B12 Deficiency and The Paleo Diet

I came across Chris Kresser recently.  He’s been around for a while, and he’s just released a new book, Your Personal Paleo Code.  The Paleolithic Diet is reaching fad status now, and I usually stay away from fad diets.  After what Dr. Terry Wahls accomplished with supplements and the Paleo Diet, however, I had to sit up and pay attention.  Dr. Robert Lustig even supports the Paleo Diet.  These people aren’t idiots but neither are some of the naysayers.  For the past few months I have continually run into the Paleo Diet and ignored it until my neighbor, a registered dietitian, recommended I look into it.  Then Chris Kresser released the aforementioned book.  I went back to his website.  What did I have to lose? The dude is no slouch!

I bought the ebook because I’m a Kindle junkie, and then I noticed he had seven free ebooks all addressing different health issues.  When I was in high school I just knew that I was going to medical school.  A seizure disorder thwarted my plans.  Chronic sleep deprivation, medical school and residency don’t go together.  So, I chose differently.  Consequently, I now find myself doing all sorts of reading about health in an effort to see if I can help Grace feel better and improve my own well-being.  It’s something, right? The first ebook I read was about B12 deficiency.  It’s a quick and dirty read.  You’ll be done with it almost as soon as you start, but if you have any issues with depression, anxiety, cognitive slowing, memory loss, or neuropsychiatric conditions, then you’ll want to read this ebook.

What does Kresser have to say?

What do all of these diseases have in common?

  • Alzheimer’s, dementia, cognitive decline and memory loss (collectively referred to as “aging”)
  • Multiple sclerosis (MS) and other neurological disorders
  • Mental illness (depression, anxiety, bipolar disorder, psychosis)
  • Cardiovascular disease
  • Learning or developmental disorders in kids
  • Autism spectrum disorder
  • Autoimmune disease and immune dysregulation
  • Cancer
  • Male and female infertility

Answer: they can all mimic the signs and symptoms of vitamin B12 deficiency.

He starts off with this:

Data from the Tufts University Framingham Offspring Study suggest that 40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low normal range – a range at which many experience neurological symptoms. 9 percent had outright deficiency, and 16 percent exhibited “near deficiency”. Most surprising to the researchers was the fact that low B12 levels were as common in younger people as they were in the elderly.  That said, B12 deficiency has been estimated to affect about 40% of people over 60 years of age. It’s entirely possible that at least some of the symptoms we attribute to “normal” aging – such as memory loss, cognitive decline, decreased mobility, etc. – are at least in part caused by B12 deficiency.

Why is B12 deficiency under-diagnosed?

B12 deficiency is often missed for two reasons. First, it’s not routinely tested by most physicians. Second, the low end of the laboratory reference range is too low. This is why most studies underestimate true levels of deficiency. Many B12 deficient people have so- called “normal” levels of B12.

Yet it is well-established in the scientific literature that people with B12 levels between 200 pg/mL and 350 pg/mL – levels considered “normal” in the U.S. – have clear B12 deficiency symptoms. Experts who specialize in the diagnosis and treatment of B12 deficiency, like Sally Pacholok R.N. and Jeffery Stewart D.O., suggest treating all patients that are symptomatic and have B12 levels less than 450 pg/mL. They also recommend treating patients with normal B12, but elevated urinary methylmalonic acid (MMA), homocysteine and/or holotranscobalamin (other markers of B12 deficiency).

In Japan and Europe, the lower limit for B12 is between 500-550 pg/mL, the level associated with psychological and behavioral manifestations such as cognitive decline, dementia and memory loss. Some experts have speculated that the acceptance of higher levels as normal in Japan and the willingness to treat levels considered “normal” in the U.S. explain the low rates of Alzheimer’s and dementia in that country.  (B12 Deficiency)

If Kresser’s observation about Japan’s Alzheimer’s and dementia lower rates in relation to B12 is sound, then I feel shocked.  I thought about it and decided to do some research on B12 and schizophrenia.  Had anyone done any studies? Were there any results? Yes.  In March of 2013, the results of a study were published in JAMA wherein 100 patients with schizophrenia were given B12 and folate:

“The symptoms of schizophrenia are complex, and antipsychotic medications provide no relief for some of the most disabling parts of the illness. These include negative symptoms, which can be particularly devastating,” says Joshua Roffman, MD, MMSc, of the MGH Department of Psychiatry, corresponding author of the JAMA Psychiatry paper. “Our finding that folate plus vitamin B12 supplementation can improve negative symptoms opens a new potential avenue for treatment of schizophrenia. Because treatment effects differed based on which genetic variants were present in each participant, the results also support a personalized medical approach to treating schizophrenia.”

After looking around the journals, I found that there is research being done on folate and B12 in relation to dementia and schizophrenia.  It seems that there is a genetic mutation that affects the metabolic pathways which affects folate metabolism, and this mutation directly affects the negative symptoms of schizophrenia.  There is a connection between elevated homocysteine levels and low folate and B12 levels.  It’s all very complex.  Needless to say, B12 and folate matter.  Other countries are doing better than we are.  This is an easy fix.


Randomized multicenter investigation of folate plus B12 supplementation in schizophrenia

Dr. Terry Wahls and The Wahls Protocol: Dr. Wahls wrote her first book, Minding My Mitochondria, and it is now nowhere to be found.  No one wants to give it up.  It was a runaway success, but the publishers will not release any more editions because Wahls is releasing her second book The Wahls Protocol in March.  Wahls theorizes that MS is a mitochondrial disorder at heart, and that’s how she treated her own illness to get well.  Keep in mind, Grace’s neurologist thought that her illness might be mitochondrial in nature as well.

Dr. Robert Lustig: Dr. Lustig’s talk on sugar, Sugar: The Bitter Truth, was a Youtube sensation, and it’s now a short book.  I have the book.  I recommend it.  You can’t approach health, healing, and well-being without taking a look at the standard American diet (SAD) of which sugar is a huge part.  If you really want to feel horrible about eating sugar, then read this study: International Variations in The Outcome of Schizophrenia and Depression in Relation to Dietary Practices: an ecological analysis.

Chris Kresser: Kresser’s website is full of ebooks, recipes, links to his podcasts, and all sorts of other resources.  Of all the people recommending the Paleo Diet, I think Kresser is the most centrist in his approach.


6 thoughts on “B12 Deficiency and The Paleo Diet

    • That’s the good stuff, what you’re taking. If you couple that with 2 mg of folate, then you increase absorption, I’m told and potentially lower homocysteine levels. Yeah, we are very complex creatures.

  1. It is good stuff! My np prescribed it for me, I do take folate, but it’s only about 400mcg. All for the deficiency from pyroluria. We are amazingly complex… It blows my mind. Did you read the one on Thyroid?

    • I haven’t read that one yet. I’m in the middle of reading the book and still trying to peel myself off the ceiling about the microglial cells and the enteric nervous system. It’s all very troubling.

  2. Well, basically, cells from an inflamed gut cross the blood/brain barrier activating the microglial cells in the brain which are in charge of repairing brain tissue and neurons. When there is chronic microglial activation, the neurons stop firing and nothing gets repaired over time resulting in depression and anxiety most likely caused by insufficient neurotransmitters. This is all related to problems with the gut. That is beyond bothersome to me.

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