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From the Desk of Dr. James Greenblatt

The International Society for Orthomolecular Medicine (ISOM) just published a new case report about B12 and reading difficulties.

This case highlights the need for wider uptake and acceptance of the growing knowledge base regarding vitamins and their deficiencies. In this case, a better-informed patient was able to contribute to her own recovery. The patient, a mother in her early forties, was a practicing physiotherapist and had been a lifelong vegetarian.  The patient said:

“I am now quite sure that my B12 levels had been low for years. I observed the following changes after the course of nine Meganeuron injections:

  • Resolution of leg pains and improved energy levels.
  • Improvements in my short-term memory: I always had problems remembering facts, e.g. names of people or places, dates in history lessons. It even led me to hate history in school. In the months leading up to my injections, I was struggling to recognize familiar people in unfamiliar places.
  • Improvement in my reading comprehension: Reading was torturous. I felt I had a problem with my reading comprehension and found it hard to remember what I read. Registering read information was arduous, however when someone read out the same content to me, I had no problems comprehending or remembering it.”

Best known for its role in forming red blood cells, methylation pathways, and DNA synthesis and repair, Vitamin B12 is often overlooked in modern psychiatry. For although established as an essential micronutrient that the human body requires yet cannot synthesize – meaning that consistent dietary intake of B12 is necessary – Vitamin B12 is typically omitted from traditional diagnostic workups. . .despite mountains of research evidence demonstrating powerful associations between B12 deficiency and mental and neurologic illness.

Myriad neurocognitive and psychiatric manifestations are associated with B12 deficiency, including depression, mania, anxiety, paranoia, memory loss, behavioral changes, and psychosis. Low B12 levels are robustly associated with reduced neurotransmitter synthesis and activity, particularly that of serotonin. Studies have documented B12 deficiency rates of up to 70% amongst depression patients, and the demyelination associated with prolonged B12 deficiency can lead to progressive neuropathy.

Assessing vitamin B12 status and addressing any deficiencies found to be present is one of the most important components of a functional medicine approach for the treatment of mental illness… as well as for the maintenance of overall good mental health.

That a deficiency of an essential nutrient associated with potentially severe psychiatric symptoms is being routinely omitted from diagnostic considerations in psychiatric medicine is tragic. This tragedy is compounded by the fact that testing for Vitamin B12 and relevant functional biomarkers is simple, accessible, and affordable, and supplementation can elicit profoundly positive changes in patients’ therapeutic trajectories.

It is time to bring B12 into the limelight, and to recognize the significance of this critically essential vitamin in terms its implications for neurologic and psychiatric health. Psychiatry desperately needs to implement a broader approach to educating today’s clinicians about B12’s roles in supporting optimum brain function, about the complexities inherent in the biomedical analysis of patients’ B12 levels, and best practices for B12 supplementation.

This fascinating case report published by the International Society for Orthomolecular Medicine underscores vitamin B12’s essentiality, and illuminates some of the neurologic and physiologic sequelae of prolonged B12 deficiency. Of particular interest are the deficits in executive functioning, progressive fatigue, and physiologic pain reported by the case subject – symptoms well-established as associated with low B12.

More detailed information on vitamin B12, B12 testing, and B12 supplementation can be found in my book, Integrative Medicine for Depression.