Vitamin B12…How it works, helps, and what may be preventing you from getting enough

B12 and Digestion

Absorption of B12 in the body:

As you can see below-- When you take an oral dose of Vitamin B12, The first location for absorption by the body is in the stomach where something called Intrinsic Factor (IF) is secreted to carry B12 to the small intestine. Once B12 arrives in the terminal Ileum (end of small intestine), it is transported by a protein called transcobalamin and then ready and available for cell uptake.

Improper B12 absorption may result if digestion is compromised for one reason or another such as:

1) Frequent use of Anti-Acids (Tums), Proton Pump Inhibitors (Prilosec, Prevacid, Tagament, Pesid AC, Zantac, and certain medications like Metformin.

2) Malabsorption: Leaky enterocytes in small intestine.

3) Celiac Disease

4) Inflammatory Bowel Disease (Crohn’s and Colitis)

5) Pernicious Anemia

6) Pancreatic Insufficiency

7) Alcoholism

B12 and the Diet

Our dietary preferences can affect our intake of certain necessary vitamins and minerals. The ONLY sources of B12 are found from animal sources.  There are no vegetables with a high B12 content. Vegetarians and Vegans-be mindful of this!!

Table 2: Selected Food Sources of Vitamin B12 [13]

Food	Micrograms (mcg) per serving	Percent DV*
Clams, cooked, 3 ounces	84.1	1,402
Liver, beef, cooked, 3 ounces	70.7	1,178
Breakfast cereals, fortified with 100% of the DV for vitamin B12, 1 serving	6.0	100
Trout, rainbow, wild, cooked, 3 ounces	5.4	90
Salmon, sockeye, cooked, 3 ounces	4.8	80
Trout, rainbow, farmed, cooked, 3 ounces	3.5	58
Tuna fish, light, canned in water, 3 ounces	2.5	42
Cheeseburger, double patty and bun, 1 sandwich	2.1	35
Haddock, cooked, 3 ounces	1.8	30
Breakfast cereals, fortified with 25% of the DV for vitamin B12, 1 serving	1.5	25
Beef, top sirloin, broiled, 3 ounces	1.4	23
Milk, low-fat, 1 cup	1.2	18
Yogurt, fruit, low-fat, 8 ounces	1.1	18
Cheese, Swiss, 1 ounce	0.9	15
Beef taco, 1 soft taco	0.9	15
Ham, cured, roasted, 3 ounces	0.6	10
Egg, whole, hard boiled, 1 large	0.6	10
Chicken, breast meat, roasted, 3 ounces	0.3	5

*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers determine the level of various nutrients in a standard serving of food in relation to their approximate requirement for it. The DV for vitamin B12 is 6.0 mcg. However, the FDA does not require food labels to list vitamin B12 content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet. The U.S. Department of Agriculture's Nutrient Database Web site [13]) lists the nutrient content of many foods and provides acomprehensive list of foods containing vitamin B12.

B12 and Depression

Inadequate intake, digestion, or assimilation of B12 can affect our mental/emotional health. In an Observational study, it was found that 30% of hospitalized, depressive patients were found to have a B12 deficiency. B12 plays a role in the production of SAMe which is responsible for the bioavailability of neurotransmitters causative of depression. Those struggling with depression should be screened for B12 levels as a standard measure.

Signs and Symptoms of B12 deficiency:

·      Fatigue

·      Megaloblastic Anemia

·      Constipation

·      Loss of appetite

·      Weight Loss

·      Neurological Changes (numbness and tingling in hands and feet)

·      Difficulty maintaining balance

·      Confusion

·      Poor memory

·      Depression

·      Soreness of mouth or tongue

·      Swelling of tongue

And there is much more that B12 does, and many more conditions that it will benefit. Stay tuned for more....

The Magic Weight Loss Pill

 My father has struggled for many years to keep his weight within ‘acceptable’ limits for his primary care physician. For a short time, he exercised to keep the weight off. He ran road races, half marathons, marathons, went to the gym daily, etc. As long as he was active, he could enjoy eating plenty of food as he may have come close to balancing the amount of calories coming in with the amount of calories burning off. But like many, as time passed by he was unable to keep the vigorous running up do to injury, a busy work schedule, lack of motivation, and is since stable with inactivity, and as a result back to taking more food in than calories burned… As of now, he has been on a cholesterol medication for many years to keep his cholesterol within healthy limits, and by god- the rest of him has stayed healthy! His blood pressure is good, his carotid arteries are clear, no signs of heart disease, organ failure, diabetes, etc. As a result, he continues his lifestyle of choice because he doesn’t have anything wrong with him. The doctors stand with their mouths dropped, in awe of a man that is continuing to break medical convention. So as you can expect, the question becomes- Why should he lose weight? Why should he change if there is nothing wrong with him? His genes are tough, his mother and father lived a long enough life!???

