B Vitamins-Comprehensive Guide to B1, B3, B6, B9 and B12

welcome back this is Dr Jin sung we're a clinical Excellence meets excellent results today we're going to talk about vitamin B1 or thymine B1 is often overlooked in the medical community and the deficiencies or subclinical deficiencies are very common and it creates a lot of different symptoms that mimics other diseases so let's get right into what B1 is [Music] vitamin B1 thymine deficiency so many symptoms subclinical thyme insufficiencies so this is a quote from Dr Derek Lonsdale is it critical and rate limiting cofactor to multiple enzymes involved in this process including those at the entry point and at critical junctures for the glucose fatty acid and amino acid pathways what that means is without thymine you will not be able to process your carbohydrates your fats and your proteins it's a rate limiting cofactor without it some of these processes will not work now I will go ahead and Link some of the enzymes that are associated with it as well as the article where I got this quote from here's another one thymine availability dictates molecular oxygen homeostasis and mitochondrial ATP production it's important for oxygenation and energy production of your mitochondria or atps which is a Powerhouse right the the energy of the cell [Music] if you just look at this if you're not processing your Foods appropriately you're not getting enough oxygenation and you're not producing energy your body will fail it is a crucial nutrient now the recommended daily intake for men 1.2 milligrams for women 1.1 milligrams it's woefully inadequate especially in this Society where we are fascinated with a lot of carbohydrate intake now thymine is fortified in a lot of foods however with a high carbohydrate diet thymine will be depleted because it is a factor in the metabolism of carbohydrates in glucose so what is B1 or thymine okay B1 is a water-soluble vitamin with a half-life of between 1 and 12 hours that means you have to take in B vitamins regularly daily approximately 30 milligrams are stored in muscle tissue heart lungs kidney brain right however if you don't take any thymine and on a daily basis you can deplete your thymine stores in about two to three weeks in acute illnesses where you have a heart attack or in critical care you can deplete your thymine in 72 hours so it's a crucial cofactor B1 deficiency let's go back here absorbed in the jejunum of the small intestine it's absorbed in the small intestines so sometimes enteric coated B vitamins can be more helpful to get down into the small intestine versus where it gets broken down by the acids of the stomach B1 deficiency is rare in the United States but sub-optimal level is very common and it creates a lot of different symptoms that mimic other diseases so it gets confusing why do this why does this patient have a compilation of symptoms that do not match it's because they may have a thymine deficiency so B1 deficiency is very rare but the the rare forms are called berry berry there's a wet form and a dry form the wet form impacts cardiovascular systems so you can get tachycardia you can get autonomic symptoms shortness of breath you can get edema a swelling in the legs dry berry berry affects the nervous system it affects nerves to the lower extremity let's say so you can get atrophy of the muscle you can get confusion you can get trouble moving the legs memory loss right it impacts the brain the autonomic symptom can be things like pots or postural orthostatic tachycardiac syndromes Wernicke's kosikov syndrome often to do induced by alcohol meaning alcoholics don't take in other Foods they're drinking all the time and they deplete their thymine malabsorption anorexia all these things can also do the same thing now when we look at this let's go back to this because it's a critical factor in a lot of enzymatic processes and energy production it creates a lot of Havoc if you don't have optimal levels of thymine so what we're going to do is we're going to separate the video we're going to make a part two of this video going into the subclinical signs and symptoms what my block or inhibit absorption of thymine but forms of thymine should you take and look into the matters of testing for thymine today we're going to do part two of thymine deficiency or B1 last week we spoke about how B1 is a rate limiting cofactor and a lot of enzymatic processes and it's important for oxygen homeostasis as well as ATP production or energy production from your cells today we're going to talk about the foods and subclinical signs of B1 deficiency B1 deficiency thymine deficiency so many symptoms so let's talk about food first foods high in thymine beans legumes Dairy meat fish pork whole grains peas nutritional yeast Seafood asparagus there's an interesting story about whole grains back in the late 1800s in Japan they started to process the rice they used to Mill the rice and the wealthy were enjoying the white rice versus the the poor population were still using the whole grain some of the wealthy populations started to develop beriberi or significant overt thymine deficiency so it's better to have the whole grain versus a processed grain symptoms related to subclinical thyroid deficiencies fatigue or general fatigue weight loss confusion muscle weakness so you're working out and you still don't have that oomph for whatever reason your muscles start to fatigue out peripheral neuropathy decreased immune system cold hands and feet Reynolds sometimes it can be Associated for Ray nods mood swings irritability GI discomfort decrease in appetite you can see how there's so many different symptoms and systems that can be affected and if you went and you had mood swings and irritability you might be given an antidepressant if you have gi discomfort they might just give you fiber or some sort of medication