Low Levels Of Vitamin B12 May Worsen Walking Cognition In Parkinsons Patients
Supplement May Boost Balance, Memory, But Impact on Disease Trajectory Unknown
A study of patients with early Parkinsons disease found that groups with lower levels of vitamin B12 faced on average a more rapid acceleration of both motor and cognitive symptoms, which slowed in some cases after taking a daily multivitamin.
In the two-year study, blood levels of vitamin B12 were tested in 680 patients who had recently been diagnosed with Parkinsons. Researchers led by first author Chadwick Christine, MD, a neurologist with the UCSF Weill Institute for Neurosciences, also assessed patients gait and mobility, ability to perform activities of daily living, cognition and symptoms of depression.
Our findings demonstrate that low B12 levels are associated with greater walking and balance problems, possibly due to the known effect of B12 deficiency on the central and peripheral nervous systems, said Christine. Alternatively, low B12 may have a direct effect on the progression of Parkinsons disease, or it may be a marker of an unknown associated factor, perhaps correlating with another aspect of the disease or nutritional status.
The study was published March 6, 2018, in the early view version of the journal Movement Disorders.
Deficiencies of B12, which are more common in people with Parkinsons than the age-matched general population, are associated with weakness, tiredness, numbness, tingling and walking difficulties symptoms that are found in Parkinsons disease.
Which Vitamins Are Good For Parkinsons Disease
Nutritional interventions, which act via different types of mechanisms may slow or avoid the accumulation of damaged brain cells associated with the production of Parkinsons disease. Particularly, nutrients responsible to increase the utilization of brain energy, prevention of mitochondrial dysfunction, protection against oxidation damages and inflammation of tame are few leading contenders associated with anti-Parkinsons therapies.
When Should I Take My Parkinsons Medication
When you take your Parkinson’s medication should always be discussed with your GP, specialist or Parkinsons nurse.
Some people with Parkinsons may feel sick after taking medication, especially if they take it on an empty stomach.
Having a snack, such as a plain cracker or biscuit, at the same time as taking your medication can help ease this side effect. Or you may find taking medication with plenty of water can help to reduce nausea.
Your GP can also prescribe anti-sickness tablets if you do feel sick after taking your medication.
Talk to your GP, specialist or Parkinson’s nurse if you have difficulty swallowing your medication. It may help to take your medication with a cold drink, such as water, squash or fruit juice, or with yoghurt.
You may also benefit from a referral to a speech and language therapist.
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Side Effects & Precautions With Vitamin E Use
Dietary vitamin E is safe, and changes in diet are sufficient to combat Vit E deficiency.
The most common side effect associated with high dose vitamin E is its blood thinning or antiplatelet activity. If you are already taking blood thinners, avoid high dose Vit E.
Tocopherol supplements may interact with medications such as niacin, simvastatin or cholesterol-lowering drugs.
A few studies have demonstrated that high dose Vit E over a long period increases the risk of death however, there are several reasons why these results may not apply to the general population or the young and healthy subgroup.
Please consult a health practitioner before taking Vitamin E supplements.
What Causes Parkinsons Disease
Parkinsons is caused by the degeneration of brain cells in an area of the brain called the substantia nigra. These neurons are responsible for the production of a particular neurotransmitter called dopamine and it is the lack of this neurotransmitter that is responsible for the main Parkinsons symptoms. The cause of the disease is not known. However, like most degenerative illnesses, it is likely to be due to a range of factors including interactions between genes and environment. Contributory factors may include environmental toxicity, physical trauma, genetics, drugs, disease , nutritional deficiency, mitochondrial insufficiency, enzyme deficiency and unremitting stress.
