments significantly increased hemoglobin levels from baseline with no significant differences between groups. Adverse events occurred in 9-13% of subjects across the groups, mostly gastrointestinal disorders, with no serious adverse events reported. The study demonstrated that ferrous bisglycinate chelate at both doses and ferrous ascorbate were effective and well-tolerated treatments for iron deficiency anemia.
This document provides guidelines on nutrition in the intensive care unit (ICU). It defines patients at risk of malnutrition in the ICU, how to assess nutritional status, determine energy needs, choose feeding routes, and adapt nutrition based on clinical conditions. It discusses initiating and progressing nutrition administration, determining macronutrient needs, and paying special attention to glutamine and omega-3 fatty acids. The guidelines also address nutrition for patients with conditions like dysphagia, trauma, surgery, sepsis, and obesity that are common in the ICU.
Fat as a Health Food: Benefits & Course Corrections During a Year of Tracking...James McCarter
Ketosis, where the body burns fats in preference to carbohydrates, is being promoted as an approach to weight loss and treatment for chronic diseases. I’ve taken a Quantified Self approach to tracking my experience with ketosis seeing a number of benefits and challenges along the way. One of the conclusions, which I’m testing further, is that the types of fats used to replace carbohydrates may be critical to optimal health in response to a ketogenic diet. These slides are from my March 17, 2015 presentation to the Quantified Self St. Louis Group (www.quantifiedstl.com) at the Cambridge Innovation Center.
This document presents a study on the correlation between vitamin D levels and diabetic retinopathy. It begins with an introduction stating that diabetes prevalence is increasing globally and that longer duration of diabetes increases risk of retinopathy. It then discusses the aims and objectives of studying the association between vitamin D levels and retinopathy severity. The methodology section outlines how cases and controls will be selected from patients with and without diabetes and retinopathy and the inclusion/exclusion criteria. The document reviews several previous studies that found inverse relationships between vitamin D levels and retinopathy severity or progression.
This document discusses nutritional support for ICU patients. It begins with a brief history of ICU nutrition and outlines the basis for nutritional support. Providing nutrition is important to prevent the physiologic effects of malnutrition, which can lead to organ dysfunction and poor outcomes. The nutritional requirements of ICU patients, including calories, protein, fluids and micronutrients are described. Enteral and parenteral routes of feeding administration are covered, along with their indications. Guidelines for initiating feeding, monitoring for complications, and calculating nutritional needs are provided. The goal of nutritional support is to improve patient outcomes by preventing and treating critical illness-related malnutrition.
This document discusses various nutritional disorders including malnutrition, undernutrition, micronutrient deficiencies, overweight, obesity, and metabolic syndrome. It defines each condition and provides details on signs, causes, and health effects. Malnutrition refers to deficiencies or imbalances in energy and nutrient intake and includes undernutrition, micronutrient deficiencies, overweight, and obesity. Undernutrition is insufficient food intake over time and includes wasting, stunting, and being underweight. Micronutrient deficiencies involve inadequate intake of vitamins and minerals. Overweight and obesity result from excessive calorie intake over time and not enough physical activity.
Annals of Nutritional Disorders & Therapy is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients leading to various Nutritional diseases including obesity, eating disorders, malnutrition, developmental abnormalities that could be prevented by diet, hereditary metabolic disorders that retort to dietary treatment, food allergies and intolerances, and potential hazards in the food supply. It also focuses upon the chronic diseases caused due to improper nutrition such as cardiovascular disease, hypertension, cancer, and diabetes mellitus.
Presented at Johns Hopkins Bayview Medical Center. Evidence-based research surrounding the potential association between vitamin D deficiency and risk for developing gestational diabetes among pregnant women and women of reproductive age.
Many clients take bone health for granted until they’re presented with a diagnosis of osteoporosis, often following a fracture. Whether your client is nutrient deficient, concerned about bone health, or diagnosed with a metabolic bone disease, adding the right nutrients to a protocol is paramount.
In her latest webinar, Dr Danielle Crida discusses:
- The importance of bone health
- Consequences of low bone mineral density
- The most important nutrients for bone health and their synergistic roles
- Exercise and lifestyle choices for bone strength
- Supplement and dosing recommendations, introducing our new Ca/Mg/D3/K2/Boron product
Vitamin B12 deficiency is a common cause of megaloblastic anemia and neuropsychiatric symptoms, especially in older persons. There are several risk factors for vitamin B12 deficiency including prolonged metformin use. While major organizations do not recommend routine screening, high-risk patients such as those with malabsorptive disorders may warrant screening through CBC, serum B12, methylmalonic acid, and homocysteine levels. Treatment involves intramuscular B12 injections or high dose oral B12 supplementation.