to help with that or if you have a poor immune system they will start to look into different viruses and all this stuff so thymine deficiency is kind of like an umbrella of these symptoms it's used for AIDS canker sores cataracts cerebellar syndrome cerebellar syndrome so it also impacts balance if you have thymine deficiencies you may get dizziness and so forth diabetes peripheral neuropathy cardiovascular disease autonomic dysfunction weakened immune system so you can use this in a lot of different conditions an autonomic dysfunction you can have a heart rate increase or tachycardia right you can have swelling in your legs and so forth sometimes this autonomic type symptoms or pots you're treating but you're not getting to the bottom of it and sometimes it can just be a thymine deficiency [Music] yeah now there is testing available for thymine however there are different tests and some are very expensive and not commercially available so there's some problems with testing right really B vitamin or B1 is a water-soluble vitamin and there is no harm in taking larger amounts to see if you have a B vitamin deficiency so I don't really recommend any specific test for B1 deficiency decrease thymine availability and increase demand these are the factors if you have a high carbohydrate diet because thymine is is part of the process that converts carbohydrates to energy High carbohydrates will deplete your thymine food chemicals you know things that they put into your Foods coloring and so forth obesity Alcohol Tobacco coffee and tea coffee and tea has something called tannins we can also inhibit absorption of thymine medications and environmental toxins will also hinder the process of absorption and utilization of thymine now let's talk about the different forms you have thymine HCL you have thymine mononitrate both the synthetic forms Bentyl thiamine is a liposoluble of thymine so it stays in your system a little bit longer and the half-life is longer right increases blood thymine Levels by 100 to 240 percent more than regular thymine also impacts the brain significantly because there's a lot of fat tissue in the brain right so the brain can be impacted significantly with Bentyl thiamine ttfd thymine tetrahydrofurallo disulfide it's a long name right it's another form of thymine and some say that it's actually the most absorbable or highly highly active at the end of the day if you're going to take high doses of thymine you need to work with a physician who understands what's going on because it's not just about getting your recommended daily allowance of vitamin B1 it's about saturation and optimal levels so sometimes you can use high levels of B vitamins or bentho thiamine or ttfd to get a more profound effect with certain patients but I would suggest using a or doing it with the help of a physician who understands what's going on with that okay typical dosages 50 to 100 milligrams twice a day sometimes three times a day if you're doing three times I would go 50 50 50. again the short half-life of B vitamins you need to kind of separate out the B vitamins and higher dosages again work with a physician so this is the basic idea of how things work the B vitamins and it is a great mimicker of a lot of different conditions and it's usually pretty safe if you're taking a water-soluble vitamin to increase thymine levels what I failed to mention right over here is you can use nutritional yeast which has the B vitamins in a tube which is a natural form or eat the foods that are higher in thiamine but you can use these forms to help improve some of the signs and symptoms of subclinical thymine deficiency today we're going to talk about vitamin B3 or niacin and the impact it has on cholesterol so let's get right into it niacin is also called nicotinic acid and there are other versions called nicotinamide or niacinamide which has an amine group attached to it deficiencies can occur when you have a highly refined carbohydrate diet you have a lot of corn in your diet sugar or people who are vegans or sometimes vegetarians because they're not eating animal products GI issues or GI dysfunction can also create a depletion of B3 because the small intestine is where it's absorbed and if you don't have proper GI function you can have a depletion of B3 and acid use you need stomach acid to break down your fats proteins and carbohydrates if you have low stomach acid because of prolonged use of anti antacids it can deplete your B3 and other B vitamins liver disease people don't realize that liver disease can create B3 deficiency because some of it is produced in the liver so when you have liver disease you can have a depletion or lack of B3 certain medications can also deplete your B3 okay now there is a condition called pellegra this can occur with severe B3 deficiency or maybe someone who who's an alcoholic and is not eating anything and they're just drinking or severe anorexia so pellegra is the four D's dermatitis which is skin issues obviously Dementia or cognitive function diarrhea all eventually leading to death okay so when we look at niacin it's been shown to decrease decrease triglycerides LDL total cholesterol LP little a which can be very damaging to your arteries because they're very small particles it can increase your HDL or quote-unquote good cholesterol right now there are a couple of studies that were done one is called hps2 Thrive study and it had missed mixed results and there were definitely some side effects they were using a product that had lower propion in it which is the chemical that would prevent the flushing related to nicotinic acid so there was definitely problems with that study does the aim high study and they use niacin plus the Statin to see if it would have a a better effect on the Statin medication okay now in terms of foods what kind of foods have high B3 in it