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All Posts in Category: MTHFR

Vitamin B-12

Vitamin B12 plays an important role in the body and if you are feeling tired or weak it could be a sign you are deficient.

There are two types of vitamin B12 in the body, these are active B12 and inactive B12, both make up Total B12. The simple difference between the two forms is that active B12 is the form used by the body.

WHAT IS ACTIVE B12?

Active B12 is when B12 binds to transcobalamin protein (known as Holotranscobalamin or HoloCT) and is made available to cells for use in the body, hence being called active B12. 

The most widely used B12 test on the NHS checks total levels of B12. Active B12 typically makes up 10% - 30% of the total B12 in the body, so being in the “normal,” range of the total B12 might hide a B12 deficiency. It’s the levels of active B12 you really need to be concerned with if you are worried about thyroid issues, fatigue or any other symptoms associated with a vitamin B12 deficiency.

WHY TEST YOUR B12 LEVELS?

The two main reasons to check your Vitamin B12 levels are:

  • You’re concerned about a thyroid disorder
  • You are experiencing unexplained fatigue

WHAT ARE THE SYMPTOMS OF VITAMIN B12 DEFICIENCY?

Some of the symptoms of vitamin B12 deficiency include:

  • Fatigue
  • Anaemia
  • Neurological features
  • Sore tongue
  • Bone marrow suppression
  • Cardiomyopathy

Low vitamin B12 levels

B12 as a key co-factor in metabolic methylation is involved in several vital biological processes. Therefore, the increase of food sources high in vitamin B12 (see picture) and supplementation - ideally with a methylated form of B12 - are important for rapid restoration of the B12 status, which is indicated by low serum levels.

High vitamin B12 serum concentrations without supplementation: the pitfalls of interpretation

High active B12 concentrations may be due to excessive levels of the vitamin, increased levels of its transport proteins [1] or related to autoimmune or haematological disorders [2].

High or supraphysiological serum B12 levels without supplementation have been associated with many health problems kidney failure, blood disorders, cancer, and liver or autoimmune diseases. [2,3]  All conditions may show elevated concentrations of B12 transport proteins.

Elevated serum B12 levels may also be associated with a functional deficiency of the vitamin. Functional deficiency is caused by a failure of uptake into processing within the cells, Uptake can be reduced due to abnormal increases of B12-binding proteins or the formation of immunoglobulin-B12-complexes.It is unknown, whether B12 should be supplemented in these conditions.

Recent findings in diseases associated with oxidative stress have revealed that intracellular oxidative stress results in local functional B12 deficiency [4]. Treatment with glutathione and/or vitamin C, a key  regenerator of intracellular glutathione, may provide therapeutic benefit.

As supraphysiological levels may serve as a new important diagnostic marker in serious conditions unrelated to the individual patient’s B12 status, further investigations to rule out an underlying health condition need to be initiated, if supplementing with glutathione and vitamin C fails to improve levels.

References:

[1] Jeffery J, Millar H, Mackenzie P, Fahie-Wilson M, Hamilton M, Ayling RM. An IgG complexed form of vitamin B12 is a common cause of elevated serum concentrations. Clin Biochem 2010; 43:82–8.

[2] Remacha AF, Zapico E, Sarda MP, Rojas E, Simo M, Remacha J, et al. Immune complexes and persistent high levels of serum vitamin B12. Int J Lab Hematol 2014; 36:92–7.

[3] Andres E, Serraj K, Zhu J, Vermorken AJ. The pathophysiology of elevated vitamin B12 in clinical practice. QJM 2013; 106:505–15.

[4] Solomon LR. Functional cobalamin (vitamin B12) deficiency: role of advanced age and disorders associated with increased oxidative stress. Eur J Clin Nutr 2015; 69:687–92..