Vitamin B12 deficiency is a common cause of megaloblastic anemia and neuropsychiatric symptoms, especially in older persons. There are several risk factors for vitamin B12 deficiency including prolonged metformin use. While major organizations do not recommend routine screening, high-risk patients such as those with malabsorptive disorders may warrant screening through CBC, serum B12, methylmalonic acid, and homocysteine levels. Treatment involves intramuscular B12 injections or high dose oral B12 supplementation.
This case report describes a patient who presented with symptoms of anemia but had falsely elevated vitamin B12 levels on laboratory tests. Further investigation revealed features consistent with pernicious anemia, including the presence of intrinsic factor antibodies. The patient responded well to vitamin B12 supplementation, demonstrating that the initial vitamin B12 results were inaccurate. The report discusses how competitive binding luminescence assays used to measure vitamin B12 can produce falsely elevated results in cases of pernicious anemia due to intrinsic factor antibodies interfering with the test. It emphasizes the importance of considering additional diagnostic markers beyond vitamin B12 levels alone when pernicious anemia is suspected.
This review discusses biomarkers used to diagnose vitamin B12 deficiency. Total serum B12 has limited value as it does not reflect cellular B12 levels. Homocysteine and methylmalonic acid are more specific biomarkers, with elevated levels indicating B12 deficiency, but they can also be influenced by folate or renal status. Holo-transcobalamin is the protein-bound, bioavailable form of B12 and the preferred biomarker. Diagnostic algorithms incorporating two or more biomarkers provide improved detection of vitamin B12 deficiency over single markers. Challenges remain in special populations like the elderly, vegetarians, and those with gastrointestinal or renal disorders.
This document discusses the use of vitamin D in preventing and treating non-bone diseases. It begins with an introduction and covers topics like immunomodulation related to allergy, fetal development, and the prevention and modification of diseases like asthma, COPD, allergic rhinitis, atopic dermatitis, and food allergy. It also briefly mentions autoimmunity and other diseases. The document provides information on vitamin D synthesis and metabolism and cites several studies on vitamin D levels in different populations and its effects. It concludes with a discussion of vitamin D's immunomodulatory effects in relation to allergy.
Causes of vitamin b12 and folate deficiencyfrankln
This document discusses the main causes of vitamin B12 and folate deficiency. The most common causes of vitamin B12 deficiency are inadequate dietary intake, especially among strict vegetarians who do not consume animal foods, and malabsorption in elderly people due to gastric atrophy. Low intake of animal foods can also cause vitamin B12 depletion in some lacto-ovo vegetarians and populations with low animal food consumption. The primary cause of folate deficiency is also low dietary intake of foods rich in folate such as legumes and green leafy vegetables.
Screening for Vitamin B12 deficiency in Wales: a targeted multiphasic approach.Josep Vidal-Alaball
Vitamin B12 deficiency commonly causes megaloblastic anaemia, chronic tiredness, loss of appetite and mood disturbance. If left untreated, serious neurological and neuropsychiatric complications occur.
This document summarizes a study examining vitamin B12 deficiency in patients with primary hypothyroidism. The study found:
1) Nearly 40% of the 116 hypothyroid patients studied had low vitamin B12 levels, indicating a high prevalence of B12 deficiency in this group.
2) Common symptoms of B12 deficiency like numbness and impaired memory were seen in both B12 deficient and sufficient hypothyroid patients, making symptoms a poor guide to determining B12 status.
3) Treatment with B12 injections led to reported improvement in symptoms in over half of B12 deficient patients, and some non-deficient patients also reported improvement, suggesting a possible placebo effect.
The study concludes that
Megaloblastic anemia is caused by a deficiency of vitamin B12 or folate, which inhibits DNA synthesis during red blood cell formation. This leads to large, abnormally-developed red blood cells. Symptoms include anemia, neurological issues, and gastrointestinal problems. Diagnosis involves examination of blood smears to find megaloblasts, along with low vitamin B12 or folate levels. Treatment consists of vitamin B12 injections and oral folic acid supplementation. Pernicious anemia, a specific type, results from gastric atrophy and lack of intrinsic factor, requiring lifelong B12 injections.
