B12

15 March 2024

Unexpected Micronutrient Deficiencies

Recently we talked about the vitamin and mineral deficiencies which may trigger more headache and migraine attacks in patients using certain heartburn medications. The truth is that nutritional deficiencies can be caused by a variety of things, and the consequences can be quite serious.

Curt Hendrix over at Akeso Health Sciences recently wrote about the admittedly extreme case of a teen boy who eventually went blind because of undetected micronutrient deficiencies. After finding a B12 deficiency, he was given injections and a recommended diet plan. But more information came out about three years later:

Upon further examining his eating habits, doctors learned that “since elementary school, [the boy] would not eat certain textures of food.” Subsisting only on a diet of chips, processed meats, white bread, and a daily portion of french fries. Doctors also found copper, selenium, zinc, and vitamin D deficiencies, as well as decreased bone density.
Your Body’s Language: Nutritional Deficiencies and Consequences

An extreme case – I hope so – but maybe not as unusual as we think. Hendrix quotes estimates that 2 billion people in the world have a nutritional deficiency. And lest you think that we’re talking about only the poorest countries, the Centers for Disease Control and Prevention estimates that almost 10% of the US population has at least one deficiency.

Certainly, these issues can be caused by genetics and many medications. But it is also surprisingly easy for us to fall into a diet that lacks variety and balance. One of the problems is that many of these tricky symptoms don’t show up right away – it may take years – and then, as in the case of this boy, the results may be irreversible. And even supplements may not be enough to correct the problem.

If you’re looking for one simple test for all deficiencies, you’re out of luck. But your doctor, or even certain home tests, can catch some of the major ones. You might want to consider testing, especially for iron, B2, B12, magnesium, and vitamin D. But certain symptoms may point to other deficiencies – your doctor can help you with that.

Sometimes, even with tests, it’s hard to nail down certain deficiencies. But what you can do is eat a balanced, nutrient-rich diet. Remember, just because you don’t have immediate problems because of what you ate yesterday doesn’t mean that you’re eating healthy.

After many years of migraine and headache research, I remain convinced that diet is one of the most powerful weapons you can use to fight migraine. Its importance is given lip service, but its true power is frequently underestimated.

To read more about this sad case and the danger of nutritional deficiencies in general, check out the full article here.

11 August 2022

Is Vitamin B12 a Migraine-Fighter?

James Discoveries & Stats, Treatments 0

Is vitamin B12 – otherwise known as cobalamin – a migraine-fighter? Researchers from the USA think it may be. With the obligatory “more studies are needed” disclaimer.

Best Practice & Research Clinical Anaesthesiology

We’ve actually talked a lot about vitamin B12, because it’s already well known for its important roles, related to migraine. You may remember that testing homocysteine levels may be one way to detect migraine, because this test may show deficiencies in B6, B12 and folate. High levels may not only be a sign of migraine, but also depression, and blood clots. Read more at A Blood Test For Migraine?.

We also talked about how heartburn drugs may relate to a B12 deficiency, which is why migraine patients may want to avoid these medications. NSAIDs (e.g. ibuprofen) may also cause problems with B12 levels, if used too often.

But actually, there have been many studies on B12, as these researchers point out in their 2020 paper, published in the journal Best Practice & Research Clinical Anaesthesiology, titled Utilization of B12 for the treatment of chronic migraine. In fact, for 70 years we’ve been talking about B12 and migraine, thanks to a study in the Netherlands in 1951.

The researchers discuss some of the relationships between B12 and migraine. But one of the biggest is the relationship with nitric oxide (NO), which we’ve also discussed often. B12, in its active form (hydroxocobalamin), helps control levels of NO. Here is just part of the explanation of the paper:

While the pathogenesis of migraine is not fully understood, NO is an important contributing element, and its effects can be mitigated through the scavenger action of vitamin B12. Patients experiencing migraine have neurogenic inflammation and vascular dysfunction, enabled by increased release of NO and homocysteine. N0 is an endothelial-derived vasodilator, and oxygen radical that plays a role in cell signaling [46]. Multiple factors. including CGRP. stimulate N0 production. NO turns on a pathway resulting in vasodilation of smooth muscle. Clinically, NO serves as a factor in pain pathways, including chronic pain, inflammation, central pain sensitization, and hyperalgesia via cyclic guanosine monophosphate {cGMP) contingent activity.
Utilization of B12 for the treatment of chronic migraine

It’s technical stuff, but if you’re at all familiar with migraine, you’ll recognize some of the connections here.