nutritional yeast animal-based products eggs salmon anchovies okay also like I said it synthesizes through the liver so you'll need tryptophan B2 and iron in order to produce your B3 through the liver okay other benefits of taking niacin or nicotinic acid is brain health skin especially if you're the type when you go out into the sun it irritates your skin sometimes it's a lack of B3 ATP production cell signaling DNA repair insulin sensitivity so people who are diabetic or insulin resistant it could improve insulin sensitivity it's known to reduce inflammation and arthritis sleep issues and Stress Management hair growth it'll increase oxygenation because of that flushing effect so you need oxygen and nutrients to get to your groceries into your head in order to grow hair hair nails really nutrient metabolism so B3 is a cofactor in the processing of your fats proteins and carbohydrates so it's very important for that dosages you can use between 1200 to 2000 milligrams per day okay side effects of using nicotinic acid or niacin adverse effects can be flushing but you can use uh applesauce prior to taking it or you can take aspirin in order to minimize the flushing of nicotinic acid however the use of prolonged use of aspirin is really not good for you but you can also get itchy skin because of the flushing effect people who have gout sometimes it can exacerbate gout or increase your uric acid level so you got to be careful okay and very rare can uh situations you can have hepatotoxicity this is usually associated with really really high levels of B3 or maybe the slow release form with a chemical attached to it can create hepatotoxicity so that's it's pretty rare though okay there is another product called enisitol hexaniacinate that's not the same and I wouldn't use that to have the same effect as nicotinic acid now you can also use niacinamide or nicotinamide because that has less of the flushing effect and it's often used in multivitamins so B3 can be a very important factor in a lot of different things so if you have issues with triglyceride management of your cholesterol you can use nicotinic acid I prefer the flushing effect if you can utilize it but niacinamide can also work you have to remember that niacinamide is more bioavailable but it doesn't have that flushing effect so you can use different combinations but I would prefer using nicotinic acid if you don't have those side effects and it's you can tolerate the side effects of the flushing okay today we're going to talk about B vitamins in particular vitamin B6 so let's go into this vitamin B6 the Forgotten B vitamin right oftentimes people are you know talking about oh I'm taking B12 or I'm taking folate right but B6 vitamin is a prevalent deficient nutrient in the U.S population why because things like birth control pills hormone replacement antibiotics and diuretics can deplete B6 right also highly refined diets carbohydrates and so forth can also deplete B6 so one of the functional reasons that you can have B6 deficiencies because of these types of things now how many million Americans are on birth control pills hormone Replacements antibiotics and diuretics diuretics for like excessive swelling or sometimes for hypertension right there are millions and millions of people on this and it can cause a functional deficiency not like an over deficiency where you might have seizures and so forth but functional deficiencies so what is B6 used for right it's it's a cofactor coenzyme for metabolism of amino acids and then neurotransmitters right your happy hormones serotonin dopamine your inhibitory hormones like Gaba right and also it helps to convert ala to EPA DHA basically you take certain types of oils and you can convert it and make it usable in the EPA or DHA form or the omega-3 fatty acid family right so when you think about Omega-3s we talk about fish oil or maybe krill oil so you could take certain types of oils that you can convert it into the usable or good fish oil or good oils the Omega-3s so you need B6 as a cofactor or coenzyme there also if you don't have enough b6 and b12 and B9 you could increase homocysteine right so you need B6 to decrease the homocysteine level so homocysteine is a marker it can be actually a independent marker or risk factor for cardiovascular disease because homocysteine needs to be converted to cysteine and the way to do that is you need cofactors like B6 B6 B9 and B12 so in order to reduce formosastine you'll need B6 that's one of the cofactors now what are some of the signs and symptoms of someone who has a clinical or subclinical B6 deficiencies right so E6 deficiencies right in the subclinical phases you're going to have numbness in the hands and feet possibly you can have a trigger figure is pretty common where your finger will lock right sometimes that can be an issue with a deficiency in B6 joint pain or joint stiffness is another Factor carpal tunnel syndrome is another one where you have numbness and tingling in these three fingers right in here and possibly half of this finger so oftentimes people do carpal tunnel release surgery and oftentimes it's not needed sometimes you can take B6 and can help improve the numbness in the hands obviously there's other factors for carpal tunnel like excess of use typing injury and so forth but certainly you can try B6 for that also depression people don't realize B6 is utilized to make Gaba serotonin dopamine all these neurotransmitters so B6 deficiencies are related or are linked to depression another one is some people can develop life sensitivity right the lights and the causes tearing in the eyes and so forth another one is Fisher tongue when you look at someone's tongue you should be pink and and smooth however you can get fissures in the tongue right or sometimes people get some numbness in their tongue and it can be related to the B6 