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Vitamin B12 Levels Could Be Predictive Of Parkinsons Disease Dementia
Cognitiveimpairment, in particular dementia,is one of the most feared non-motor features of Parkinsons disease .1 Lower levels ofvitamin B12 have been reported in PD patients with cognitive impairment. However,the value of vitamin B12 at PD diagnosis as a predictor for dementia is unknown.2
A retrospective study recently published in Parkinsonism & Related Disorders investigated whether serum vitamin B12 levels at PD diagnosis was associated with risk of dementia. Clinical data collected as part of the Rochester Epidemiology Project was used to identify the individuals with clinically diagnosed PD between January 1, 1991, and December 31, 2010. Researchers identified 25 patients with clinically diagnosed PD who did not have dementia at the time of diagnosis and whose data included serum vitamin B12 levels within one year prior or 90 days after the diagnosis of PD. The median age at PD diagnosis was 74.0 years . Among the 25 patients included, 15 were later diagnosed with dementia at a median age of 79.4 years .3
In an interview with VJDementia, Rodolfo Savica, MD, PhD and Stuart McCarter, MD, from Mayo Clinic, Rochester, MN, discuss the rationale of this study, the key findings and the potential impact on clinical practice. This interview was recorded during an online conference call with The Video Journal of Dementia .
References:
Which Foods Are Rich In Vitamin E
Given the powerful effects Vit E has on brain and nerve health, one should include it in their regular diet.
Some common sources of vitamin E include almonds, spinach and sweet potato. The compound is also present in avocado and sunflower seeds.
Cooking using olive oil is another way of including Vit E in ones diet. Eating trout can provide the body with both proteins and Vit E.
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Its Not Necessarily Alzheimers
More than 50 conditions can cause or mimic the symptoms of dementia, and a small percentage of dementias are reversible. Two common examples are dementia caused by vitamin B12 deficiency or an underactive thyroid . Getting the right diagnosis is important so that you know what options you have, because symptoms subside when the underlying problem is treated.
Parkinsons And Weight Gain
Parkinsons medication does not tend to make people gain weight, but a small number of people may experience impulsive and compulsive behaviour. This is a side effect of some Parkinsons medication, particularly dopamine agonists and, in some cases, levodopa.
Impulsive behaviour is when a person cant resist the temptation to carry out certain activities. These are often activities that give an immediate reward or pleasure, such as gambling, hypersexuality and overeating.
So, someone may eat large amounts of food in a short period of time because they cant control their appetite, and as a result, they gain weight.
If you think youre experiencing this behaviour, speak to your GP, specialist or Parkinsons nurse.
We dont advise anyone to stop taking or to change their Parkinsons medication without the advice of their specialist or Parkinsons nurse.
Any changes have to be made slowly and gradually, and should always be carried out and reviewed by a specialist, because of the risk of side effects and withdrawal symptoms.
Someone experiencing impulsive or compulsive behaviour may not realise they have a problem. So it’s important that their carer is aware of these side effects.
Deep brain stimulation and weight gain
Some people with Parkinsons may put on weight quickly after having deep brain stimulation, a surgery sometimes used to treat the condition.
If you think youre experiencing this behaviour, speak to your GP, specialist or Parkinsons nurse.
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What Can I Do To Help With Swallowing
Make sure you are comfortable at meal times. The following suggestions may help make it easier to eat:
- Take your time and eat in a comfortable, quiet place.
- If you feel you are taking too long and food is getting cold, consider eating smaller, more frequent meals and snacks, or food that is easier to eat.
- You can buy heated plates to keep food warm for longer or consider serving smaller portions so that a second portion can be kept warm or reheated if its safe to do so.
- Posture is important to trigger a good swallow. Try eating sitting upright in your chair.
- Try planning your meals for when your medication is working. Avoid trying to eat large meals when you are ‘off’.
- If you wear dentures try to ensure they fit comfortably. Ask for a review by your dentist if you are concerned.
- Try to eat when you are less tired, this may mean moving your main meal to lunchtime rather than in the evening.
It Can Reduce Oxidative Stress And Inflammation In Parkinsons
Oxidative stress is the imbalance between prooxidant and antioxidant defences in the body.
Oxidative stress is linked to the dopamine cell degeneration, mitochondrial dysfunction and toxicity in PD.