There are also many studies that directly show a decrease in migraine with B12 supplementation. However, these researchers warn that the studies were generally small, and that we need to see larger clinical trials, especially trials that only involve B12. This is always tricky, because sometimes a supplement only works, or may work better when taken with other supplements. But we need to know somehow how much B12 by itself affects migraine.

As mentioned above, B12 can also help the body avoid blood clots, leading to conditions such as stroke, which has also been known to be related to migraine for many years.

Other B vitamins have also been important in migraine treatment.

So in the end, these researchers basically say that there are many positive studies, and it makes sense from what we know about migraine that B12 plays an important role. But we need more studies. If only to find out who this may help. Is it only people with a deficiency? Is it only those with a certain type of migraine? We’re not sure.

Meanwhile, make sure you have good levels of B12 in your diet. Dairy products and eggs (eggs are pretty amazing, actually), salmon and tuna, beef and especially organ meats, are all high in vitamins and especially B12. If you’re vegan, you may be especially prone to B12 deficiency, so talk to your doctor. Some foods are fortified with B12, but you may need to look at other options.

Supplements may also help vegans and non-vegans in their fight against migraine. Garden of Life mykind Organics Vitamin B Complex is recommended by ConsumerLabs and also highly rated by customers. Consider talking to your doctor about your B vitamin levels.

B12 does seem to directly lower migraine attacks in some people, but even if it plays a smaller role in conjunction with other things, a proper level is critically important to your overall health.

28 March 2016

Why Headache Patients Are Running from Esomeprazole (Nexium) and other “Heartburn” Drugs

James Discoveries & Stats, Information, Resources 1

Heartburn medications, such as esomeprazole (Nexium and other brand names), are so common, it’s not surprising that they get blamed for quite a number of symptoms. But some recent studies are making headache patients wonder – is the stomach cure making my head worse?

Esomeprazole belongs to a class of medications known as proton-pump inhibitors (PPIs). Other medications in this class include omeprazole (e.g. Prilosec, Losec), lansoprazole (e.g. Prevacid), and rabeprazole (e.g. AcipHex), among many others.

Heartburn Medication: Triggering Headaches? Headache is actually a common, well-known side effect of PPIs. Other side effects include diarrhea, nausea, and abdominal pain.

If taken for more than three months, PPIs can also lead to low magnesium levels. Migraine sufferers in particular are familiar with the connection between magnesium and their condition. Low magnesium can also lead to general muscle stiffness.

In 2013, a study out of the USA showed that PPI use was related to B12 deficiency. B12 deficiency has been linked not only to cases of migraine, but also dementia. Interestingly, the risk of deficiency was especially high in young adults.

It seems that the PPIs interfere with the absorption of the vitamin.

Last month a study in Germany linked the use of PPIs with dementia yet again.

This does not mean that patients taking PPIs will automatically get dementia, or will automatically have B12 deficiency. And certainly there are people who benefit from at least short term use of PPIs.

However, the risks exist, especially for long term users. With concerns about risk of bone fractures, muscle stiffness, headache and dementia, it might be time to look into other options.

Writing about the recent studies, Dr. Alexander Mauskop of the New York Headache Clinic expressed concerns that tests for B12 levels are often not accurate, and that many doctors will be satisfied with lower vitamin D levels (also associated with dementia) than they should be.

Quitting PPIs

Getting off the PPI treadmill can be a challenge (talk to your doctor), but many patients have done it. The problem is that there can be rebound symptoms after a few days.

Dr. Mauskop’s recommendation – switch to a histamine-2 blocker (such as ranitidine or famotidine (Zantac and Pepcid) and an antacid such as Tums. Watch your diet, and after a few weeks you can stop taking the Zantac and rely only on atacids. Eventually you may be able to avoid the antacids as well.

Another suggestion is to start lowering your dosage of PPIs, for example going to one every day, to one every two days, and so on. Again, you can rely on antacids to get over the hump.

There are many other tips out there – probiotics, for one. Of course a healthy diet is key. But every patient is different.