I guess we can cross our fingers and hope that plan works out- I know I do everyday. However, I also worry he may not be so lucky one day, as I am sure we can all relate to. The problem with having learned a bit about medicine is I understand the process of disease does not happen over night. Symptoms are not the disease; they are the building blocks of it. High blood pressure is a measurement of force, an indicator the heart is working harder than it should. Lower than normal amounts of HDL (good) cholesterol allows LDL (bad) cholesterol to elevate and is unable to keep the arteries clean and free of debris. Blood sugar can elevate after eating a sugar rich meal but when it stays elevated, insulin builds a tolerance to an adjusted glucose level and creates insulin resistance- much the same as building alcohol tolerance through long term drinking. The illusion is there are no problems as long as the body adapts, and the body WILL adapt, (some longer than others) but the ‘stressor’ is evident.  Think of it this way: would it be reasonable to drive fast on a highway with a tire you know is thin and worn? It is easy to see the tire is living on borrowed time and it is a more reasonable action to change the tire to prevent an accident rather than continuing to drive with it. I suggest we weigh this decision making with our own health. Much like a weak tire, symptoms are red flags and indicators it is time to make change. 

The truth is, a lifetime sets the stage for chronic disease or even acute disease processes. The leading causes of death in America are preventable. Without a magic pill or vampire venom to ravage through our systems and rescue us from disaster, we are better off taking care of ourselves, if only at the very least: foundational principals such as good sleep, laughter, exercise, healthy diets (regular meals, vegetables, fiber, adequate protein), plenty of water and good digestion. 

Fluoride in Water

The Importance of Water.

Water seems to be a topic of interest these days. I always discuss the importance of water with my patients, as having an adequate amount of it is seriously important to our health.

Water is important for many things such as:
1) Hydration
2) Every biochemical reaction in the body
3) Metabolism
4) Kidney and bladder health
5) Detoxification-the removal of toxins
6) Assimilation of nutrients from diet and supplements.
7) Digestive Function

And the list goes on...

Fluoridation of Water?
Despite water being such an important nutrient in our lives, the quality of water running from our taps is in question. It is regular practice to include chemicals into the water supply for sanitation and other purposes. Lets take fluoride for example. Apparently, every major US city has fluoridated their water supply except Portland, OR where it is currently under consideration via the public vote. This absence of fluoride in the water has long been suspected the reason for excess tooth decay and poor dental health. Interestingly enough, there is a lot of research suggesting there is no good reason to add fluoride to our water supply. Drinking fluorinated water allows fluoride to be absorbed systemically when fluoride's benefits are topical in nature.

A couple points of consideration I offer in regards to fluorinated water are: 1) The choice is not up to the individual. Those of us who do not consent with the fluoridation of water are 'pigeon holed' as it is difficult/expensive to avoid exposure to fluoride in the water once it is in there. 2) There are systemic risks of having exposure to fluoride as it is a toxic free radical.

What You Need to Know About Fluoride.
Chemically speaking, flouride is a ion. The manner in which it benefits tooth decay is by creating a stonger environment so the acids from bacteria cannot survive as readily.  Note this is a topical influence and except for the initial contact/swooshing of water in one's mouth, there is no other benefit for fluoride in water as it travels through our body. It does not serve as a treatment to the tooth or gums themselves and it does not benefit oral health when absorbed systemically. Fluoride, when taken systemically is toxic to the body, it is stored in the bones and processed through the kidneys.  Water supplies allow 0.7 mg/L which is decreased from the previous 0.7-1.2 mg/L range. There are many health claims and conditions that are suspected to be related to fluoridation such as thyroid problems, kidney disease, cancer, etc. Fluoride has an affinity for calcium and therefore makes it insoluble and unusable to the body. (We need calcium!!) Fluoride was once used to decrease the function of the thyroid gland in a HYPERthyroid state and it is interesting to consider that chronic exposure of it may little by little decrease the function of the thyroid gland by this same mechanism. There are studies that also indicate the improvement in dental health over years and years to be unclearly correlated with the addition of fluoride in water and may more likely have improved regardless because of the increase in hygeine and regular cleanings. It is my contention that fluoride may be beneficial topically but to be put into our water supply seems a LOT unnecessary.

Can you Filter Fluoride Out?