Vitamin B12, also known as cobalamin, is the most chemically complex vitamin. It contains a central cobalt atom and is synthesized exclusively by bacteria. Deficiency can result from inadequate dietary intake, food-bound malabsorption, or absorption issues in the gastrointestinal tract. Pernicious anemia, a historical fatal disease, is now known to be caused by B12 deficiency. Notable historical figures like Mary Todd Lincoln and Marie Curie have been diagnosed posthumously with B12 deficiency disorders. The discovery and isolation of B12 resolved the "cobalamin mystery" and led to effective treatment for pernicious anemia using liver extracts and later bacterial cultures.
Study of Serum Homocysteine and Vitamin B12 levels in Eclampsia, Pre-Eclampsi...Internet Medical Journal
The present study was carried out to evaluate the occurrence of association between homocysteine, and vitamin B12 in patients with Preeclampsia , Eclampsia and those with history of previous PIH. 30 such patients from obstetric ward were studied for estimation of serum homocysteine, and vitamin B12 over a period of Jan10 to Jun 2011. Serum homocysteine and vitamin B12 were determined by means of Immulite 1000 analyzer. The statistical analysis of study group of preeclampsia compared with normotensive control group, showed significant alterations in serum homocysteine, and vitamin B12 concentrations in preeclampsia and eclampsia group. Inverse association between serum homocysteine and vitamin B12 levels were observed in preeclampsia and eclampsia. The present study found hyperhomocysteinemia and deficiency of vitamin B12 along with increased blood pressure as a risk factor in preeclampsia. Final outcome of these patients after Inj Vitamin B12 therapy has improved at par with control group without any neonatal or maternal mortality in all four groups
Current Thoughts on Nutrition With Emphasis on Treating the Cause of Degenera...Visionary Ophthamology
Current Thoughts on Nutrition
With Emphasis on Treating the Cause of Degenerative Eye Disease, Safety Issues, B Vitamins and Essential Fatty Acids and Dry Eyes
Ellen Troyer, MT MA
Management of Peripheral Neuropathy and Cardiovascular Effects in Vitamin B1...PARUL UNIVERSITY
Peripheral nerves are susceptible to damage by a wide array of toxins, medications, and vitamin
deficiencies. Vitamin B12 (VB12) deficiency neuropathy is a rare debilitating disease that affects
mostly the elderly. It is important to consider these etiologies when approaching patients with a variety
of neuropathic presentations in this review were have included most relevant and latest information on
mechanisms causing Peripheral neuropathy in VB12 deficiency. We also have included cardiovascular
disorders and their management. Hyperhomocysteinemia has been implicated in endothelial
dysfunction and cardiovascular disease. The association of homocysteine (Hcy) and VB12 with
cardiovascular risk factors in patients with coronary artery disease (CAD) has also been studied
7843Effect of Vitamin D Supplementation on Blood Glucose Homeostasis, BMI and...IIJSRJournal
Background: Vitamin D deficiency seems to be frequent and involved in pathogenesis of numerous diseases, including metabolic abnormalities and glucose homeostasis. The aim of study was to investigate the effect of vitamin D supplementation on FBS, glycemic control, lipid profile and BMI in diabetic patients with vitamin D deficiency. Methods: A case control study conducted on diabetic and non-diabetic patients include 50 health and 150 diabetic patients. Diabetic patients have no or vitamin D deficiency and health control as well. Both were thereafter FBS, HbA1c measured first time on supplemented vitamin D either 50, 000 UI orally or 200,000 IU IM. After three months all blood parameters were measured include FBS, HbA1C, lipid profile and BMI. T test was used for determination of statistical significant between groups. Results: Vitamin D supplementation had profound effect and control FBS, HbA1C, lipid profile and BMI P< 0.05 on both Types 1 and types 2 diabetes mellitus. However, such effect has not been found in counterpart healthy control with vitamin D deficiency. The regular weekly dose of 50,000 IU were found more promising values on FBS, HbA1C, lipid profile and BMI P< 0.05 than the monthly does. Physical activities of cases and control did not shown to have any cofound factors on FBS, HbA1C, lipid profile and BMI. Conclusion: Vitamin D can be considered as a therapeutic agent along with the other treatments for both types of Diabetes mellitus in which could be deemed to use for routine treatment due to vitamin D deficiency is worldwide problem.
