Of all the lab tests I run in my clinic, vitamin D and vitamin B12 are among the most common problems. Last month the ministry of health in the UAE acknowledged that in a country bathed in sunshine, vitamin D levels are clinically low across most age groups, genders and ethnic origins. Vitamin B12 is also a concern for vegetarians and particularly vegans, picky eaters, and in people with digestive disorders and auti-immune dysfunction. It is an invisible epidemic estimated to affect about 40% of elderly people with research highly supporting its links with Alzheimers, cognitive decline and memory, cardiovascular disease, multiple sclerosis and other neurological diseases. Much of this research has further moved into the similarities of these diseases in children to affect learning and developmental disorders, autism, autoimmune disease, cancer and fertility. Both of these nutrients have been missed in the past firstly because they were not routinely tested by most physicians and secondly, the laboratory reference ranges were too low.
Vitamin D is actually a hormone building block needed for many functions within the body, including bone strength, mood balanced, sleep, learning and for a strong immunity.
The average range is from 30-100, but from a functional medicine angle, around 50-60 is a safer target to avoid health issues occurring. In the months where you get outside more, sunlight on cholesterol in the skin should be adequate as this converts to vitamin D and in the months where you stay indoors or with sunscreen, including vitamin D rich foods or a supplement maybe good practice.
Vitamin D is formed in the skin with exposure to UV B rays from the sun. The midday summer sun gives us about 20,000 IU in 20 minutes which could be why we are all happier in warmer and sunny weather!
A number of debatable reasons may support the recent pandemic in vitamin D deficiency from a shift away from outdoor activities to more time spent indoor, excessive use of sunscreen and the avoidance of eating foods such as dairy, eggs and butter which are valuable sources of dietary cholesterol and not to be confused with increased levels of LDL cholesterol indicated as a problem in hyperlipidaemia.
Low levels of Vitamin D have been identified in many patients with depression and research has shown psychiatrists whom have treated depression with Vitamin D before prescribing antidepressants with great success. This is very interesting and worthy of serious consideration when looking for a natural approach to health.
There are a few signs of deficiency such as a pale complexion, dark circles under the eyes, bone loss (teeth count too), and chronic depression. However running a test is always the best practice before supplementing. This however does not stop you from topping up on foods that are a source of this vitamin. Fish especially cod, herring, oysters, sockeye salmon and trout are the best source. Mushrooms especially Portobello have been finished off under lights and then there is sun. Milk and dairy is not a great source unless it has been fortified
Supplementation is also a good addition and can be cod liver oil or fish oil. Fat soluble vitamins are measured in International Units (IU) which sound high but in fact are not.
Supplementing with straight vitamin D is more likely to be around 1000 – 3000 IU (international units) per day for about three weeks and then 10,000IU per week for about 2 months. I consulted our clinic paediatrician and internal medicine specialist to clarify treatment routines. They both were cautious about recommending doses as the level of insufficiency is important to assess and long term intake and toxicity can lead to excessively calcium absorption, causing ataxia whereby the patient experiences confusion, instability in coordination and speech. Oral doses are more routine these days rather than intravenous. Retesting is advised and dietary intervention as well as exposure to sunlight. Vitamin D is a fat soluble vitamin and is stored in the body unlike water soluble B vitamins which are flushed out if not required. I also suggest taking vitamin D supplements with a little fat such as coconut oil or avocado to aid absorption and this good fat gives some resistance to the bowel lining. If you are taking magnesium, do not take them together.
B12 is the only vitamin we cannot get from plants and contrary to belief, power-foods such as seaweed, spirulina, fermented soy and brewers yeast may have B12 but not the essential element cobalamine which is produced in the stomach of animals. Plants don’t need it and therefore don’t store it.
The effects of B12 deficiency on children are especially alarming. Studies have shown …a significant association between cobalamin B12 status and performance on tests
measuring short term memory, spatial ability and fluid intelligence (reasoning, the capacity to solve complex problems, abstract thinking and the ability to learn), comparing vegan children to children whom include animal products such as eggs, dairy and meat.
Making dietary choices is people’s right however recognizing and understanding how best to balance specific diets is important and keeping up with individual needs is crucial to your health and the health of your off-spring.
Vitamin B12 works in synergy with folate in the synthesis of DNA and red blood cells. It is involved in the formation of myelin, the insulating and protective sheath around the nerves, and in the conduction of nerve impulses. Research into neurological disorders such as Parkinsons and Alzheimers has highlighted low levels of B12 status in patients and the effect it has on cognitive function. This has also been identified as having a significant effect on children with autism spectrum disorders, hence your practitioner is very likely to screen your child for B12 if they are diagnosed with a pervasive learnuing disorder.
Severe B12 deficiency is associated in conditions such as pernicious anemia, an autoimmune condition where the body destroys a specific protein necessary for the absorption of B12 in the stomach. Symptoms such as lethargy and fatigue, weakness, memory loss and cognitive problems become evident before anemia is diagnosed as B12 deficiency takes some time to become a problem and the best protection is to include foods of animal origin. Deficiency is usually only a problem, even for mixed eaters if the stomach protein mentioned above, is absent.
Why has B12 deficiency become so common?
The absorption of B12 is complex and involves several steps. Causes of B12 malabsorption include:
- intestinal dysbiosis which is the wrong mix of bacteria in the gut as well as high levels of yeast and parasites
- leaky gut or inflammation
- atrophic gastritis or low stomach acid which sets the scene for yeast overgrowth and acidity as well as self administered supplements to sooth the gut.
- pernicious anemia (autoimmune condition)
- medications (especially PPIs and other acid-suppressing drugs)
- Genetic polymorphisms
While eating a diet to include animal proteins does help, it still may be by-passed if digestive issues such as those found particularly in children with high yeast overgrowth, parasites, on-going gastritis and bowel inflammation; people being treated for acidity or taking antacids on a regular basis and in the elderly. Those senior moments may not be “just aging” but B12 deficiency.
If you suspect your B12 levels may be low, the first steps to take are to eat foods that are rich in B12 such as chicken livers and lambs liver, meat, fish and chicken, dairy and eggs. If you are vegetarian, you may get enough through eggs and dairy and if you are completely free of any animal foods, supplementation is essential. If you are a high user because of other influences such as low stomach protein specific to B12 absorption then regular intravenous supplementation probably every three months is required. If you are prone to dysbiosis, yeast or other gastro-intestinal issues, you need to check with your GP and nutritionist about a more natural way to heal the gut.
The body is an amazingly resilient system that wants to heal given the right conditions and by taking incremental steps. The best approach for improving digestion is to remove the stimulus that is causing problems, re-inoculate the gastro-intestinal tract with optimal bacteria and replace what is needed to allow for healing. Once adverse symptoms have gone, it is time to challenge your system and find the best foods for you.
Please feel free to share your journey!