Some resources that I have seen recommended include Dropping Acid: The Reflux Diet Cookbook & Cure, The Acid Reflux Escape Plan: Two Weeks to Heartburn Relief, Killing Me Softly From Inside: The Mysteries & Dangers Of Acid Reflux and The Acid-Alkaline Food Guide

Have you successfully quit PPIs? Tell us your story!

Other Sources and Resources:

5 December 2011

A Blood Test For Migraine?

James Information, Treatments 0

What if you could have a simple blood test done which could confirm your diagnosis of migraine – and also put you on the road to proper treatment?

True, scientific, individualized treatment is something we’ve been promised for years – but still there’s no good genetic test or blood test or any other kind of test that can diagnose migraine every time and tell you which treatment will be the most effective.

But that’s not to say that blood tests (or other types of tests) are useless. As a matter of fact, there is a blood test that may help some migraine patients discover an important treatment for them. And it’s not only helpful for migraine patients, but for those with depression – and often one patient is dealing with both issues.

And there’s more.

If this test comes up positive, it may also warn you of a higher risk of stroke and heart disease. Sound familiar? Yes, migraine patients (at least some) do seem to have a higher risk of stroke and heart disease.

Now, we’re talking about a simple test that can help you treat migraine, depression, and your risk of heart disease. I should ask those of you with migraine – or migraine and depression – have you ever heard of such a thing? Have you had a blood test done? Some of you I hope will be saying yes. Others of you are wondering why no doctor has sent you for blood work before.

And that would be a good question.

What is the test? It’s a homocysteine test.

Homocysteine is an amino acid that converts into another amino acid known as cysteine. If it’s not converting properly, homocysteine levels rise – and those high levels are linked to the heart disease and to depression.

There’s a link to migraine as well. Those who suffer from migraine with aura in particular seem more likely to have high homocysteine levels. (See The relationship between homocysteine and genes of folate-related enzymes in migraine patients)

In studies of both men and women, high levels were associated with depression, and in many cases lowering homocysteine levels helped to treat the depression significantly. It has been hypothesized that the high levels caused vascular disease and neurotransmitter deficiency, which in turn had an impact on mood. (See The homocysteine hypothesis of depression.)

So just how to all these things fit together? Research is still being done to understand the connection. But there is a connection.

Before we go any further, let’s be clear. We’re not saying homocysteine is a cause of migraine (it could be a trigger, or a result), and we’re not saying that everyone with depression or migraine has high homocysteine levels. And not everyone with high levels is depressed or has migraine disease.

But here’s the problem. It’s very likely that many people suffering from migraine and depression could be helped by dealing with this problem – a problem detected by a simple blood test. But the blood work has never been done. Instead, they’re on two or three medications.

Solving the Problem

So what do you do for high homocysteine levels?

This blood test often goes together with other tests, checking levels of folate, vitamins B12 and B6, and zinc. You see, these vitamins and minerals help with the conversion of homocysteine into cysteine. High homocysteine levels can be an early detector of deficiency.

A proper checkup needs to go along with the blood test – it’s not just a matter of checking the numbers. For example, Dr. Alexander Mauskop of the New York Headache Clinic points out that you could have high levels of B12 and yet still have deficiency – due to problems with the transport of B12 into the blood cells. (See Homocysteine and migraine)

The solution is to make sure proper levels of folate (what folic acid or B9 is in your body), vitamins B12 and B6, and zinc are getting where they need to go in your body.

That doesn’t mean taking a B complex vitamin. It usually means taking higher amounts of folic acid (B9) and B12 than you would find in that B complex pill from the drugstore. And it may mean taking a sublingual version, or an injection. B12 sublingual tablets like these have helped some people.

A good doctor will also help you look at your diet, which could be contributing to the deficiency, and lifestyle issues such as smoking.

The point is, once you are aware of a deficiency, the treatment will very much depend on your individual case, because a number of things can cause the high homocysteine levels. Patients who have tried taking certain vitamins and think it "didn’t work" may need a more complete check-up by a migraine specialist. A different series of vitamins, or different types, or a change in medication may be required to solve the problem.

Though it may not help everyone, this simple test will probably get many on the road to a better treatment. Isn’t it worth talking to your doctor about?

For more, read Can a Simple Blood Test Solve Depression? and Homocysteine and migraine