CRS is, of course, an acronym for I can’t remember things. Memory is the second thing that disappears when we get old; I used to know which one was first, but right now I can’t think of it. As a physician, you have no doubt encountered older patients who have memory and concentration problems; and some who have actual dementia.
Mark Goodman Ph.D. believes that many patients diagnosed with Alzheimer’s disease actually have dementia caused by a lack of vitamin B12. Dr. Goodman has an accredited Ph.D. in behavioral medicine (with a concentration in clinical neuropsychology) from the University of Maryland School of Medicine.
Dr. Goodman is quoted in an interview by Kirk Hamilton that appeared in Clinical Pearls. Dr. Goodman says, “I initially suspected that the vitamin B12 limits were too low, when I encountered geriatric patients admitted in the office with a diagnosis of Alzheimer’s whose frontal lobe function was obviously intact. This is inconsistent with the diagnosis of Alzheimer’s.” They exhibited other global neuropsychological deficits with a systemic/metabolic profile, all were on cardiac lipid-lowering diets.”
He went on to say that he believed there are many older people who have a subclinical deficiency of B12. Many times these patients have normal blood levels of B12. He points out that people with B12 deficiency experience neurological changes before there are changes in their blood counts (pernicious anemia) and that a good dietary history is an important part of the evaluation. According to Dr. Goodman, “There is little red meat in the nursing home diet due to expense and the desire for residents to follow a lipid-lowering regimen. In addition, there is a normal increase in gastric atrophy in the elderly.” , which reduces the absorption of vitamin B12. Third, there is a down-regulation of the enzymes necessary for the formation and manufacture of vitamin B12 when less vitamin B12 is consumed.” Dr. Goodman points out that if there is no frontal lobe degeneration, the dementia is not Alzheimer’s disease.
Dr. Goodman says that high doses of vitamin B12 do not have serious adverse side effects. Some reports of reversible symptoms of diarrhea, rash, polycythemia, and possibly peripheral vascular thrombosis, but these are minor and reversible.
Vitamin B12 deficiency is quite common in older people. Even when tests for B12 levels are normal, symptoms such as forgetfulness, fatigue, and depression respond to B12 supplementation. Dr. Goodman’s point is that the symptoms of this deficiency can be so severe that the patient is often diagnosed with Alzheimer’s disease, even when blood tests are normal.
Very commonly, lack of concentration, forgetfulness or even depression in an older person is due to the need for vitamin B12. Dr. Goodman has recommended B12 injections for patients who need B12. If he doesn’t have a license that allows him to inject his patients with vitamins, this often presents a problem. When I first started practicing, I often referred elderly patients to their doctor for a vitamin B12 injection. Most of the time, the doctor would test the B12 levels and tell the patient that the injection was unnecessary. However, there has been research showing that high oral doses (greater than 3 milligrams per day) can be used to effectively restore vitamin B12 levels. I use a pill that has 2 milligrams of B12 and 800 micrograms of folic acid. It’s a good idea to give folic acid with the B12, because they cover similar neurological territory.
Dr. Goodman’s information has been valuable; gives some scientific validity to a nutritional approach to a common problem. But like so much in natural health care, we took some science, added some common sense and some clinical experience, and created something truly amazing.
The best thing I learned about B12, I learned from Dr. Harry Eidenier, who is a chemist and a bit of a clinical genius. Since vitamin B12 and folic acid deficiencies can lead to macrocytic anemia. So why wait until the MCV is above 100 to realize there is a problem? A person is not normal one day and suddenly his cells just swell. Indeed, if someone comes in with CRS, fatigue, a short attention span, or depression, a simple CBC could show them the reason for the problem. An MCV greater than 90 may mean a need for vitamin B12 and folic acid.
Depression is worth mentioning here; Americans spend about $3 billion each year on antidepressants. I remember a patient who was severely depressed and had tried four different antidepressants without any success. The next step was electroshock therapy. It was in the late 1980s and I was surprised that they were still doing this. Had some labs with him and his CBR was below 4 and his MCV was 97 (still “normal” according to his doctors). He responded to B12 and never received shock therapy.
Another thing you might see with a B12 deficiency is a low neutrophil count. Sometimes the total white blood cell count is low and the percentage of neutrophils is low. If you see forgetfulness, fatigue or depression, and a high MCV, you may be looking at a B12 deficiency and not an immune problem or chronic infection.
The other thing Dr. Eidenier pointed out to me is that if a person needs B12, they probably aren’t making enough HCl in their stomach. If a person does not produce enough HCl, it is likely that he is deficient in several amino acids (many of which are precursors to neurotransmitters) and in most minerals. This is the patient who has gas and bloating after meals. Interestingly, the patient may have gastric reflux. Nails break easily and bad breath is common.
As we get older, we produce less HCl in the stomach. So while Dr. Goodman claims that the problem many older people have is that they don’t eat meat. The truth is, they may not get the nutrients from meat even if they eat it. People tend to develop a sweet tooth as they get older because protein becomes difficult to digest. Very often, the high cholesterol that Dr. Goodman talks about is due to a metabolic syndrome-type situation caused by eating too much sugar and starch.
A trace element, rubidium, is valuable in treating memory and concentration problems. I also learned this from Dr. Eidenier, who cited research that found high rubidium levels in people who stayed young into old age. I have to mention one company in particular here, because I don’t know of anyone else that makes a rubidium supplement. The combination of HCl, B12 and rubidium is a powerful combination that helps people who have too many “older moments”.
There are a number of studies showing the importance of antioxidants (both those found naturally and in supplements), DHA, and omega-3 fatty acids in general in helping to protect against dementia. To quote Edward Zamrini, MD “A large body of evidence implicates oxidative damage in the pathogenesis of Alzheimer’s disease.” (March 21, 2006 issue of Geriatrics and Aging.) In a study, published in the journal Neurology (March 2000;54:1265-1272) it was shown that vitamin C and E supplementation could protect against vascular dementia. There is also research showing that pesticides create neurological damage. Of course, the presence of aluminum in the plaques associated with Alzheimer’s disease has caused many to look to aluminum in cookware, antacids, and deodorants. Aluminum is one of the most abundant elements on the planet. If it may be prudent to look at other heavy metals, especially mercury. Mercury can actually interfere with the body’s ability to detoxify and get rid of other metals, perhaps this is the root of aluminum buildup. To protect against Alzheimer’s disease, get plenty of antioxidants, eat DHA and omega-3 oils, and remove metals and toxins from the body. The oils are especially important, there are studies that show that the consumption of fish or fish oil seems to protect against dementia.
Curcumin is an antioxidant found in turmeric. Turmeric is a perennial plant, botanically related to ginger, native to India, China, and Indonesia. It is a component of curry powder and prepared mustard. It is used in traditional Chinese medicine and Indian (Ayurvedic) medicine for its anti-inflammatory properties. The lowest incidence of Alzheimer’s disease in the world is found in the villages of India. Only about 1% of Indians over the age of 65 get the disease. So perhaps curry consumption may be the reason why there are so few cases of Alzheimer’s disease. Curcumin, found in turmeric, has been shown to combat the buildup of amyloid plaques found in Alzheimer’s disease. Dr. Sally Frautschy, of the University of California, Los Angeles, presented these findings at the 2005 annual meeting of the Society for Neuroscience in San Diego, California. Her paper was titled: Curcumin Reduces Oxidative Damage and Amyloid Pathology in a Transgenic Alzheimer’s Mouse.
So the things that work to keep your mind sharp are the same things that work for everything else. You need fresh produce as a source of natural antioxidants, good essential fatty acids, avoidance of trans fats, exercise, and detoxification.