This document discusses two antioxidants - vitamin C and lutein. Vitamin C is found naturally in fruits and vegetables and helps prevent oxidative damage associated with diseases. The average vitamin C intake in the US meets recommended levels. Lutein is a carotenoid found in green leafy vegetables, fruits, and eggs that is absorbed with fat. Clinical trials found that lutein supplements enhanced macular pigment and improved vision in older adults with early macular degeneration. Another study found lutein and DHA supplements improved cognitive test performance in seniors. Due to these benefits for vision and cognition, lutein supplements or diets high in lutein may be beneficial for older adults.
The aim of this work is to illustrate a difficult diagnostic in vitamin B12 deficiency because of using of multivitamin preparations to a patient with unknown etiology of anemia. History Patient: a 70 year old engineer, following 8 years vegetable – dietary, was admitted to the county hospital, in neurology department, with diagnostic of poli-radiculonevrites, received in ward the treatment with milgama (containing 250 micro-gram multivitamin). After a lipotimia status the patient was transferred to cardiology department. Laboratory examinations showed in peripheral blood: Hb = 6 3 g/dl; Ht = 18.8%; RBC= 290.000/mm³; PLT. = 214000/mm³; WBC = 5300/³mm; Ret. = 3, 7%; Erythrocytes indices = normal values; ESR = 38 mm/h, moderate increase and serum iron decreased, 36 microgram/dl value. On blood smear in optic microscopy was registered: Band = 5% (with nucleus in ring!!!), differential count being normally with aspect flags on Coulter HMX Analyzer with 22 parameters: neutrophilia, lymphopenia, anemia. To microscopic examination of slide from bone morrow, have occurred the hyperplasic series of erythrocytes ~ 45%, deficiency of erythropoiesis, poly-cromathopil and acidophil erythroblasts with megaloblastic character, large metamielocytes and giant band forms. Macrocytes and ovalocytes where also presented. Biopsy results from gastric mucosa showed lesions of chronic gastritis, non-atrophic epithelium. Conclusions: Megaloblastosis appears in some time with vitamin B12 deficiently in bone morrow but no in peripheral blood because of administration of multivitamin drugs, deleting haematological shape of megaloblastic anemia.
The document discusses the evaluation and diagnosis of pediatric blood disorders. It notes that the history, physical exam, and initial laboratory tests provide clues to diagnose blood diseases. Diagnosis requires knowledge of normal hematological values that vary by age. The initial workup involves tests like hemoglobin, red blood cell indices, blood smear exam. Further tests are used depending on the results to diagnose causes like anemia, hemolytic disorders, and hemoglobinopathies. Specific disorders discussed in more detail include iron deficiency anemia, thalassemias, sickle cell disease, and their typical laboratory findings and treatment approaches.
Anaemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Wo...Lifecare Centre
ANAEMIA : its prevalence across age and gender group has increased. Aneamia has increased by 2-9% among children , Pregnant women and men according to data shared in the National Family health survey 5 (NFHS-5) released November 24, 2021
Anemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Women : Dr Sharda Jain
Oral Vitamin B12 for the treatment of Vitamin B12 deficiency: A Systematic Re...Josep Vidal-Alaball
This systematic review assessed the effectiveness of oral versus parenteral vitamin B12 for treating vitamin B12 deficiency. The review identified 3 randomized controlled trials that met the inclusion criteria. The evidence from these trials shows that high daily doses of oral vitamin B12 (1000 μg) are as or more effective at producing hematological and neurological responses as parenteral administration. Lower doses of oral vitamin B12 (50 μg daily) also produce a hematological response compared to placebo but may not produce a significant neurological response. Very low doses of oral vitamin B12 (10 μg) do not produce significant hematological or neurological responses compared to placebo.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
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Answers about how you can do more with Walmart!"
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
2. Connecting military family service providers
and Cooperative Extension professionals to research
and to each other through engaging online learning opportunities
https://militaryfamilieslearningnetwork.org
MFLN Intro
2
4. Today’s Presenter
4
Dr. Roman Pawlak, Ph.D, RD
• Associate Professor, Department of Nutrition Science,
East Carolina University
• Worked on Vegetarian Nutrition Evidence Analysis
Project for the Academy of Nutrition & Dietetics
• Authored eight books in five languages
• Research interests: Vitamin B12, vegetarian diets
9. Participants will:
1. List populations and groups at risk of vitamin B12
deficiency/inadequate vitamin B12 status
2. Understand what constitute adequate vitamin B12
intake
3. Distinguish between reliability of different vitamin
B12 assessment methods
4. Assess the role of vitamin B12 in prevention and
treatment of selected health conditions
5. Evaluate the efficacy of different vitamin B12
deficiency treatment options 9
11. “The human body stores several years' worth of
vitamin B12, so nutritional deficiency of this
vitamin is extremely rare. Although, people who
follow a strict vegetarian diet and do not
consume eggs or dairy products may require
vitamin B12 supplements.”
