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10/7/2014
HOSPITALIST SECRETS
ROLE OF B12 AND VITAMIN D IN HM
Joseph A. DeStefano MD, FACP
Case 1
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R.P 78 Yo female admitted with syncope and
sepsis. Chronic Diarrhea. Hx of C diff.
¤C
diff DNA +
level 83
¤ Vit D 25-Hydroxy 14.1
¤ K 2.9
¤ Mg 1.4
¤ WBC 8.6
¤ Hgb 11.3
¤ MCV 77.7 L
¤ Iron Sat 4% Iron 12 TIBC 319
¤ B12
Case 2
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RS 48 yr old WF diabetic presents to Hospital
Obese on Oral Agents
¤ Metformin
and Glipizide
Facial cellulitis
¤ B12: 180
¤ Vitamin D 25hydroxy = 6
¤ Severe
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Case 3
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SS 75 yr old AAF found confused by neighbors. Admit US
obtained from Foley was suspicious for UTI
Large Leuk Est rbc 11-20 WBC 21-30 Bact 2+ cath specimen
before ABX UC no Groth
¤ HX of Breast CA Chronic Abd Pain
¤ Vitamin D 25-Hydroxy Less than 4 basically undetectable only
up to 7 after 100,000 PO
¤ B12 188
¤ EGD showed Gastritis anti TTG and anti-parietal and H pylori
all negative
¤ Quanterferon Gold test +
¤ MS improved with B12 replacement treated with PPI and
Rocephin
¤ Discharge Home for outpatient work up on B12 and Vitamin D
¤
Case 4
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JS admitted
¤ 85
yr old WM who presents to ER in Chattanooga with
severe Pancytopenia bilateral Lower extremity edema,
DOE, and bilateral pleurisy
¤ WBC 2.0 hemoglobin 7.5 Plt 50
¤ MCV100
¤ Retic Count 0.5
¤ 4+ bilateral LE edema
¤ BM BX confirms pancytopenia and hypersegmented
poly
¤ B12 100 folate 25
Case 4 cont.
¤ Homocysteine
report out greater than 100
LE US showed bilateral LE Edema
¤ CTA showed Bilateral PTE
¤ APA Ab + 100
¤ B12 replaced patient needed aggressive K
replacement started on Lovenox and Coumadin
¤ CBC normalized over 1 week
¤ Eventually discharge on B12 shots with Hem-Onc
Follow up On Coumadin
¤ Bilateral
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Vitamin D and Asthma
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Important for Bone health and Calcium Homeostasis
Powerful immunomodulator
Severe and Uncontrolled Adult Asthma Is
Associated With Vitamin D Insufficiency and
Deficiency
Stephanie Korn, Marisa Hübner, Matthias Jung, Maria
Blettner, Roland Buhl
Respiratory Research. 2013;14(25)
Vitamin D, C. Diff, and Staph. Aureus
Deficiency associated with prolonged Hospitalization for C.Diff and
Staph Aureus
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Healthcare costs of Staphylococcus aureus and
Clostridium difficile infections in veterans: role of
vitamin D deficiency.
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Epidemiol Infect. 2010; 138(9):1322-7 (ISSN: 1469-4409)
Youssef D; Bailey B; El Abbassi A; Copeland R;
Adebonojo L; Manning T; Peiris AN
Mountain Home VAMC Medicine Service, East Tennessee
State University, Johnson City, TN, USA.
Vitamin D and Multiple Ilnesses
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Severe Vitamin D Deficiency Is Associated With Frequently Observed Diseases in
Medical Inpatients
A. Marra, G. Leoncini, M. Mussap, M. Bovio, E. Nazzari, M. Giusti, F. Minuto, G.
Murialdo, P. Ameri
Int J Clin Pract. 2014;68(5652.
The probability of having an infection remained significantly higher in cases with less
than 8 ng/ml 25(OH)D after adjustment for age, hepatic disease and PTH values. In
agreement with this finding, it has been recently shown that patients with low vitamin D
levels before admission have higher odds of both community- and hospital-acquired
bloodstream infections.[34,35] Other factors that were not taken into account may have
underlain the association between vitamin D deficiency and infections disclosed by us
and others. For instance, 25(OH)D concentrations dramatically decrease during a
systemic inflammatory response and remain lower than normal for at least 3 months.[36]
Furthermore, chronic disorders and medications such corticosteroids, which are not
uncommon among medical inpatients, may predispose to both vitamin D deficiency and
infections. On the other hand, experimental data indicate that vitamin D boosts the
antimicrobial immune response and thereby is protective against infections.[37]
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Vitamin D and Multiple Ilnesses
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In conclusion, several conditions typically affecting medical inpatients
are more frequent in those presenting with severe vitamin D
deficiency, who are also more likely to stay longer in hospital. With
the exception of infections, these associations are indirect and
mainly mediated by age. Further studies are needed to determine
whether early assessment of vitamin D status might help stratifying
specific categories of patients by clinical severity and thus assigning
them to the most appropriate level of care
October 6, 2010 — Vitamin D deficiency (VDD) has been linked to
bacterial vaginosis (BV) among pregnant women, according to the
results of a study reported online October 4 in the American Journal
of Obstetrics & Gynecology.
Vitamin D and MS
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Appears to be the explanation of latitude correlation for MS
Factors Associated With Recovery From Acute Optic Neuritis in
Patients With Multiple Sclerosis
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Malik MT, Healy BC, Benson LA, et al
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Neurology. 2014;82:2173-2179
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Contribution of Vitamin D Insufficiency to the
Pathogenesis of Multiple Sclerosis
Charles Pierrot-Deseilligny MD, Jean-Claude Souberbielle
PhD
Ther Adv Neurol Disorders. 2013;6(2):81-116.
