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B vitamins for better brains...or not?

An article recently published in the journal Neurology and circulated in the popular news source Journal Watch claims that B vitamin supplementation doesn't help declining cognitive function in elderly folks with elevated homocysteine. Since that is not my clinical experience, nor what I would expect based on what I know of cognitive physiology, I was of course intrigued.

Background info is that modern clinicians agree that elevated homocysteine is a risk factor for both cardiovascular disease and dementia. Homocysteine is elevated in people who are deficient in B12 and Folate, so supplementation has been "tried" to see if correcting homocysteine would alleviate its correlated ailments. Previous research, like this research, showed no benefit. Clinicans disagree as to why vitamin supplementation has been ineffective in clinical trials.

Conventional docs generally fall into the "supplements don't really help anyone anyway" camp, bolstered by research showing that if you take whatever discount multi-vitamin you want, there is no improvement in quality or quantity of life.

More nutritionally-oriented docs would have to say..."It's complicated." 

In this study, the form of folate used was "folic acid", a non-food form of the vitamin that requires quite a bit of translation for the body to use it. It's cheap, very very cheap, and guess what: in this case you get what you pay for. Folate is abundant in organ meats and leafy greens, in the folate (readily absorbable) form, and it can also be found in supplements in that form. Folinic acid is another absorbable and usable form of folate. Folic acid can actually be more harmful than helpful if it overtaxes our translation mechanisms. The placebo group was actually safer without this effect than any benefit I'd expect to see in the intervention group.

About 30% or more of individuals tested have a "methylation" defect, lessening their ability to "activate" the folate and B12 that they do use. A quick end-run around that defect is to take methyl folate (more spendy, for sure) and methyl B12, happily quite inexpensive. 

Sadly, supplement companies may have an advertising budget, but few also have a research budget and public funds for clinical research have dried up over the last couple decades. Although there has been at least one study showing the value of Methyl B12 in lowering homocysteine, a trial comparing clinical outcomes using an intervention of pre-methylated vitamins (B6 also requires some special handling in that 30% of people) has not been waged. 

Until that time, I'm acting as if the trial has been done and shown to be helpful. I'll continue to evaluate elevated homocysteine levels, correct methylation defects, and advise my patients to continue their B vitamins where indicated. If you don't know your methylation status, read the label, look for folate and methyl B12 and take your B vitamins!

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