(Linda Vorvick, MD)
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19517.htm
11
12. How common is vitamin B-12 deficiency?
Lindsay H Allen 2009;89(suppl):693S–696S
“Vitamin B-12 deficiency and depletion are common in
wealthier countries, particularly among the elderly, and are
most prevalent in poorer populations around the world. This
prevalence was underestimated in the past for several
reasons, including the erroneous belief that deficiency is
unlikely except in strict vegetarians or patients with
pernicious anemia, and that it usually takes 20 y for stores of
the vitamin to become depleted.” 12
13. Individuals 50 years and older
All vegetarians and vegans
Patients receiving metformin
Patients after upper GI surgery
Anyone after surgery with general
anesthesia
Patients receiving chemotherapy
Individuals taking anti-acid
medications
Individuals infected by
Helicobacter pylori
Who is at risk of B12 deficiency?
Individuals taking non-steroidal
anti-inflammatory medications
(e.g. Aspirin, Ibuprofen, Aleve)
Individual with MTHFR 677
genetic mutation
Individuals taking anti-
convulsant drugs, protein pump
inhibitors, β2 blockers, bile acid
sequestrants, tetracycline,
calcium channel blockers
Patients with hypothyroidism
13
15. Recommended intake
Institute of Medicine
(1998)
2.4 µg/d
European Food Safety
Authority (2014)
4.0 µg/d
“The Recommended Dietary Allowance (RDA) for
vitamin B12 is based on the amount needed for the
maintenance of hematological status and normal
serum vitamin B12 values.”
Institute of Medicine
66%
15
16. “In persons with normal absorption, our data indicate
that an intake of 4–7 µg vitamin B-12/d is associated
with an adequate vitamin B-12 status, which suggests
that the current RDA of 2.4 µg vitamin B-12/d might be
inadequate for optimal biomarker status even in a
healthy population between 18 and 50 y of age.”
16
17. “Daily vitamin B12 losses in apparently healthy
adults and elderly probably range from 1.4 to 5.1
μg. Vitamin B12 intakes needed to compensate for
these losses seem to range from 3.8 to 20.7 μg.”
17
18. Association between vitamin B12-containing supplement
consumption and prevalence of biochemically defined
B12 deficiency in adults in NHANES III (Third National
Health and Nutrition Examination Survey)
Evatt et al., Public Health Nutr. 2010;13(1):25–31
“Daily consumption of more than 75 µg B12 may
nearly eliminate low B12 and biochemical B12
deficiency, but more research is needed to
determine how much supplement is needed by
those individuals for whom 6 or 25 µg/d does not
prevent low B12 or biochemical B12 deficiency.”
18
20. Assessment methods
Serum B12
Mean Corpuscular Volume (MCV)
Homocysteine
Holotranscobalamin II (holo TCII or TCII)
Methylmalonic acid (MMA)
20
21. Clinical presentation and metabolic consequences
in 40 breastfed infants with nutritional vitamin B12
deficiency – What have we learned?
Honzik et al. Eur J Paediat Naurol 2010;14:488–495
Characteristics of 17 infants with profound B12 deficiency
+ 5.9% + 100% +100%+ 100%
21
25. Dietary Reference Intakes for Thiamin,
Riboflavin, Niacin, Vitamin B6, Folate, Vitamin
B12, Pantothenic Acid, Biotin, and Choline
Food and Nutrition Board, Institute of Medicine
“The concentration of B12 in the serum or
plasma reflects both the B12 intake and stores.
The lower limit is considered to be approximately
120 to 180 pmol/L (170 to 250 pg/mL) for adults
but varies with the method used and the
laboratory conducting the analysis.”
25
26. “… a serum B12 value above the
cutoff point does not necessarily
indicate adequate B12 status. …”
Institute of Medicine
Dietary Reference Intakes for Thiamin,
Riboflavin, Niacin, Vitamin B6, Folate, Vitamin
B12, Pantothenic Acid, Biotin, and Choline
Food and Nutrition Board, Institute of Medicine
26
27. “Future study may show that the consideration of
total serum vitamin B-12 concentration < 222
pmol/L (< 300 pg/ml) as being subnormal (rather
than the concentration of 148 pmol/L or 200
pg/ml, which is generally accepted today) …”
Staging vitamin B12 (cobalamin)
status in vegetarians
Herbert V. J Clin Nutr l994;59(suppl): 12 l3S-22S.