Picture source

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Your Gut – Your Second Brain

In recent years scientists have discovered that our gut contains a vast amount of bacteria which are called the microbiome. The number of genes in these bacteria is about 3.3 million whilst the human body has around 23.000. The total weight of the microbiome is about three pounds – the same as our brain, which is why it is also called the Second Brain.

One millilitre of colonic contents contains more bacteria than there are humans on this planet.

One of the important functions of the microbiome is to provide immunity (70% of our immune system is located in the gut), and this starts at birth. The birth canal is filled with lactobacilli – which prevent the growth of candida (which causes vaginal thrush). Lactobacilli are the first thing that enters the baby’s mouth during birth.

When mothers have C-sections the child does not get these beneficial lactobacilli. 80% of babies born via c-section are likely to develop asthma versus those born naturally, and they are also more likely to develop diarrhoea in the first year of life, have a tendency to be allergic to cow’s milk and have food intolerances.

Mothers milk also contains lactobacilli. They help to break down lactose, which is the major sugar in milk. The first milk also contains a lot of antibodies for the baby. Later breast milk contains carbohydrates (sugars) and prebiotics which provide food for the microbiome.

People often say they have a “gut feeling” and this is true as the brain is connected to our gut and vice versa.

The gut contains as many nerve cells as the spinal cord. The microbiome affects not only our nerves and immune system, but also our endocrine system. It modulates our emotions, desires and moods. The microbiome also produces neurotransmitters. Imbalances or deficiencies of neurotransmitters are known to cause, among other things, behavioural problems in children and psychiatric problems such as depression.

Environmental chemicals can change the gut microbiome. They can trigger inflammation and metabolic disorders.

Functional medicine is the new way of investigating how your body works and can often provide answers for chronic diseases.

Healthy regards

Dr Oliver Frey, MD MRCGP

Picture: UAB Comprehensive Cancer Centre
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Bedwetting

Babies need to be in nappies as they cannot control their bladder. As they get older and turn into little people their nervous system is moving along nicely and the frequency of bedwetting goes down and eventually stops. 

Bedwetting is one of the most common disorders among children. It occurs in up to 20% of 5 year olds and 10% of 10 year olds, with a spontaneous remission rate of 14% per year. Weekly daytime wetting occurs in 5% of children, most of whom (80%) also wet the bed. Approximately 5% to 10% of all seven-year-olds have enuresis.

The reasons for bedwetting involve the inability to awaken from sleep in response to a full bladder, coupled with excessive nighttime urine production or a decreased functional capacity of the bladder.​

​Children who wet the bed may do so for emotional reasons. They may feel insecure due to the arrival of a new baby, a change of school or because of the parents' marital problems. In these cases, the child needs love and reassurance.

Why do some children have a problem?

There are numerous possible reasons why children - and their families - suffer from bedwetting: 

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  • Slower central nervous system development
  • Food allergies or intolerances
  • Infections (kidney or bladder)
  • Diabetes
  • Excess water consumption prior to bed
  • Being scared of the dark
  • Laziness
  • Side effects of medication
  • Caffeine (some give this to their kids – and I highly suggest not doing it), e.g in tea, coffee and many fizzy drinks

Vitamin B12, folate and iron levels 

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A study from 2012 found significantly lower mean vitamin B(12) and folate levels in patients who suffered from bed wetting. These findings were confirmed in a study in 2015 which also identified that average blood iron was significantly higher. 

A February 2018 study in the Journal of Pediatric Urology may offer hope for those pursuing non-drug options. 

Based on these results, the authors concluded that supplementation with vitamin D and omega-3 fish oil could help prevent nighttime bedwetting episodes among children seven to 15 year of age:

  • Vitamin D – 1,000 IU minimum but children frequently take up to 2,000 IU daily under the guidance of their physician.
  • Omega 3 – 1,000 mg daily, can be taken as a capsule, gummy or liquid.


Traditional Approach

Parents and children are often given the following advice by doctors  to curb bedwetting:

Bed alarms – alarms have sensors that detect moisture, which wake the child up as they begin having an accident.