deficiency so there are a lot of little things if you have some of these signs and symptoms you can go ahead and try B6 I'm going to go ahead and talk about some of what types of forms what kind of lab markers and so forth we can check for B6 deficiency okay [Music] so as we continue we have we want to know what clinical markers what lab markers can we look for when we have a B6 deficiency not just looking at the blood for B6 but what other markers right so one of the monitors is homocysteine like I spoke about so the number it ranges is a big range but ideally you want that number to be close to seven and if your home assistant goes above 9 10 you could have some of those symptoms that I just talked about right so you want that number to be below nine just around that seven mark another marker called a s t often people think about it as a liver enzyme however it's also related to Heart liver kidneys and brain right so without the proper levels of B6 your marker can be below 10 or below nine right the range goes up to around 32 34. however if the numbers are actually lower than 10 it could be indicative of a B6 deficiency another marker is MCV or mean anything over 92 so mean corpuscle volume or MCV is a marker for red blood cell if you do not have enough B vitamins B9 B12 B6 the Red Cell becomes large to carry more oxygen and the the higher the number the worse you are so if the number goes above 92 or some people will see at like 102 that means there is severely lacking in certain B vitamins and B6 being one of them and this can actually create a anemia a megaloblastic anemia due to B vitamin absorption issues or or genetic defects and so forth so you have to have that number below we like to see it below 90. but anything about 92 you better be concerned the other one is remembering dreams so if you don't remember your dreams at all you feel like you don't dream at all then it's a possibility that you can have a B6 deficiency right that's an interesting fact so when you can um you could do an experiment where you take 100 milligrams for 30 days of B6 the form I'd recommend is p5p of paradoxyl 5-phosphate and the reason it's become this does not accumulate in the body it cause damage if you have if you take excessive amounts of B6 so you want the p5p version of this so if you don't dream or you feel like you can't remember any of your dreams what you can do is take up to 100 milligrams or 30 days per day right um most people can titrate down and get down to about 50 or even 25 milligrams but you can take it until you start remembering your dreams you get up you get vivid dreams and you restart to remember the dreams that you've had that can be an indication that you had some deficiencies and you took some B6 in your dreams you could start remembering the dreams that you had at night right again the most important thing there is you want to use the periodoxify phosphate form B6 not straight up B6 because if you take a lot of B6 you could actually do a little damage to the nerves so it's very important to do that okay today we have a very important lecture on vitamin B9 folate or folic acid oftentimes folate and folic acid are used interchangeably however they're not the same so let's get right into some of the differences folate is a natural form found in green leafy vegetables organ Meats yeast avocados and fish it has several glutamate residues and is in the reduced form now folic acid is synthetic it has a mono glutamate attached to it where this one has several it's fully oxidized in actuality it's actually more stable in temperature and heat and so forth so folic acid is actually more stable it also has greater bioavailability by 1.7 so there is a measurement called a dietary folate equivalent so like I'll give you an example 60 micrograms of folate the natural form when taken is equivalent to 60 microgram grams of dietary folate equivalent when you take fortified food that has folic acid 60 milligrams it's actually equivalent to 102 micrograms of dietary folate equivalent so the bioavailability of folic acid is actually higher okay however folate is converted to the active five methyl tetrahydrofolate and it's done primarily in the GI tract it's more efficiently converted where folic acid converts to the active form in the GI tract as well as the liver and other tissues so this process of converting folic acid to the active form takes longer up to 24 hours or longer in order to convert so what happens you get a buildup of folic acid in your system so you it's the conversion process takes a while so if you're eating fortified cereal you're eating bread and fortified processed foods and all this stuff you're going to have a excess builds up of folic acid in your system which has been shown to increase the risk of cancer now if it increases the risk of cancer I'm sure it's going to have problems in other tissues right all cells can be have issues or problems in replication and so forth so that is why folate the natural form is more preferable [Music] now causes of deficiency usually it's things like alcoholism or increased alcohol intake because you're not taking in dietary folate so low dietary intake smoking pregnancy because pregnancy requires folate in order for cell replication and DNA replication also with cancer inflammation and inflammatory bowel disease so oftentimes people have Crohn's disease or issues with their GI tract they can't absorb also people who are taking antacids for long periods of time will get depleted in nutrients also okay so what are some of the symptoms right well increase homocysteine that's not really a symptom but increased homocysteine is increases your risk of cardiovascular disease right so it's important to understand that this right here elevation homocysteine can increase heart attack and stroke also increases the risk of cancer so here