27
28. “It has become common practice to reassure those with serum
vitamin B-12 above the traditional cutoff for pernicious anemia
(148 pmol/L) that their vitamin B-12 status is “normal” and so
cannot be a cause of any observed cognitive impairment. This view
can no longer be supported: there is abundant evidence that those
with serum vitamin B-12 concentrations in the “low-normal”
range (150–300 pmol/L) may, but not necessarily will, suffer
cognitive impairment that can usually be corrected by vitamin B-
12 supplementation.”
Hippocampus as a mediator of the role of
vitamin B-12 in memory
Smith DA. AJCN, First published ahead of print March 16, 2016 as doi: 10.3945/ajcn.116.132266
28
29. Do we need to reconsider the desirable blood
level of vitamin B12?
“Several large population studies have examined the
relationship between plasma total homocysteine (tHcy) and
MMA to blood vitamin B12 concentrations. It has been
found that the concentrations of these metabolic markers
start to increase at vitamin B12 levels considerably above
the typical cut-off value used to define B12-deficiency, (148
pmol L) (200 pg mL), as can be seen from the Fig. 1.”
Smith & Refsum
29
30. Classic
hematological
deficiency
symptoms
Smith & Refsum
2012;271(2):179-82
Do we need to reconsider the desirable blood
level of vitamin B12?
Metabolic insufficiency
NTD, cognitive deficient/decline,
Alzheimer’s disease, brain atrophy,
white matter damage, stroke,
depression, low BMD, DNA damage
Classic
hematological
deficiency
symptoms
30
31. Review of the magnitude of folate and
B12 deficiencies worldwide
McLean et al. Food Nutr Bulletin, 2008;29(2):S38-S51
31
33. Homocysteine and vitamins in
cardiovascular disease
Jacobsen DW. Clin Chem. 1998;44(8(B)):1833–1843
“We have shown that risk for coronary
artery disease is represented by a
continuum of total homocysteine
concentration, with substantial risk
occurring between 10 and 15 µmol/L.”
33
38. Clinical presentation and metabolic consequences
in 40 breastfed infants with nutritional vitamin B12
deficiency – What have we learned?
Honzik et al. Eur J Paediat Naurol 2010;14:488–495
Characteristics of 17 infants with profound B12 deficiency
+ 5.9% + 100% +100%+ 100%
38
40. Serum Ferritin in
Megaloblastic Anaemia
Hussein et al. Scand J Haematol(l978) 20, 241-245
Ferritin(µg/L)
Effect of vitamin B12 therapy
on serum ferritin in 13 patients
with megaloblastic anemia
40
47. “The epidemiology data linking Hcy with
atherosclerosis is strong (…). Experimentally
Hcy stimulates a range of potentially pro-
atherosclerotic changes, including inflammation
and thrombosis and causes apoptosis of
endothelial cells.”
Role of homocysteine in aortic calcification
and osteogenic cell differentiation
Van Campenhout A., et al. Atherosclerosis. 2009;202(2): 557–566
47
48. Endothelial cells constitute the inner
lining of blood vessels
https://www.washingtonpost.com/apps/g/page/world/deadly-ebola-virus-on-the-move-in-africa/904/
48
49. Humphrey et al, Mayo Clin Proc. 2008;83(11):1203-1212
“Each increase of 5 μmol/L in
homocysteine level increases the
risk of CHD events by
approximately 20%, independently
of traditional CHD risk factors.”49
50. Is Vitamin B12 Deficiency a Risk Factor for
Cardiovascular Disease in Vegetarians?
Pawlak R. Am J Prev Med 2015;48(6):e11–e26
Auto-oxidation
of Hcy
Foam cell
formation
Hydrogen
peroxide
synthesis
Superoxide
anion
synthesis
Hydroxyl
radicals
LDL
oxidation
Nitric oxide
impairment
Endophelial
inflammation
Endophelial
apoptosis
50
51. Is the role of Hcy concentration
in atherosclerosis/CVD
development controversial?
51
52. Is Vitamin B12 Deficiency a Risk Factor for
Cardiovascular Disease in Vegetarians?