Parkinsons disease patients tend to have lower levels of antioxidant enzymes in the body.
Vitamins A, C and E improve levels of antioxidant enzymes, superoxide dismutase, glutathione transferase and catalase and protect the brain from oxidative damage.
A pilot study published in Annals of Neurology, 1992 revealed that treatment with high doses of antioxidants- alpha-tocopherol and ascorbate slowed down the progression of Parkinsons disease.
To reduce the oxidative stress in the brain, there is a need for an antioxidant which has the ability to cross the blood-brain barrier.
Tocotrienol is more effective than alpha-tocopherol in reducing oxidative stress in the brain and also crosses the blood-brain barrier.
Neuroinflammation or inflammation in the brain is also involved in the pathophysiology of Parkinsons disease.
Activation of microglia (immune cells found in the nervous system and increase in inflammation-causing agents is observed in PD.
All these can cause the death of dopaminergic neurons in the substantia nigra of the brain, leading to disease progression.
It has been reported from several preclinical and clinical studies that both alpha and gamma tocopherol have good anti-inflammatory action.
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I Am Underweight Or Losing Too Much Weight What Should I Do
If you are underweight or have difficulty putting weight on, it may be because of the side effects of Parkinsons medication or difficulties with chewing or swallowing.
Weight loss is caused by your body using more calories than youre consuming. This may be due to increased movement caused by tremors or dyskinesia. It may also be due to practical problems, such as food shopping, preparation or keeping your food hot while youre eating.
You may find the following tips useful:
- Make the most of adding extras to foods, such as extra cream, butter, oil or honey where you can. These will make the food more energy-dense and tasty.
- Try to have 3 meals a day and 2 to 3 snacks between your meals. Its important to try to eat every 2 to 3 hours during the day.
- Instead of snacks, try having a milkshake, malted drink or smoothie. These may be used to supplement your usual diet. But, if you find you are replacing your meals with these, it is important to seek help from a dietitian.
If you are finding it difficult to maintain your weight or reach a healthy weight, your GP, specialist or Parkinsons nurse can refer you to a dietitian.
They may recommend tailored changes to your diet and special high-calorie products that are available on prescription.
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Since there is evidence relating oxidative damage of nerve cells to PD, some researchers are studying antioxidants:
- A 2002 study focused on the potential antioxidant Coenzyme Q10 , which is believed to play an important role in mitochondria health. Mitochondria are the “powerhouses” of a cell. Some scientists think that abnormalities of mitochondrial function may play a role in PD.
In 2011, a large clinical trial studying the potential benefits of CoQ10 on reducing the progression of early PD was stopped because a mid-study analysis suggested that there was no improvement in the people taking CoQ10 in comparison to those receiving treatment. Researchers decided that continuing the study would have shown an extremely low likelihood of CoQ10 showing any benefit in delaying the progression of early PD.
Scientists have also examined Vitamin E, Vitamin C and health foods to evaluate oxidative properties. Vitamin E can fight damage in the brain caused by free radicals and has been suggested to lower the risk of PD. However, researchers conducted an extensive and thorough study more than 10 years ago and failed to find any evidence that Vitamin E slows the progression of PD or manages symptoms. Since Vitamin E has few side effects, many people with PD continue to take it in high doses of 400 IU or more.
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Many Peopleespecially The Elderlyare Deficient In Vitamin B12
Many people are deficient in vitamin B12, and other B vitamins, for multiple reasons.
For instance, some circumstances either boost the body’s demand for B vitamins or greatly inhibit vitamin B absorption, making supplementation necessary.
Individuals in the following categories have the greatest risk of a vitamin B12 deficiency. For these individuals, the need for a daily supplement can be much more critical.