it is MI my myocardial infection infarction and coronary arterial disease it also is associated with infertility migraines depression decreasing neurotransmitters right you need neurotransmitters to fire your brain to function normally right depression and so forth detox issues and anemia there's a type of anemia that B9 B12 and B6 can be associated with and anemia or fatigue is a clinical sign and symptom lab markers we like to check homocysteine in the blood and then we can also check MCV or mean copuscular volume which can indicate when you have large red blood cells can indicate megaloplastic anemia so MCV should be below 92 but when it climbs to 98 99 102 then it could indicate you have megaloblastic anemia and fatigue can be an issue for that patient so let's recap cell replication is very important amino acid synthesis as well as DNA repair if you just look at this right it's involved in everything right now let's talk about genes genetic defects we call methylene tetrahydrofolate reductase mthfrg so you can do common blood test markers to look for this genetic defect and there are two that you could check in your regular blood work and this one is called c677t and the other one is called a1298c okay so there's something called heterozygous and homozygous heterozygous means you have one copy of it from one parent homozygous means you have two copies of the same gene from both parents okay so if you have this Gene right here and your hetero meaning you have one copy the efficiency of reduction of efficiency will be 40 percent and then if you're homozygous if you have two copies it's 75 percent and then for this one the heterogene has 20 reduction and the homogene has 40 reduction so it doesn't mean that every person that has the exact percentage deficiency it just means that you're genetically predisposed so it can go up to those types of percentages so if you're taking fortified foods and folic acid and you're not really getting better then you have to look and see if you're having issues with this genetic defect and you might have to bypass that genetic defect by taking other types of supplements now there are other genes there are many genes associated with methylation comt Snips right Sue Ox genes you have CBS genes there's a lot of genes I would encourage you if you're interested in looking at other genetic defects is to look at a book called Dirty genes and this book is written by Ben Lynch it's an excellent book it's it's readable for for most common people to read write the lay people so go ahead and purchase that book and if you want to really understand some of the other genetic defects read that book all right but this is the most common ones that we're talking about [Music] now what do we prefer well in mother's milk folate is found not folic acid so we prefer folate right from foods okay if we're going to take it and we're going to supplement you want to use methylfolate or you can use L5 methyl tetrahydrofolate and this will bypass some of the genetic defects and it's more usable and bioavailable in terms of getting to the next step right without the conversion from let's say folate or folic acid to the active form now there are cofactors involved in this we like to use vitamin C vitamin E riboflavin p5p which is B6 B12 in the form of methylcobalamin you can use magnesium choline trimethylglycine and MSM these are things that are that donate methyl donors through this process so methylation and B vitamin usage is very complicated but what I'm trying to do is simplify for you so it's understandable so if you go into supplement use one of these and use some of these cofactors you eat green leafy vegetables fish and organ meats and avocados to improve the outcome if you're using folic acid and you have a lot of fortified Foods I would look into how much folic acid you're actually taking in because like I said it can build up in your system and cause problems all right so I hope that was helpful in understanding what B9 is today we're going to talk about an important nutrient called B12 or cobalamin what is it what does it do how much do we take and what kind of food sources can we eat in order to improve B12 levels so let's get right into it B12 is an essential water-soluble nutrient and it's crucial for the formation of DNA red blood cells and proper neurological function what that means is it's important for genetic potential it's important for oxygenation and it's important for cognitive and nerve function it's also important for building myelin for the nerves in order to improve conduction right so it has a lot of different functions to it the main uses is for anemias like we said autoimmune disease particularly the ones that affect the GI tract right Crohn's colitis celiac disease homocysteine management as well as neurological conditions and neuropathy especially diabetic neuropathy and they've done different studies on this right autism spectrum disorders gastric bypass GI disorders cognition or cognitive function diabetic neuropathy fatigue a pernicious anemia if you just look at the conditions fatigue may be related to either ATP production right because B12 are cofactors to produce ATP anemias because it's important for red blood cell production and diabetic neuropathy because it helps nerve or myelin formation so it has a lot of different functions here now there are also different forms of B12 that you can take methylcobalamin hydroxycobalamin a dinosaur cobalamin these are all natural forms and there is one called cyanocobalamin which is synthetic now these are all commercially available you can get them at nutrition shops and stores I in particular like to use methylcobalamin but we may use methylcobalamin in conjunction with the others in order to help absorption and um utilization in our body okay so what kind of foods can we eat so B12 or