|
B Vitamins are the name given for a handful of essential substances that the body needs to get from food or supplements in order to be healthy. B Complex (B-1, B-2, B-6, B-12) Helps Leg Cramps: 28 elderly with high blood pressure in a DB PC 13 weeks study were treated with fursulthiamine 50 mg (B-1), hydroxocobalamin 250 micrograms (B-12), pyridoxal phosphate 30 mg (B-6), and riboflavin 5 mg (B-2) three times a day or placebos. 86% vs. 0% resolved. Randomized, double-blind, placebo-controlled study of the safety and efficacy of vitamin B complex in the treatment of nocturnal leg cramps in elderly patients with hypertension. Chan P, Huang TY, Chen YJ, Huang WP, Liu YC. J Clin Pharmacol 1998 Dec;38(12):1151-4 B-1 (Thiamine) Thiamine has double-blind studies to support its use in alcohol detox, congestive heart failure, diabetic neuropathy, Dilantin patients, teenage menstrual cramps, elderly with low levels, and possibly depression. In most of these, I have found only a single double-blind study. In all cases, the amount of research is inadequate to draw any firm conclusions of benefit. Because of the very low cost and virtual absence of side-effects, it seems reasonable to use thiamine even though the research is inadequate to assure benefit. Alcoholic Detox Helped by Thiamine: DB PC of 107 patients receiving various dosages of IM thiamine. Highest dosages proved best for cognition. Thiamin treatment and working memory function of alcohol-dependent people: preliminary findings. Ambrose ML, Bowden SC, Whelan G. Alcohol Clin Exp Res 2001 Jan;25(1):112-6 Alzheimer's Thiamine No Help in Small Study: In a very small 15-patient 1-year DB PC study of a huge 3 mg/day dose of thiamine, no measurable impact on Alzheimer's was detected. A trial of thiamine in Alzheimer's disease. Nolan KA, Black RS, Sheu KF, Langberg J, Blass JP. Arch Neurol. 1991 Jan;48(1):81-3 Blood Pressure and Weight: Thiamine Helps only in 15% of Elderly Who Have Two Low Thiamine Tests: In a 76-patient DB PC study of thiamine 20 mg/day, 35 of 222 people over 64 had two concentrations of erythrocyte thiamine pyrophosphate (TPP) < 140 nmol/L 3 mo apart and 41 other people had the first, but not the second, TPP concentration below this value. These 76 low thiamine subjects were randomly assigned to receive thiamine showed increases in TPP concentrations compared with control subjects. Only the subjects with persistently low TPP concentrations showed subjective benefits from treatment with improvements in quality of life (measured on a visual analogue scale; P = 0.02) and decreases in systolic blood pressure (P = 0.05) and weight (P < 0.01) when compared with subjects given placebo. There was a trend toward benefits in sleep and energy (P = 0.07). New Zealand. The response to treatment of subclinical thiamine deficiency in the elderly. Wilkinson TJ, Hanger HC, Elmslie J, George PM, Sainsbury R. Am J Clin Nutr. 1997 Oct;66(4):925-8 Congestive Heart Failure: Thiamine High Dose Helps: In a DB PC 1 week study of CHF patients on furosemide diuretic, thiamine 200 mg IM decreased erythrocyte thiamine pyrophosphate effect and increased left ventricular ejection fraction. In another 6 weeks of open treated of all 30 patients, the LVEF increased 22% with increased diuresis and sodium excretion. Israel. Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy. Shimon I, Almog S, Vered Z, Seligmann H, Shefi M, Peleg E, Rosenthal T, Motro M, Halkin H, Ezra D. Am J Med. 1995 May;98(5):485-90 Depression: Says Four DB Thiamine Studies Show Benefit, Iron Decreased in Women: In four double-blind studies an improvement in thiamine status was associated with improved mood. Iron deficiency anemia is common, particularly in women, and is associated with apathy, depression and rapid fatigue when exercising. The effects of nutrients on mood. Benton D, Donohoe RT. Public Health Nutr 1999 Sep;2(3A):403-9 Diabetic Neuropathy: Thiamine Better than Pyridoxine in Tanzania: In a 200-patient DB study of thiamine 25 mg/day vs. pyridoxine 50 mg/day, 88% of thiamine vs. 30% of pyridoxine patients improved at four weeks. Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy. Abbas ZG, Swai AB. East Afr Med J. 1997 Dec;74(12):803-8; Similar results in a German DB PC with thiamine, B-6, and B-12. Exp Clin Endocrinol Diabetes. 1996;104(4):311-6 Diabetic Neuropathy: B-1 & B-6 Help Diabetes Peripheral Neuropathy: DB PC 200 patient study of thiamine 25mg/d and pyridoxine 50mg/dm vs. placebo found a 49% vs. 11% decrease. Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy. Abbas ZG, Swai AB. East Afr Med J 1997 Dec;74(12):803-8 Dilantin Patients: Thiamine Helps: DB PC 6 mo for 72 patiants on phenytoin placebo vs. folate 5 mg vs. thiamine 50 mg vs. both. Patients had blood levels 30% below normal in both. No benefit from folate but thiamine group did better on Wechsler both verbal and non-verbal. Botez, Montreal, Epilepsy Res ’93;16:157 Exercise Performance: Thiamine Not Much Value for Improving: Three DB PC studies document little or no benefit even at 100 mg/day. Metab Brain Dis. 1996 Mar;11(1):95-106; Eur J Appl Physiol Occup Physiol. 1997;75(6):520-4; Int J Sport Nutr. 1997 Mar;7(1):39-47 Menstrual Pain in Teens: Thiamine Claimed Curative: In a DB PC study of 556 girls 12-21 in Indian with painful periods, those given 100 mg/day (1.6 mg/day = 100% of the Daily Value) for 90 days had dramatic relief in 95% with 87% "completely cured." Two months after stopping thiamine, improvement persisted. Curative treatment of primary (spasmodic) dysmenorrhoea. Gokhale LB. Indian J Med Res. 1996 Apr;103:227-31. Ed: This sounds too good to be true. Thiamine B-1: Moderate thiamine deficiency was found in 40% of hospitalized elderly with higher with depression, Alzheimer's disease, cardiac failure and falls. Belgium, Pepersack, Gerontology 3/99;45:96 Thiamine Supplement Helped Elderly Irish: 80 healthy elderly Irish women were treated in a DB PC study with 10 mg/day of thiamine for 6 week. Increased appetite, weight, well-being, and decreased fatigue occurred in the thiamine group. Smidt, UC Davis, J Gerontol ’91;46:M16; Thiamine Claimed to Help Post-ECT Confusion: Three cases of elderly patients getting ECT for depression. Using thiamine to reduce post-ECT confusion. Linton CR, Reynolds MT, Warner NJ. Int J Geriatr Psychiatry 2002 Feb;17(2):189-92 Vitamin B1, B2, B6 DB with Nortriptyline Helpful Trend: In a very small DB PC study of 14 elderly treated with nortriptyline for depression, seven received 10 mg/day of each vitamin and showed trends toward better cognitive functioning and decreased depression as well as higher nortriptyline levels and B-12 levels. Harvard. Brief communication. Vitamin B1, B2, and B6 augmentation of tricyclic antidepressant treatment in geriatric depression with cognitive dysfunction. Bell IR, Edman JS, Morrow FD, Marby DW, Perrone G, Kayne HL, Greenwald M, Cole JO. J Am Coll Nutr 1992 Apr;11(2):159-63. Harvard. B-2 (Riboflavin) Migraines: B-2 Riboflavin High Dose Helped: DB PC 3 months 400mg/d. Mitochondrial dysfunction from impaired oxygen metabolism may cause migraines and B-2 may augment mitochondrial activity. 