Education and reassurance – diet changes, avoidance of caffeinated drinks and also avoidance of fluid before going to bed.  Make sure the child urinates before going to sleep.

Positive reinforcement – encouraging the child after dry nights.

Medications Commonly used include:

Desmopressin – Taken at night with a small sip of water, this medication can be used for children age 6 or older.  Common reactions listed by Epocrates Drug Database include headaches, nausea, abdominal pain, high blood pressure and rarely seizures, respiratory arrest and anaphylactic allergic reactions.

Imipramine – This medication can also be used for those 6 or older.  Epocrates lists a “black box warning” for this medication, stating that it may increase suicide risk in children, adolescents, and young adults with major depression. Additional common reactions listed include drowsiness, dizziness, and blurred vision to name a few.

Due to the possible side effects of medications, more natural alternatives are desired as first line by most.

​Common strategies to help with bedwetting

  • Shift times for drinking. Increase fluid intake earlier in the day and reduce it later in the day.
  • Schedule bathroom breaks. Get your child on a regular urination schedule (every two to three hours) and right before bedtime.
  • Be encouraging. Make your child feel good about progress by consistently rewarding successes.
  • Eliminate bladder irritants. At night, start by eliminating caffeine (such as chocolate milk and cocoa) and if this doesn’t work, cut citrus juices, artificial flavorings, dyes (especially red) and sweeteners. Many parents don’t realize these can all irritate a child’s bladder.
  • Avoid thirst overload. If schools allow, give your child a water bottle so they can drink steadily all day. This avoids excessive thirst after school.
  • Consider if constipation is a factor. Because the rectum is right behind the bladder, difficulties with constipation can present themselves as a bladder problem, especially at night. This affects about one third of children who wet the bed, though children are unlikely to identify or share information about constipation.
  • Don’t wake children up to urinate. Randomly waking up a child at night and asking him or her to urinate on demand isn’t the answer, either – and will only lead to more sleeplessness and frustration.
  • Don’t resort to punishment. Getting angry at your child doesn’t help him learn. The process doesn’t need to involve conflict.

What can you do to identify the cause of bedwetting in your child?

  • Identify food allergies and remove (gluten and dairy are big)
  • Avoid caffeine and fizzy drinks
  • Limit intake of water and fluids prior to bed
  • Always have them go for a whee right before bed
  • Use a night light 
  • Star board (get a star for each night they don’t wet their bed and a prize at X stars)
  • Taking off their bedsheets self and taking them to the laundry
  • Supplement with Fish oil
  • Give a Multivitamin
  • Give a Probiotic
  • Give a methylated B-complex

A known cause of bedwetting is slower development of the central nervous system + low b12 and low folate contribute to a slowed central nervous system = increased susceptibility to nocturnal enuresis (ie. bedwetting).

If one has low folate and low B12, then their methylation system is going to be less functional.

As their methylation is not up to speed, then the development of the CNS is hindered.

As the CNS development is hindered, so is the nervous system of the bladder which leads to nocturnal enuresis.

Restoring nutrients for CNS development is critical to reducing bedwetting.

The younger the child, the more development they are experiencing. The more development they are experiencing, the more methylation they are utilizing. The more methylation they are utilizing, the more nutrients they require to support methylation.

If the child’s methylation is not supported with nutrients, then bedwetting may show up.

Before you start blindly supplementing your child we would highly recommend to arrange some of the following tests which are all available from CountryHealth:

Which Lab Tests can be useful?

References:

  1. Journal of  Pediatric Urology. 2018 Feb 5. pii: S1477-5131(18)30034-2. doi:10.1016/j.jpurol.2018.01.007. [Epub ahead of print]

Do you want your child to be tested?

We are keen to help you finding the root causes of bedwetting in your child

Why do some kids get dry and others struggle with bedwetting?

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