Elderly
Many older adults experience a decline in their appetite, reducing their overall dietary intake of all B vitamins. Older individuals may also be unable to absorb naturally occurring vitamin B12. With age, many people develop a loss of certain important functions of the stomach and digestive tract. This includes a decreased production of stomach acid, an intrinsic factor needed to release B12 from foods, and for its absorption in the small intestine.31,32
Certain Medications
Commonly prescribed drugs that reduce stomach acid production decrease absorption of vitamin B12.33 Metformin, the popular diabetes drug, is known to interfere with the absorption of vitamin B12.34,35 Birth control pills can also deplete B12 and other B vitamins.36
Pregnancy
B vitamins, especially B12, are important for healthy fetal development. In breast-feeding or pregnant women, a deficiency of B12 can result in severe neurological damage or birth defects in the infant or fetus.37,38
Some Medical Conditions
Vegetarians and Vegans
Distinguishing Between Types Of Dementia
For physicians and families intent on pinning down a diagnosis, one major complicating factor is the existence of so many kinds of dementia. More than 50 conditions can mimic or cause dementia.
Alzheimers disease is by far the most common intractable condition. But other causes of irreversible dementia include blood vessel diseasevascular dementia), other degenerative disorders , slow-growing brain tumors, or infections of the central nervous system .
In some types of dementia, treatment will improve mental functioning, and in a small percentage, the dementia is completely reversible if treatment begins before permanent brain damage occurs. Thats why it is important to report to a doctor any signs of dementia as early as possible.
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How Does Fibre Help
Fibre absorbs fluid as it moves through your bowel, forming a soft stool that can be passed more easily.
It is very important to increase your fluid intake if you increase the fibre in your diet, because too much fibre without enough fluid can increase constipation.
A dietitian can give you more information and advice.
How can I increase my fibre intake?
Fibre is found in cereals, seeds, nuts, fruit, vegetables and pulses, such as peas, beans and lentils. To increase your fibre intake you can try:
- eating high-fibre varieties of foods, such as wholemeal bread, pasta or brown rice
- altering recipes to use some wholemeal flour instead of all white flour
- choosing a breakfast cereal containing wheat, wheatbran or oats, such as Weetabix, porridge or bran flakes
- eating more vegetables. They can be raw or cooked, fresh or frozen. Try using more peas, beans or lentils
- eating more fruit. It can be fresh, stewed, tinned or dried. Try bananas, oranges or prunes
- gradually introducing ground linseeds. You can add 1 teaspoon to cereals, salads or yoghurts to start with and increase this over time to 1 tablespoon. If you do this, make sure you drink an extra glass of fluid a day, otherwise it wont work and may make constipation worse
When increasing your intake of fibre, it is important to do so gradually to avoid bloating or flatulence . Aim to introduce 1 new high-fibre food every 3 days.
Find out about speech and language therapy and keeping a diary.
What You Need To Know
Active Forms of Vitamin B12 Protect the Brain
- Vitamin B12 is critical for nerve function, cell metabolism, the formation of red blood cells, DNA production, and more.
- Aging, and vegan or vegetarian people often suffer from vitamin B12 deficiency. Oral supplementation can correct this.
- There are two active forms of vitamin B12adenosylcobalamin and methylcobalamin. The body needs both forms.
- The better-known form of the two, methylcobalamin, is used to reduce stress, lower dangerously elevated levels of homocysteine, and treat conditions including nerve damage.
- Animal data now show that adenosylcobalamin uniquely protects brain neurons, prevents a decline in dopamine levels, and may block neurodegeneration.
- Initial findings suggest that adenosylcobalamin inhibits overactivity of an enzyme linked with Parkinson’s disease.
- Daily oral intake of 500 mcg of adenosylcobalamin and 500 mcg of methylcobalamin is a great choice for whole-body health and potential defense against neurodegeneration.
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How About The Motor Symptoms
Its not yet clear whether its consumption can also treat the typical motor symptoms of Parkinsons. So far only one study has reported that it may help improve balance in patients who are younger. In this study, a high dose of vitamin D supplement for 16 weeks was found to cause a significant improvement in the balance of those patients who were 66 or younger, compared with the placebo group or those patients who were 67 and older.