The three successful ways to get fluoride OUT of water is by either: Reverse Osmosis, Distillation, or by using an Activated Alumina Defluoridation filter. These are usually quite expensive investments and there are some uncertainties behind drinking distilled water all the time. Your typical water filter (ie Brita or Pur) are ineffective at removing fluoride and likewise no matter how you treat the water be it baking, boiling, freezing, or sautéing-- be sure it will not do a thing to the fluoride content.

Natural Alternatives?
Other suggestions for dental health that are on the more natural front is that of Xylitol. This is a natural sugar that has no glycemic index, (not appropriate for sweetening coffee and baked goods) but is a sugar that creates an uninhabitable environment for bacteria that contribute to dental caries along side reducing overall plaque build up and helps with bone remineralization! This is available in gums, mints, and toothpaste and the research is looking good in terms of overall benefit. However we need to be cognizant of how this is derived and manufactured, and yet again we can't go throwing it in our water supply as a sentiment to better dental health. Just because it is natural, does not mean it is always the safest thing for us. Use in moderation, use in small doses and by gosh if you really want good teeth-- eat a healthy diet for your mouth and body's sake! ie. clean water, low sugar, lots of vitamins and minerals.

Alkaline Water

Alkaline water is all the buzz these days. Is is healthy or harmful to ingest? What are the best sources or best methods of producing alkaline water?

Let's start with the science:

Regular water has a pH of 7 (neutral). The pH scale ranges from 0-14. Anything below 7 is considered acidic and anything above 7 is considered basic. Too much acid or too much base can be hazardous at a certain point-- for instance, we would not drink battery acid or bleach.)

Alkaline Beverages
There are plenty of beverages we drink that are considered acidic: Orange juice, lemon juice, tomato juice to name a few. However despite their initial pH, because these fruits naturally contain minerals like potassium, calcium, magnesium, and selenium- they actually have an alkalizing affect on the body. This applies to most FRESH squeezed juices. The alkalizing effects change when cane sugar is added to the juice, (sugar increases acidity) or when chemicals are added. Now coffee is another weird one; Coffee is by definition acidic, however the better quality the coffee, the less acidity. The more pesticides and chemicals added to the coffee, the higher the acidity, and it applies again here that adding sugar to the coffee increases acidity. The best way to drink coffee is black, and made from good quality organic beans. Dairy products are alkaline or at least have a highly alkaline component to them (calcium) and an acidic component (protein). Different dairy products have different pH values. For instance: ice cream has lots of sugar or artificial sweeteners added to it. But good goat milk and whole milk, are both alkaline.

The key to understanding alkaline benefits of beverages and foods is to know how our body metabolizes something in order for us to understand whether it will have a acidic or alkaline influence on the body.

Alkaline Water
First of all, do we need water to be alkaline? The normal pH of water is actually neutral. But of course we are talking distilled water here. The addition of minerals like magnesium, calcium, sodium increase the pH of water. Water that is naturally running over rocks and through streams is in a naturally alkalized state due to picking up all sorts of minerals that naturally occur. Now, tap water is generally acidified in order to put it in a more sanitary form by adding things like chlorine and fluorine to the water to allow it to be drinkable for a general population and be free of any harmful bacteria. So the typical glass of fresh tap water is around a 6 in pH....still not horribly acidic, but ingesting chlorine and fluorine might be a problem.

There are many water alkalizing devices out there and most of which use platinum and titanium rods to 'ionize' the water. Ionizing the water will move electrons around, therefore casting off the acidic water by exchanging the left over hydrogen to create a more alkaline pH. These ionizers increase alkalinity still by sometimes adding minerals to the water after the water is alkalized, creating a water with as high as 9.5 pH.

The cost of these ionizers can be thousands of dollars to install into a home system and usually only effect one source of water like the tap you drink from or cook from, leaving out the shower, and other faucets you may use in the house. Now, while alkalizing water could be good for us, the quality of the water is in question if the source is coming from a tap. For example: Chlorinated/fluorinated water that has been alkalized. We then just change the pH with a ionizer and still leave in all the crud. The better option to consider is to first filter the water and THEN ionize it. But still, what would be best for our health would be to have minerals in filtered water that increased pH naturally. So maybe all we are left with by drinking ionized water is a changed pH, and when filtering water THEN alkalizing it, we are left with VERY expensive water that could be replicated by adding some sodium bicarbonate to filtered water.

Lastly, determining the nutritional benefit of alkaline water is a hard one. There are many claims made on it suggesting it has anti-cancer properties and helps to alkalize our blood as acidic drinks and foods are thought of as harmful to our health and linked with cancer, cardiovascular disease, diabetes, etc. Alkaline substances are beneficial to our health but as far as water goes, I wonder if it is better to just filter our water VERY WELL and look to food for the rest. ??