methylcobalamin like we said food source is a beef liver or even chicken liver clams fish grass-fed beef natural dairy products and nutritional yeast these are all great sources you can also use eggs for it if you look at the list here though it's basically animal products right so vegans and vegetarians may have some problems with B12 malabsorption or malnutrition right they're not having enough B12 in our diet B12 depletion absorption with medications now this can occur with things like metformin metformin is helping treat diabetes right and there is something called diabetic neuropathy now if you're treating diabetic neuropathy right it's usually because of sugar dysregulation however if you're taking metformin you're also going to have malabsorption of B12 B12 which compounds the issue with neuropathy you have colchicine which is used for acute gout conditions you can also have PPI or proton pump inhibitors which is decreasing your stomach acid therefore you're not able to break down your proteins and liberate B12 you have histamine 2 receptor antagonists right for allergies and alcohol alcohol tends to make your stomach a little bit more basic and also creates B12 deficiencies there is an alcoholic B12 deficiency syndrome too right dosages can be anywhere from 1000 to 12 to 2000 micrograms you should take it in divided doses it is a water bottle water-soluble vitamin so it gets excreted out of our system quickly so you want to make it in divided doses testing on routine blood work you can do homocysteine MMA or methylmalonic acid you can also check for pernicious anemia by checking intrinsic factor antibodies and parietal cell antibodies this is an autoimmune condition where immune system is attacking either the intrinsic factor which is produced by the parietal cells or the parietal cells itself there's another condition where the receptors for intrinsic factor can be affected by the autoimmune process MCV or mean copper scalar volume is another one that you can check that's usually related to B12 and B9 but MCV above let's say 94 95 you have to consider B12 issues now if we eat something like a protein or beef liver let's say right to get B12 the first process that occurs is through the saliva starts to break down the protein as it hits the stomach the parietal cells of your stomach produces HCL okay and then another cell called the chief cells produce pepsinogen HCL will help pepsinogen convert to pepsin right now you have pepsin and HCL to break down your protein liberate B12 and as it goes down it will attach to intrinsic factor which is produced by the parietal cells again gets down into the ilium of the lower small intestine where it gets absorbed now if you have enough B12 or high levels of B12 it's going to work by diffusion right some of it's just going to get absorbed through the small intestine and then if you are low on B12 or very minimal B12 it attaches to intrinsic factor and goes way down into the ilium where it gets absorbed where there are receptors for intrinsic factor right so this is kind of an important fact because you need proper stomach acid and digestive enzymes right even from the pancreas like amylase protease lipase you need these enzymes to make HCL work correctly and to break down your proteins and let the cofactors work B12 is so crucial because it's cofactors to many different things right if you think about it nerve function right cognitive function brain function right red blood cells anemias you need B12 in order to make things work properly so it's crucial nutrient and if you have low stomach acid it's a problem if GI issues gerd if you're taking a lot of medications like metformin and ppis or proton pump inhibitors right um this will cause a deficiency right and if you're a vegetarian or vegan on top of that it causes more problems and then you have refined sugars poor diet Etc and then you have diabetes it's just kind of this factor that people don't really think about right first thing to do is to improve stomach acid make sure you have the foods that actually have B12 and if you're still low on testing then you should certainly supplement with B12 there's really no side effects or adverse effects of taking B12 if you have a hard time absorbing because of autoimmune disease you can certainly take injections B12 injections which can raise your levels right they're sublingual forms there's dermal forms where you can kind of put it into your skin and make it absorb too right there's a lot of different ways you can increase B12 right but it's important to understand that you may have a deficiency today we're going to talk about vitamin B12 and the best marker to utilize to see if you have B12 deficiency let's get right into it vitamin B12 best lab test vitamin B12 is an essential water-soluble vitamin okay and it's used in a lot of functions such as DNA replication neurological function oxygen carrying capacity because you can create anemia the best lab test is called methylmalonic acid okay so methylmalonic acid has to go all the way down to succinyl COA in order for that to happen you need B12 now if you're deficient in B12 what happens is methylmalonic acid will go up so if you don't have enough B12 it's going to create a backup over here and you're going to have an elevation of methylmalonic acid on your blood test now you can do this blood test through your regular lab it's a simple test to do now the regular test that most Physicians run or most primaries will run is something called serum B12 now this marker will Elevate if you're taking a B vitamin or B12 supplement so it's not a true indication of need it's just that you're taking it and it's in the bloodstream okay so serum B12 might be elevated but it does not mean that it's being utilized in order to get the proper measurement you need methyl malonic acid okay it'll be an elevation now why do we check for methylmalonic acid oftentimes patients will come in they'll have gastritis or they're on a proton pump inhibitor or an antacid they can be a vegetarian or vegan and sometimes they'll be depleted in B12 you have H pylori infections which will decrease the acidity in your stomach and then something called megaloblastic anemia where you have an elevation of MCB okay the autoimmune version is called pernicious anemia so methylmalonic acid is the best test for B12 but you can also check for something called MCV which is me copuscular volume you can also check for homocysteine in the blood and that gives you some indication of B12 status but not the most accurate so the most accurate would be methyl malonic acid or an elevation of methyl malonic acid okay I made a separate video on B12 and cobalamin more detailed information there so I'll link that video below so you can go ahead and watch that and educate yourself about B12 today we're going to talk about autoimmunity and b12 deficiencies B12 deficiency is called megaloblastic anemia basically the red blood cell becomes enlarged and the total number of red blood cells become small so megaloblastic anemia very large red blood cells and a decrease in those cells okay there are two forms one is called acquired the acquired B12 deficiency or sometimes folic acid deficiency is a lack of B12 due to diet right either you're not taking enough B12 in your diet such as a vegan diet or vegetarian diet or medications will reduce the absorption of B12 or deplete B12 some of the medications are called metformin colchicine which is for gout PPI or proton pump inhibitor histamine II receptor antagonists for allergies and alcohol will also create B12 deficiencies if you want to supplement with B12 the natural forms are called methylcobalamin hydroxycobalamin and adenosil cobalamin there is a synthetic form called cyanocobalamin which you can also utilize I like to stick with the natural forms I prefer to use methylcobalamin sometimes we'll use the other two forms in conjunction with methylcobalamin now let's get into the autoimmune version of megaloplastic anemia the autoimmune version is called pernicious anemia right so pernicious anemia is the form of megaloblastic anemia autoimmune in nature basically your body's own immune system is attacking the parietal cells of your stomach as well as the intrinsic factor okay antibodies to intrinsic factor and parietal cells parietal cells produce intrinsic factor and HCL or hydrochloric acid so if you have an autoimmune attack on your parietal cells of the stomach one you're going to lack B12 . two you're not going to produce enough hydrochloric acid to make your stomach acidic to break down your proteins fats Etc now there's another soil called Chief cells produced and they produce pepsinogen and pepsinogen is broken down to pepsin for digestion but you need HCL to do that so if you have an attack on your parietal cells due to autoimmunity you will not go from pepsinogen to pepsin for digestion purposes so you need HCL also now the other autoimmune version is when it's attacking just the intrinsic factor okay intrinsic factor is very important for transport of B12 now if you have a lot of B12 in your system some of it gets through into the bloodstream through diffusion right it'll just get into a concentration high enough where it'll diffuse into the bloodstream to a certain extent but primarily that you need the intrinsic factor to transport B12 to the Ilion of the small intestine for absorption right so when you have an autoimmune version of this you can have a immune attack on the parietal cells and the parietal cells are the are the ones that produce intrinsic factor or you can have an autoimmune attack on the intrinsic factor itself all right so let's go into some of the summary right what forms of B12 if you have an autoimmune version what can you do okay one you can use intramuscular injections of B12 okay to get your B12 levels up to decrease your MCV or mean couple scalar volume another way is sublinguals so you take drops and it'll absorb through the buccal mucosa and get your B12 levels up another way is to use it through the skin so there are creams available with B12 that can absorb through the skin so those are the three primary methods usually the injections work pretty well in getting the levels up okay so markers you want to look for antibodies for parietal cells antibodies for intrinsic factor on regular lab work that you can run you can also look to see if your MCV is elevated anything above 90 to 92 you suspect that you have B12 deficiency you can also check homocysteine which can indicate a need for B6 9 and 12. okay you can also check methylmalonic acid which is a better indication of B12 deficiency rather than serum V12 serum V12 can be elevated if you just take a little B12 it can go up right but you have to understand how it works so some of these other markers are better in terms of determining if you have B12 deficiency so if you're taking B12 right and your MCV is still elevated you have to suspect that you may have an autoimmune condition so you should check for parietal cell and intrinsic factor antibodies if you have those two you might want to consider intramuscular injections sublinguals sometimes the transdermal forms may work but you have to understand what is going on and what's creating your fatigue levels now I made another video on B12 which kind of goes into all the different benefits and and studies and dosing and so forth so I'll link that video below but essentially you have to understand that anemia is not just iron deficiency it can be related to B12 and some of the causes can be rectified by using different methods of supplementation today we're going to talk about a very important lab marker which is often missed in routine blood work and this lab marker is called homocysteine and it's important for B vitamin deficiencies it's an indicator of a B vitamin deficiency or issues with genetics so let's go right into it homocysteine the Forgotten lab marker for B vitamin deficiency homocysteine is an amino acid which occurs in the body as a intermediate between methionine and cysteine so what is methionine methion is a is a essential amino acid and is sulfur rich [Music] cysteine is needed to make glutathione so you take methionine which is an essential amino acid and has to go from methionine to cysteine and the intermediary is homocysteine so you need B vitamins to convert this from methionine down to homocysteine down to cysteine and cysteine is so important for the production of glutathione and as you know glutathione is a very potent antioxidant and it's also involved in detoxification so it's a very in crucial amino acid that we need B vitamins which we want is folate B6 B12 right because that is involved in the breakdown of homocysteine to cysteine why is homocysteine such an important marker because if you have elevated levels of homocysteine increases the risk of heart attacks stroke blood clots damage endothelial cells of the blood vessels so it creates damage to the arterial Linings and increases your risk for cardiovascular disease also when you lack B vitamins you're going to experience nervous system symptoms right so things like fatigue or numbness and tingling there's an increased inflammation there's low glutathione associated with this issues with detoxification stress methylene tetrahydrofolate reductase which is an mthfa4 genetic defect now there's varieties of this about 30 to 50 percent of the population actually has this genetic defect and maybe 10 to 20 percent or more of the severe form right so when you look at it there's something called homozygous when you have two sets of the same genes or heterozygous when you have one set essentially MTHFR is very very common in the population but why do some people have issues with B vitamins or homocysteine when other people do not and that's usually due to environmental food intake um quality of life and so forth right so when we look at homocysteine the lab marker we're looking for is actually called homocysteine and usually they range from zero up to like 15. I've never seen anybody with zero but I've seen people above 15 easily and what you want to do is shoot for is ideally just around seven on the lab markers okay so some of the symptoms related to high homocysteine is pale skin because if you lack B12 sometimes you can create an anemia so you can have pale skin obviously fatigue weakness in the muscles twitching of the eyelids depression can be associated with it numbness and tingling okay classic example is a alcoholic someone who drinks a lot of alcohol because they're not eating food for calories sometimes they'll deplete their B12 and B6 and B9 and they will develop numbness and tingling and they'll have balance disorders because it affects the alcohol affects the cerebellum but B vitamins are also necessary for central nervous and peripheral nervous system function so numbness and tingling is one of those things diet what you want to do is increase cruciferous vegetables spinach kale lentils Etc let's get to the important part supplementation what we need is methyl donors right you need to methylate in order to convert so when we look at supplementation we don't just look at um folate b6 and b12 one we want the proper forms of those nutrients because folic acid really is junk you don't want to have folic acid so if you look at your multivitamin and instead of folate or some other form of B9 and has folic acid really it's it's junk just throw it out okay supplements you need choline trimethylglycine Sammy vitamin c and e [Music] riboflavin B6 in the form of p5p you need folate and some genetic defect people will need L5 methyl trans ropholate B12 is methylcobalamin right magnesium and MSM these are all different cofactors for B6 B9 and b12 but like I said you need certain forms of it now when you get looked into genetics of this of the methyl methylene tetrahydrofolate reductase issue there it's much more complicated that you can probably do like you know a whole month lecture just on genetic defects so if you're interested in that I would suggest looking up Ben Lynch he did a lot of work on methylation and he has a book called Dirty genes looking at different genetic defects that can create issue with methylation okay so in a nutshell what you need to do is check your homocysteine on your lab because you need to figure out if you have issues with B12 B6 B9 oftentimes like the serum B12 is really not a true indication of need or an indication of having too much so you need to check homocysteine and you need to check things like uh methylmulonic acid in order to see if you have B12 deficiencies but in a nutshell diet is very important but supplementation is also very important especially if you have elevated levels of homocysteine above let's say 10. anything above 10 I'm worried about that patient okay my name is Dr Jin sung we're a clinical Excellence meets excellent results and we'll see you guys next week on the healthy side have an awesome day

Channel: Dr. Jin W. Sung

Views: 281,093

Keywords: B3, vitamin b3, nicotinic acid, nicotinamide, niacinamide, pellegra, dermatitis, nicotinic acid and flushing, b3 and flushing, niacin flush, nicotinic flush, folic acid, folate, mthfr, methylfolate, L-5-methytetrahydrofolate, vitamin b9, B12, methylcobalamin, adenoslycobalamin, hydroxycobalamin, intrinsic factor, hcl, parietal cell, b12 neuropathy, metformin and b12, b12 and gout medications, b12 and anemia, b12 and cognitive function, homocysteine, methylmalonic acid

Id: WCLDhSscaVw

Length: 61min 49sec (3709 seconds)

Published: Wed Mar 22 2023