55 pt with >1 yr history migraines and 2-8 attacks/months. Decreased after first month with 56% decrease in final month vs. 19% placebo. No benefit on severity. Effectiveness of high-dose riboflavin in migraine prophylaxis: a randomized controlled trial. Neuro 98;50:466-70. Univ Liege Depression: Riboflavin B-2 Deficiency Common in Depressed Women: 17% of 52 acute psych admits had B-2 deficiency as measured by insufficient flavin adenine dinucleotide activity, a B-2 dependant enzyme in the folate-dependant methylation pathway. Only women were found deficient and none were deficient in other vitamins except one for folate. Thyroxine levels were lower with low B-2. Bell, McLean Hosp, Acta Scand Psych, ’92;85:360; IR Bell also did DB PC with B-1, B-2, and B-6 at 10 mg each to augment tricyclics with trend favoring supplementation in 14 geriatrics with depression. J am Coll Nutr ’92;11:159 Depression: B-2, B-6, B-12 deficiency Found, Not Folate or B-1: 20 geriatric and 16 non-alcoholic young psych patients assays and 28 deficient in at least one of the three but none to folate or B-1. Deficient tended to be more depressed. Psychotic depression lower for B-12. IR Bell, J Am Geriatric Soc ’91;39:252 B-6 (Pyridoxine) Autism: B-6 & Mg No Benefit: DB PC 10 week 12 pt. High-dose pyridoxine and magnesium administration in children with autistic disorder: an absence of salutary effects in a double-blind, placebo-controlled study. Findling RL, Maxwell K, Scotese-Wojtila L, Huang J, Yamashita T, Wiznitzer M. J Autism Dev Disord 1997 Aug;27(4):467-78 Endothelium: B-6 Pyridoxine Helps: DB PC 10 wk, 31 transplant cardiac patients B-6 100 mg/d or folate 5 mg/d or placebo. Only B-6 helps endothelium. Pyridoxine improves endothelial function in cardiac transplant recipients. Miner SE, Cole DE, Evrovski J, Forrest Q, Hutchison S, Holmes K, Ross HJ. J Heart Lung Transplant 2001 Sep;20(9):964-9 U Toronto Stroke, Heart: B-6, B-12, Folate Not Helped: In a 2 year DB PC study of 3068 stroke victims given high dose (25 mg, 0.4 mg, 2.5 mg respectively) or low dose (0.2 mg, 0.006 mg, 0.02 mg), there was no difference what so ever in strokes, heart attacks, or death during follow-up although there was a moderate decrease (2 micromol/L) in homocysteine. The study did find a more major decrease (3 micromol/L) in homocysteine was linked to decrease health risks. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, Sides EG, Wang CH, Stampfer M. JAMA. 2004 Feb 4;291(5):565-75 Schizophrenia: B-6 Not Helpful: DB PC 9 weeks 15 patient crossover pyridoxine 100 mg/d increased each week to 400 mg/d. No impact on PANSS. Vitamin B6 as add-on treatment in chronic schizophrenic and schizoaffective patients: a double-blind, placebo-controlled study. Lerner V, Miodownik C, Kaptsan A, Cohen H, Loewenthal U, Kotler M. J Clin Psychiatry 2002 Jan;63(1):54-8 B-6 Helps PMS in DB: DB PC crossover 63 pts rx B-6 50mg/d found supplement helped depression, irritability and fatigue 3 months each. Doll, Oxford, JR Coll Gen Prac ’89;39:364 B-6 Helped Elderly Memory: DB PC 76 men ages 70-79 were treated for 3 month with B-6 10mg/day. No impact on mood. Mental performance improved. Vitamin B-6 supplementation in elderly men: effects on mood, memory, performance and mental effort. Deijen JB, van der Beek EJ, Orlebeke JF, van den Berg H. Schizophrenia with Depression: A very poor quality small open study of 9 schizophrenic patients with depression given 150 mg. B6 for 4 weeks. Two had a 25% decrease in HAM-D. Shiloh, Israel, Harefuah 2001 May;140(5):369-73, 456. B-6 Pyridoxine Helped Women on BCP in DB: DB PC crossover for depressed women who had no previous history of depression. Adams, Lancet pg 897, ‘73 Tardive Dyskinesia Success with B6: B6 increases cerebral serotonin function and melatonin production in animals. Four case report of improved TD and neuroleptic parkinsonism as well as psychotic symptoms after Rx with pyridoxine. Case of a 22yo presented where Rx with 20 mg/d successful added to haldol with drastic reduction abnormal