Vitamin D and Cancer
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Also theorized to contribute to Breast Cancer and
prostate Cancer
Breast Cancer patient with Higher Vitamin D levels
with higher survival
Anticancer Research March 2014 vol. 34 no.
31163-1166
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Vitamin D and Breast Cancer
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Background/Aim: To determine whether higher serum 25-hydroxyvitamin
D [25(OH)D] at diagnosis is associated with longer survival of patients
with breast cancer. Materials and Methods: A meta-analysis was
performed of five studies of the relationship between 25(OH)D and
mortality from breast cancer. A pooled hazard ratio was calculated using
a random-effects model. The Der Simonian-Laird test was used to assess
homogeneity. Results: Higher serum concentrations of 25(OH)D were
associated with lower case-fatality rates after diagnosis of breast cancer.
Specifically, patients in the highest quintile of 25(OH)D had
approximately half the death rate from breast cancer as those in the
lowest. Conclusion: High serum 25(OH)D was associated with lower
mortality from breast cancer. Serum 25(OH)D in all patients with breast
cancer should be restored to the normal range (30-80 ng/ml), with
appropriate monitoring. Clinical or field studies should be initiated to
confirm that this association was not due to reverse causation
Vitamin D and Prostate Cancer
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Vitamin D-related genetic variation, plasma vitamin D,
and risk of lethal prostate cancer: a prospective nested
case-control study.
J Natl Cancer Inst. 2012; 104(9):690-9 (ISSN: 1460-2105)
Shui IM; Mucci LA; Kraft P; Tamimi RM; Lindstrom S;
Penney KL; Nimptsch K; Hollis BW; Dupre N; Platz EA;
Stampfer MJ; Giovannucci E
Department of Epidemiology, Harvard School of Public
Health, Boston, MA 02215, USA. [email protected]
BACKGROUND: The association of vitamin D status with
prostate cancer is controversial; no association has been
observed for overall incidence, but there is a potential link
with lethal disease.
Vitamin D and Prostate Cancer
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METHODS: We assessed prediagnostic 25-hydroxyvitamin D [25(OH)D] levels in plasma, variation
in vitamin D-related genes, and risk of lethal prostate cancer using a prospective case-control study
nested within the Health Professionals Follow-up Study. We included 1260 men who were diagnosed
with prostate cancer after providing a blood sample in 1993-1995 and 1331 control subjects. Men
with prostate cancer were followed through March 2011 for lethal outcomes (n = 114). We selected
97 single-nucleotide polymorphisms (SNPs) in genomic regions with high linkage disequilibrium
(tagSNPs) to represent common genetic variation among seven vitamin D-related genes (CYP27A1,
CYP2R1, CYP27B1, GC, CYP24A1, RXRA, and VDR). We used a logistic kernel machine test to
assess whether multimarker SNP sets in seven vitamin D pathway-related genes were collectively
associated with prostate cancer. Tests for statistical significance were two-sided.
RESULTS: Higher 25(OH)D levels were associated with a 57% reduction in the risk of lethal prostate
cancer (highest vs lowest quartile: odds ratio = 0.43, 95% confidence interval = 0.24 to 0.76). This
finding did not vary by time from blood collection to diagnosis. We found no statistically significant
association of plasma 25(OH)D levels with overall prostate cancer. Pathway analyses found that the
set of SNPs that included all seven genes (P = .008) as well as sets of SNPs that included VDR (P =
.01) and CYP27A1 (P = .02) were associated with risk of lethal prostate cancer.
CONCLUSION: In this prospective study, plasma 25(OH)D levels and common variation among
several vitamin D-related genes were associated with lethal prostate cancer risk, suggesting that
vitamin D is relevant for lethal prostate cancer.
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Vitamin D, Dementia, and Depression
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Vitamin D and the risk of dementia and Alzheimer
disease
Thomas J. Littlejohns, MSc, William E. Henley, PhD, Iain A. Lang,
PhD, Cedric Annweiler, MD, PhD, Olivier Beauchet, MD, PhD, Paulo
H.M. Chaves, MD, PhD, Linda Fried, MD, MPH, Bryan R. Kestenbaum,
MD, MS, Lewis H. Kuller, MD, DrPH, Kenneth M. Langa, MD,
PhD, Oscar L. Lopez, MD, Katarina Kos, MD, PhD, Maya Soni,
PhD* and David J. Llewellyn, PhD*
Correspondence to Dr. Llewellyn: [email protected]
Published online before print August 6, 2014,
doi:10.1212/WNL.0000000000000755Neurology 10.1212/WNL.
0000000000000755
Vitamin D, Dementia, and Depression
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Vitamin D, cognition, and dementia: a systematic
review and meta-analysis.
Neurology. 2012; 79(13):1397-405
Depressed adolescents in a case-series were low in
vitamin D and depression was ameliorated by
vitamin D supplementation.
Acta Paediatr. 2012; 101(7):779-83
Lower vitamin D levels are associated with
depression among community-dwelling European
men.
J Psychopharmacol. 2011; 25(10):1320-8 (ISSN: 1461-7285)
Vitamin D and TBI
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Combination treatment with progesterone and vitamin D hormone may be more
effective than monotherapy for nervous system injury and disease.
Front Neuroendocrinol. 2009; 30(2):158-72 (ISSN: 1095-6808)
Cekic M; