Do B Vitamins Slow Cognitive Decline?

Written by Dr. Steve Chaney on . Posted in current health articles, Supplements and Health, Vitamins and Health

The B Vitamin Controversy

Author: Dr. Stephen Chaney

 

cognitive-declineDo B Vitamins slow cognitive decline?  Heart disease, cancer and strokes are all pretty scary. Even if we survive, our quality of life may never be the same. But, we can endure many physical afflictions if our mind stays sharp. For most of us the ultimate irony would be to spend a lifetime taking good care of our body, only to lose our mind.

Last week I told you about a study showing that a holistic approach, which to me includes healthy diet, weight control, exercise, supplementation, socialization and memory training, significantly reduces cognitive decline in the elderly (https://healthtipsfromtheprofessor.com/hope-alzheimers/).

This week I’d like to focus on one aspect of that holistic approach, namely B vitamins. If you are like most people, you are probably confused about the role of B vitamins in preserving mental function. On the one hand you are seeing headlines proclaiming that B vitamins slow cognitive decline as we age. On the other hand you are being told “Don’t waste your money. B vitamins won’t slow cognitive aging.” What are you to believe?

 

Why Might Certain B Vitamins Slow Cognitive Decline?

To help you understand how B vitamins might slow cognitive decline I’m going to need to get a little biochemical. Don’t worry. I’ll be merciful.

#1: The story starts with a byproduct of amino acid metabolism called homocysteine.

Multiple studies have shown that elevated blood levels of homocysteine are associated with cognitive decline and Alzheimer’s. Elevated homocysteine levels are found in 5-10% of the overall population and elevated homocysteine levels double the risk of Alzheimer’s.

In our bodies homocysteine is converted to the amino acid methionine in a reaction involving folic acid and vitamin B12. Homocysteine is converted to the amino acid cysteine in a reaction involving vitamin B6. Thus, elevated homocysteine levels are most frequently associated with deficiencies of these three B vitamins caused by inadequate intake or increased need for those B vitamins.

#2: Many of us are deficient in the B vitamins that lower homocysteine levels.

There are many situations in which inadequate intake or increased need of those vitamins can occur. For example:

Vitamin B12:

vitamin-B12

  • The most frequent cause of B12 deficiency is the age related loss of the ability to absorb vitamin B12 in the upper intestine. This affects 10-30% of people over the age of 50.
  • Chronic use of acid-suppressing medications such as Prilosec, Nexium, Tagamet, Pepcid and Zantac also decreases B12 absorption and increases the risk of B12 deficiency. Millions of Americans use those drugs on a daily basis.
  • Finally, vegetarians can become B12 deficient because most naturally occurring B12 is found in meat and dairy products.
  • Overall, B12 deficiency has been estimated to affect about 40% of people over 60 years of age.

Folic Acid:

  • In the past, many Americans consumed diets that were low in folic acid. However, this has been minimized in recent years by the fortification of grain products with folic acid. Today, the primary concern is with factors that increase the need for folic acid.
  • For example, birth control pills along with some anti-inflammatory and anticonvulsant medications interfere with folic acid metabolism and increase the need for folic acid.
  • In addition, deficiency of the enzyme methylenetetrahydrofolate reductase (MTHFR) substantially increase the amount of folic acid needed to reduce homocysteine levels to normal. About 10% of the US population has this enzyme deficiency.

Vitamin B6:

  • Birth control pills along with some drugs used to treat high blood pressure and asthma interfere with vitamin B6 metabolism and increase the need for vitamin B6.
  • Vitamin B6 is found in reasonable amounts in meat, beans, green leafy vegetables, brown rice and whole grain flour. Unless you are consuming a balanced diet containing all of those foods your intake of B6 may be inadequate. About 25% of Americans have low blood levels of B6.

#3: Multiple studies have shown that supplementation with folic acid, B12 and B6 can lower homocysteine levels.

Based on this information it has been hypothesized that supplementation with folic acid, B12 and B6 would decrease the rate of cognitive decline in people with elevated homocysteine levels. It is a logical hypothesis, but is it correct?

The Evidence That B Vitamins Don’t Slow Cognitive Decline

The recent headlines saying that B vitamins don’t slow cognitive decline came from a meta-analysis that included the results of 11 clinical trials with 22,000 individuals B-vitamins-cognitive-decline(Clarke et al, American Journal of Clinical Nutrition, 100: 657-666, 2014). That sounds pretty impressive! But to properly assess the conclusions of this study you need to understand the strengths and weaknesses of meta-analyses.

  • The strength of a meta-analysis is pretty obvious. By combining the results of many clinical trials and thousands of patients you greatly increase the statistical power of the study.
  • However, the strength of a meta-analysis is only as good as the studies it includes. It’s the old “GIGO” principle (Garbage In, Garbage Out). If the individual studies are poorly designed, the conclusions of the meta-analysis will be misleading.

Unfortunately, many of the studies in this meta-analysis were poorly designed. They fall into two groupings:

Problem #1: Many of the studies included in the meta-analysis were not designed to test the actual hypothesis.

Remember that the original hypothesis was that supplementation with folic acid, B12 and B6 would decrease the rate of cognitive decline in people who were deficient in those B vitamins and had elevated homocysteine levels. Nobody was predicting that B vitamin supplementation would make any difference for people who already had adequate B vitamin levels and low homocysteine levels.

Five of the studies were not designed to look at that hypothesis at all. They were very large studies designed to look at the hypothesis that B vitamins might reduce the risk heart attack and stroke in patients with cardiovascular disease. Some of those patients had elevated homocysteine levels, but many did not.

It’s no wonder they did not show any significant effect of B vitamins on cognitive decline. They weren’t designed for that purpose, but they contributed the vast majority of patients and most of the statistical weight to the conclusions of the meta-analysis.

Problem #2: Some of the studies were too short to draw any meaningful conclusions.

Three of the studies were well designed in that they specifically looked at patient populations with elevated homocysteine levels and documented B vitamin deficiency, but they only lasted for 3 to 6 months. There simply was not a large enough cognitive decline in the control group in such a short time span for one to see a statistically significant effect of B vitamin supplementation.

Do B Vitamins Slow Cognitive Decline?

B-vitamins-slow-cognitive-declineThat leaves three studies from the original meta-analysis, plus another clinical study published after the meta-analysis was complete, that were actually designed to test the hypothesis and were long enough to give meaningful results. Three of those four studies showed a positive effect of B vitamin supplementation on cognitive function.

Study #1: This study was a 3-year study in patients with elevated homocysteine levels, folic acid deficiency and normal B12 levels (Durga et al, The Lancet, 369: 208-216, 2007). They were given 800 ug/day of folic acid or a placebo. Folic acid levels increased 576% and homocysteine levels decreased by 25%. At the end of 3 years the change in memory, information processing speed and sensorimotor speed was significantly better in the folic acid group than the control group.

Study #2: This was a 2-year study in patients with elevated homocysteine levels (McMahon et al, New England Journal of Medicine, 354: 2764-2769, 2006). B vitamin deficiencies were not measured. The patients were given either 1000 ug 5-methyltetrahydrofolate, 500 ug of B12 and 10 mg of B6 or a placebo. Homocysteine levels decreased significantly, but there was no effect of B vitamins on cognitive function in this study.

Study #3: This study was a 2-year study in patients over 70 with mild cognitive decline (Smith et al, PLoS ONE 5(9): e12244. doi:10.1371/journal.pone.0012244, 2010). B vitamin deficiencies were not measured. The patients were given either 800 ug of folic acid, 500 ug of B12 and 20 mg of B6 or placebo. B vitamin supplementation increased folic acid levels by 270% and decreased homocysteine levels by 22%. Brain volume was measured by MRI. Overall, B vitamin supplementation decreased brain shrinkage by 30%. The rate of brain shrinkage in the placebo group and the protective effect of B vitamins were greatest in the patients with elevated homocysteine at entry into the trial.

Study #4: This was an expansion of the previous study (Douaud et al, Proceedings of the National Academy of Sciences, 110: 9523-9528, 2013). In this study the same investigators focused on the regions of the brain most vulnerable to cognitive decline and the Alzheimer’s disease process. They found that B vitamin supplementation reduced brain atrophy in those regions by 7-fold (a whopping 86% decrease in brain shrinkage) over a 2-year period. Once again, the rate of brain shrinkage in the placebo group and the protective effect of B vitamins were greatest in the patients with elevated homocysteine at entry into the trial.

Are B Vitamins Only Effective In People With Elevated Homocysteine Levels?

The published data certainly suggest that B vitamins may reduce cognitive decline in people with elevated homocsteine levels, but what about other people with B vitamin deficiencies? For reasons that are not entirely clear, not everyone with folic acid, B12 and/or B6 deficiencies has elevated homocsyteinine levels.

Other symptoms of folic acid, B12 and B6 deficiency are depression, pronounced fatigue, irritability, peripheral neuropathy (tingling and loss of feeling in extremities), and loss of fine motor coordination. If you have these symptoms and they are caused by B vitamin deficiency, B vitamin supplementation may relieve the symptoms.

B vitamin supplementation may also slow cognitive decline in individuals who are B vitamin deficient and have normal homocysteine levels, but that hypothesis has not been clinically tested.

The Bottom Line

1)     Forget the headlines telling you that B vitamins don’t slow cognitive decline. Also ignore headlines implying that B vitamins will help everyone be an Einstein well into their 90’s. As usual, the truth is somewhere in between.

2)    Supplementation works best for people with inadequate dietary intake and/or increased needs. That is just as true for B vitamins and brain health as it is for other health benefits of supplementation.

3)     Many people with deficiencies of folic acid, B12 and/or B6 have elevated homocysteine levels. If you do have elevated homocysteine levels, the data are pretty convincing that supplementation with folic acid, B12 and B6 may reduce the risk of cognitive decline. Unfortunately, homocysteine is not something that is routinely measured in most physical exams, but perhaps it should be.

4)     Not everyone with folic acid, B12 and/or B6 deficiencies has elevated homocsyteinine levels. Other symptoms of folic acid, B12 and B6 deficiency are depression, pronounced fatigue, irritability, peripheral neuropathy (tingling and loss of feeling in extremities), and loss of fine motor coordination. If you have these symptoms and the symptoms are caused by B vitamin deficiency, B vitamin supplementation might also slow cognitive decline. However, that hypothesis has never been clinically tested.

5)     It has been recognized recently that deficiencies of methylenetetrahydrofolate reductase (MTHFR) interfere with folic acid metabolism and cause elevated homocysteine levels. Contrary to what you may have heard, 5 methyltetrahydrofolate is not essential for reducing homocysteine levels in people with MTHFR deficiency. High levels of folic acid work just as well for most MTHFR-deficient individuals. [It is also interesting to note that the only well designed clinical study that did not find B vitamins to be effective in reducing cognitive decline was the one that substituted 5-methyltetrahydrofolate for folic acid.]

6)     B vitamin deficiency is common in the elderly due to impaired absorption and the use of multiple medications that interfere with B vitamin metabolism and can contribute to many of the symptoms commonly associated with aging. In this population, B vitamin supplementation is cheap and often effective.

7)     B12 deficiency is common in adults 60 and older. High doses of folic acid alone can mask B12 deficiency and lead to irreversible nerve damage. For that reason high doses of folic acid should be paired with high dose B12 and B12 nutritional status should be determined. [Contrary to what you may have heard, 5-methyltetrahydrofolate is just as likely to mask B12 deficiency as is folic acid.]

8)     Finally, assuring an adequate intake of B vitamins is just one component of a holistic approach for maintaining brain function as long as possible. Other important lifestyle components for preserving cognitive function are healthy diet, weight control, exercise, supplementation, socialization and memory training. (https://healthtipsfromtheprofessor.com/hope-alzheimers/).

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (5)

  • Gloria Kelley Gonzalez

    |

    Some great information here.

    Reply

  • crissy handley

    |

    I am one who has absorbtion problems of B complex B12 and COQ10. Recently high homocysteine.. With supplementation of Shaklee Bcomplex (4-6 additional plus Vitalizer) and B12, my cognituve function has increased and depression totally in control. This totally makes
    so much sense!! Thank you!

    Reply

    • Dr. Steve Chaney

      |

      Dear Crissy,

      You are a perfect example of the point that I made in my blog post. It is the people who have a B vitamin deficiency (often caused by things like poor absorption) who are most likely to benefit from B vitamin supplementation.