movements after 5 days. Vladimir Lerner, Israel, J Clin Psychiatry 11/98 59:623-4.; DB 4 week crossover study 15 patients. B6 patients better by 3rd week. Am J Psychiatry 2001 Sep;158(9):1511-4 B-12: (Cyanocobalamine) also see Folate B-12 Helps Lower Homocysteine: Adding 400 microg/d better than intake in available multivit supplements. Increased the tHcy (total Homocysteine)-lowering potential of folic acid. Use of folic acid alone may mask B-12 deficiency which would otherwise show up as pernicious anemia. A Bronstrup, U Bonn, Am J Clin Nutr 11/98 68:1104-10. B-6, B-12, Folate Not Help Stroke, Heart: In a 2 year DB PC study of 3068 stroke victims given high dose (25 mg, 0.4 mg, 2.5 mg respectively) or low dose (0.2 mg, 0.006 mg, 0.02 mg), there was no difference what so ever in strokes, heart attacks, or death during follow-up although there was a moderate decrease (2 micromol/L) in homocysteine. The study did find a more major decrease (3 micromol/L) in homocysteine was linked to decrease health risks. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, Sides EG, Wang CH, Stampfer M. JAMA. 2004 Feb 4;291(5):565-75 B-12 Deficiency Psychosis Case: Previously healthy 52yo developed 3 months of acute paralysis of legs and 1 month delusions, delirium, agitation. Neurologist had earlier thought MS. Right Babinski, desquamating skin on feet, marked decrease leg strength. CBC normal but B-12 9pg/ml vs. >200 normal. Improving within 2 says IM B-12. Payinda, Am J Psychiatry 00;157:660 B-12 Helps Muscles: DB PC 4 wk high dose IM showed increased compound muscle action potential. Kaji, Kyoto U, Muscle Nerv 12/98;21:1775 B-12 Helps Back Pain: DB PC 60pt 18-65yo rx IM B-12. Large effect. U Palermo, Italy. Vitamin B12 in low back pain: a randomized, double-blind, placebo-controlled study. Mauro GL, Martorana U, Cataldo P, Brancato G, Letizia G. Eur Rev Med Pharmacol Sci 2000 May-Jun;4(3):53-8 B-12 Low Dose Not Help Sleep Phase Disorder: DB PC 50 adults 3 mg/d 4 wk no diff. Okawa, Japan, Psychiatry Clin Neurosci 10/97;51:275 B-12 10 mcg Not Enough: Cyanocobalamin supplementation of 50 microg but not 10 microg daily produced a significant increase in serum vitamin B12. Study was of 31 elderly with low or borderline B12 levels. Australia, A randomized, double-blind, placebo-controlled study of oral vitamin B12 supplementation in older patients with subnormal or borderline serum vitamin B12 concentrations. Seal EC, Metz J, Flicker L, Melny J. J Am Geriatr Soc 2002 Jan;50(1):146-51; Walmart multivit 25 microg. Walmart B-12 supplement 100 microg B-12 High 1 mg Dose Necessary, 100 mcg Not Enough: 23 B-12 deficient >65yos put on 6 weeks each of 25mcg, 100mcg, and 1000mcg. Only highest dose normalized MMA. Response of elevated methylmalonic acid to three dose levels of oral cobalamin in older adults. Rajan S, Wallace JI, Brodkin KI, Beresford SA, Allen RH, Stabler SP. J Am Geriatr Soc 2002 Nov;50(11):1789-95. (Ed: Since B-12 is stored by the body, a longer period on 100 mcg might have been enough. I recommend 500 mcg every other day. ) Mild B-12 Deficiency Common 23%: Study of elderly Dutch found 23% of free-living 74-80yos had mild deficiency. Only 1 of 25 with deficiency had inadequate intake. 31% of elderly have atropic gastritis in U.S. and Netherlands. But this explained only 25% of the deficiency cases. In US 30-40% seniors take supplements and 14% in Netherlands. Article says higher B-12 in US cereal may be reason fewer in US have high methylmalonic acid levels (MMA). Only 8% with mild def had anemia. Van Asselt, Am J Clin Nutr ’98;68:328-34 and editorial. B-12 Deficiency Very Common In India Elderly 75%: 75% of 200 adults studied had increased homocysteinemia and increase methylmalonic acid (best test for deficiency), partly due to vegetarian diets. : Am J Clin Nutr 2001 Aug;74(2):233-41 B-12 Deficiency Common in US 23%: 103 elderly adults in food program studied. 23% low B-12. This group had higher homocysteinemia and did much more poorly on cognitive testing. Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services. Johnson MA, Hawthorne NA, Brackett WR, Fischer JG, Gunter EW, Allen RH, Stabler SP. Am J Clin Nutr 2003 Jan;77(1):211-20 B-12 Deficiency 17% Without Supplement, 8% With in Seattle: 315 >65yos in med clinic screened. Cbl deficiency (serum Cbl < or =300 pg/mL and methylmalonic acid (MMA)>271 nmol/L) was found in 13% of screened patients. 46% taking B-12. These significantly less likely to be Cbl deficient than persons not taking supplemental Cbl (8% vs. 17%, P =.02). J Am Geriatr Soc 2002 Apr;50(4):624-30 B-12 and Vit C deficiency More Common: 260 noninstitutional adults not on meds over 60yo studied. Those low on B-12 and/or Vit C did worse on Halstead-Reitan or Wechsler Memory Test. Low folate or B-2 worse on Halstead-R. JAMA ’83;249:2917 Seasonal Affective Disorder: B-12 Didn't Help: In a DB PC 27 patients 2 week washout and 2 weeks of treatment with 1.5 mg TID B-12 vs. placebo, researchers found no difference in depression. Oren, NIMHY, J Aff Disorder 94;32:197 Depression: B-12 Linked to Elderly, Not Folate: 3,884 Dutch elderly screened for depression. The 278 depressed and 416 controls blood tested. B-12 deficiency may play causal role in depression, but folate did not appear to do so. Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Tiemeier H, van Tuijl HR, Hofman A, Meijer J, Kiliaan AJ, Breteler MM. Am J Psychiatry 2002 Dec;159(12):2099-10 Depression: B-12 Levels Linked to Improvement on Meds, Not Folate Levels: In 115 young and middle aged outpatients with DSM-III-R major depressive disorder, measurements at baseline and serum of vitamin B12 level again on six-month follow-up found that higher levels at baseline and higher levels at follow-up were each related to decreases in depression. Most patients were on anti-depressant medication and most were in counseling. There was no relationship between B-12 levels initially and the level of depression. No supplements were used. Folate levels were only weakly related to response. Kuopio Univ. Finland. High vitamin B12 level and good treatment outcome may be associated in major depressive disorder. Jukka Hintikka. BMC Psychiatry 12/2003, 3:17 http://www.biomedcentral.com/1471-244X/3/17 Depression: B-12: Studies Mentioned As Poor Evidence of Help: Lindenbaum J, Healton EB, Savage DG, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318:1720–8. Mentioned on herbal medicine site as proving that taking B-12 alone is effective in combating depression. Still older study mentioned = Ellis FR, Nasser S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30:277–83. www.vitacost.com on 1/10/03 (Don't trust herbal sites!) Depression: B-12 Lower in Elderly: Study 700 women over 65 in community. 14% mild 17% severe depression. Of depressed, 17% mild and 27% severe B-12 deficient. Found double rate severe depression in those with low B-12. Folate deficiency unrelated to depression in study. Penninx, Natl Inst Aging. Am J Psychiatry 2000;157:715 B-12: Anemia, Macrocytosis No Help in Predicting Deficiencies: Anemia and macrocytosis should not be used to predict folate or B12 deficiencies, or refractoriness to antidepressants. Measurement of folate and B12 should be considered when evaluating treatment refractoriness. 12% of 213 depressed with B12 deficiency and 19% with folate deficiency. Therefore, get vitamin blood levels in refractory. Mischoulou, MGH, J Psychosom Res 2000 Sep;49(3):183-7
|