Pawlak R. Am J Prev Med 2015;48(6):e11–e26
“The link between hyperhomocysteinemia and
CVD is supported by six of seven recent meta-
analyses. These meta-analyses included data
from prospective and case-control studies. They
also included data on the impact of Hcy
lowering on intima-media thickness and flow-
mediated vasodilation.” 52
54. Vitamin B12 Levels of Cerebrospinal Fluid in
Patients with Organic Mental Disorder
van Tiggelen et al. J Orthomolec Psych. 1983; 12(4):305-311
“Of our total number of 49 patients with organic mental
disorder only 4 patients would have been detected with
determination of vitamin B12 levels in serum, whilst in
fact 30 of these 49 patients have a pathologically low level
of vitamin B12 in CSF (cerebrospinal fluid – RP) and
could be treated effectively with parenteral vitamin B12 as
has been demonstrated.” 54
55. “(…) it is furthermore suggested that a
considerable number of patients is classified
and treated as dysthymic disorder (DSM-
111) in psychiatric institutions and by
psychiatric methods of expensive psycho-
social therapy, 55
Vitamin B12 Levels of Cerebrospinal Fluid in
Patients with Organic Mental Disorder
van Tiggelen et al. J Orthomolec Psych. 1983; 12(4):305-311
56. …whereas in fact these patients are
suffering from an undetected organic affective
syndrome, to which cerebral B12 deficiency is at
least a contributing, if not a causative factor. In
this respect we mention the post-natal depression
and the possibly toxic neurasthenic depression.”
56
Vitamin B12 Levels of Cerebrospinal Fluid in
Patients with Organic Mental Disorder
van Tiggelen et al. J Orthomolec Psych. 1983; 12(4):305-311
58. N = 2406, 55 years or older
Homocysteine Levels and the Risk of
Osteoporotic Fracture
Joyce et al, N Engl J Med, 2004;May 13;350(20):2042-2049
“An increased
homocysteine level
appears to be a
strong and
independent risk
factor for osteoporotic
fractures in older men
and women.”
58
59. Homocysteine Levels and the Risk of
Osteoporotic Fracture
Joyce et al, N Engl J Med, 2004;May 13;350(20):2042-2049
59
60. Auto-oxidation
of Hcy
Increases
osteocalcin
concentration
Increases
C-terminal
telopeptides of
collagen I
Increases bone
alkaline
phosphatase
Impairs taurine
synthesis
Increases
osteoclasts
activity
Reduces
osteoblasts
activity
Obstructs
formation of
collagen cross-
links
Impairs IGF-1
synthesis
Vitamin B12 deficiency and Hyperhomocysteinemia: Risk
factors for low bone density, bone turnover, and bone
fractures among vegetarian adults.
Babatunde T. & Pawlak R. Submitted to Journal of Chronic Disease Management
60
61. Vitamin B12, Folate, Homocysteine, and Bone
Health in Adults and Elderly People: A
Systematic Review with Meta-Analyses
van Wijngaarden et al. J Nutr Metab, 2013; http://dx.doi.org/10.1155/2013/486186
“Meta-analysis of four prospective studies
including 7,475 people showed a modest
decrease in fracture risk of 4% per 50
pmol/L increase in vitamin B12 levels, which
was borderline significant (RR = 0.96, 95%
CI = 0.92 to 1.00). 61
62. Meta-analysis of eight studies including
11,511 people showed an increased
fracture risk of 4% per µmol/L increase in
homocysteine concentration (RR = 1.04,
95% CI = 1.02 to 1.07).”
Vitamin B12, Folate, Homocysteine, and Bone
Health in Adults and Elderly People: A
Systematic Review with Meta-Analyses
van Wijngaarden et al. J Nutr Metab, 2013; http://dx.doi.org/10.1155/2013/486186
62
64. Homocysteine-Lowering by B Vitamins Slows the
Rate of Accelerated Brain Atrophy in Mild
Cognitive Impairment: A Randomized Controlled
Trial
Smith et al., PLoS ONE 5(9): e12244
• Randomized controlled study
• N = 271 individuals over 70 years with mild
cognitive impairment
• Group 1 – folic acid (0.8 mg/d), vitamin B12
(0.5 mg/d) and vitamin B6 (20 mg/d)
• Group 2 – placebo 64
65. (A) Subtraction image of female participant in the
placebo group, age 79 years, with baseline tHcy
of 22 µmol/L, whose tHcy concentration
increased by 8 µmol/L over two years. Atrophy
rate was 2.50% per year. Atrophy most strongly
appears here as enlargement of the ventricles.