      Dr. Chaney

      Reply

  • Rose Marie Strauss, R.N.

    |

    I have absorption problems.With one tablet of B6/B12 (Trader Joe,s ) suggested use, I take one tablet under the tongue(sublinquel) as a dietary supplement. I need to have my homo-cysteine checked again.I recently had a lab test.and I did not think to ask them to ad this to my lab test.
    It makes a lot sense.Everybody should be informed of
    this great .articles.

    Reply

    • Dr. Steve Chaney

      |

      Dear Rose Marie,

      Sub-lingual Bs are usually not necessary, but it is a good idea to monitor your homocysteine levels. We don’t know whether homocysteine causes cognitive decline, but it does correlate with cognitive decline.

      Dr. Chaney

      Reply

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Latest Article

Relieve Hip Pain After Sitting or Driving

Posted June 20, 2017 by Dr. Steve Chaney

Relief is Just a Few Movements Away!

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

relieve hip pain after sittingI’m on a long business trip, speaking and teaching in Tennessee and New York, and the drive from Sarasota, FL meant many hours of driving over several days.  One of my stops was to visit with Suzanne and Dr. Steve Chaney at their home in North Carolina.  It was that long drive that became the inspiration for this blog.

After all those hours of driving, my hip was really sore. It was painful to stand up. While talking to Suzanne and Dr. Chaney I was using my elbow to work on the sore area, and when we were discussing the blog for this month it only made sense to share this technique with you.  So, Dr. Chaney took pictures and I sat at his computer to write.  I thought others may want to how to relieve hip pain after sitting or driving for long periods.

What Causes Anterior Hip Pain?

As I’ve mentioned in posts in the past, sitting is the #1 cause of low back pain, and it also causes anterior hip pain (pain localized towards the front of the hip) because the muscles (psoas and iliacus) pass through the hip and insert into the tendons that then insert into the top of the thigh bone.  When hip pain reliefyou try to stand up, the tight muscle tendons will pull on your thigh bone.  The other thing that happens is the point where the muscle merges into the tendon will be very tight and tender to touch. You aren’t having pain at your hip or thigh bone, but at the muscular point where the muscle and tendon merge.

It’s a bit confusing to describe, but you’ll find it if you sit down and put your fingers onto the tip of your pelvis, then just slide your fingers down toward your thigh and out about 2”. The point is right along the crease where your leg meets your trunk.

The muscle you are treating is the Rectus Femoris, where it merges from the tendon into the muscle fibers.  Follow this link, thigh muscle, to see the muscle and it will be a bit easier to visualize.

You need to be pressing deeply into the muscle, like you’re trying to press the bone and the muscle just happens to be in the way.  Move your fingers around a bit and you’ll find it.

Easy Treatment for Anterior Hip Pain After Sitting

relieve hip painHere is an easy treatment for hip pain after sitting you can administer yourself.  First, sit as I am, with your leg out and slightly turned.

Find the tender point with your fingers and then put your elbow into it as shown.

It’s important to have your arm opened so the point of your elbow is on top of the spasm.  It’s a bit tricky, but if you move about a bit you’ll come on to it, and it will hurt.  Keep the pressure so it’s tolerable, not excruciating.

After you have worked on this point for a few minutes you can move to the second part of the treatment.

hip pain treatmentPut the heel of your “same-side” hand onto your thigh as close to the spasm as you can get.  Lift up your fingers so the pressure is only on the heel of your hand.  You can use your opposite hand to help give more pressure.

Press down hard and deeply slide down the muscle, going toward your knee.  You can also kneed it like you would kneed bread dough, really forcing the muscle fibers to relax.

I’m putting in a picture from a previous blog to explain how you can also treat this point of your rectus femoris by using a ball on the floor.

As shown in this picture, lie on the floor with the ball on your hip muscle, and then slightly turn your body toward the floor so the ball rolls toward the front of your body. You may need to move the ball down an inch or so to get to your Rectus Femoris.

When you feel the pain, you’re on the muscle.  Just stay there for a minute or so, and if you want you can move so the ball goes along the muscle fibers all the way to your knee.

pain free living book coverIt may be a challenge to find this point, but it’s well-worth the effort!

In my book, Treat Yourself to Pain Free Living, I teach how to treat all the muscles that cause pain from your head to your feet.

Wishing you well,

Julie Donnelly

julie donnelly

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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