(B) Subtraction image of female participant in
active treatment group, age 72 years, with
baseline tHcy of 24 µmol/L at baseline, whose
tHcy concentration decreased by 12 µmol/L
over two years. Atrophy rate 0.46% per year.
There is no clear visible pattern of atrophy.
2.5/0.46 = 5.4
Homocysteine-Lowering by B Vitamins Slows
the Rate of Accelerated Brain Atrophy in Mild
Cognitive Impairment: A Randomized
Controlled Trial
Smith et al., PLoS ONE 5(9): e12244
65
68. Vitamin B12 may be more effective than
nortriptyline in improving painful diabetic
neuropathy
Talaei et al., Int J Food Sci Nutr 2009;60(S5): 71-76
N = 50 diabetic patients from Arak, Iran
Age: mean age = 35 year; (range 18-53)
Group 1 – 2,000 µg intramuscularly twice weekly for a 3-
month period
Group 2 – 10 mg/day of oral nortriptyline
Diabetes management was not changed during the
treatment period 68
69. Pain Tingling Paresthesia
Decrease in symptoms of diabetic neuropathy
“Vitamin B12 is
more effective
than nortriptyline
for the treatment
of symptomatic
painful diabetic
neuropathy.”
Vitamin B12 may be more effective than
nortriptyline in improving painful diabetic
neuropathy
Talaei et al., Int J Food Sci Nutr 2009;60(S5): 71-76
69
71. Brain atrophy in cognitively impaired elderly: the
importance of long-chain ω-3 fatty acids and B
vitamin status in a randomized controlled trial
Jernerén et al., Am J Clin Nutr doi: 10.3945/ajcn.114.103283
Goal: to investigated whether plasma ω-3 fatty acid
concentrations (EPA & DHA) modify the treatment effect of
homocysteine-lowering B vitamins on brain atrophy rates
Participants (N = 168; Age ≥ 70 years):
Group 1 – placebo
Group 2 – treatment with
Folic acid = 0.8 mg
Vitamin B-6 = 20 mg
Vitamin B-12 = 0.5 mg
71
72. “In subjects with high baseline ω-3 fatty acids
(>590 µmol/L), B vitamin treatment slowed the
mean atrophy rate by 40.0% compared with
placebo (P = 0.023). B vitamin treatment had no
significant effect on the rate of atrophy among
subjects with low baseline ω-3 fatty acids (<390
µmol/L).”
Brain atrophy in cognitively impaired elderly: the
importance of long-chain ω-3 fatty acids and B
vitamin status in a randomized controlled trial
Jernerén et al., Am J Clin Nutr doi: 10.3945/ajcn.114.103283
72
74. Product Efficacy
Algal use (Spirulina, Nori,
Kombu, Chlorella)
Unreliable
Probiotics Make no difference
Nutritional yeast Effective if fortified
with B12
B12 supplements Effective
B12 Injections Effective
Efficacy of using different treatment
methods to improve B12 status
74
78. Cobalamin coenzyme forms are not likely to be
superior to cyano- and hydroxyl-cobalamin in
prevention or treatment of cobalamin deficiency
Obeid et al. Mol. Nutr. Food Res. 2015, 59, 1364–1372
“MeCbl and CNCbl show very similar biological effects, but CNCbl
may be superior as oral supplementation because of its stability.”
“At doses commonly used in treatment or prevention of Cbl
deficiency, all Cbl forms appear to be absorbed, internalized by the
cells and follow the intracellular metabolic pathway that converts all
forms into the common intermediate [Co2+] Cbl that in its turn
transfers into the functional coenzymes, MeCbl, and AdoCbl.”
78
80. Summary/Application
Individuals at risk of inadequate B12 status include:
Older adults and elderly, all vegetarians, patients taking
metformin, patients with GI conditions/surgery
Adequate B12 intake is very likely considerably higher than
currently recommended (supplements may have to be
utilized by individuals at risk)
MCV is unreliable assessment of B12 status
Use two different biomarkers to obtain reliable B12 status
80
81. Summary/Application
Hb and platelet count may be indicative of B12 status
B12 and hyperhomocysteinemia are associated with
CVD, organic mental disorders, osteoporosis/bone
fractures, brain atrophy
The efficacy of homocysteine lowering in disease prevention
may depend on the status of EPA and DHA
Reliable B12 deficiency treatment options include B12
injections and B12 supplements
81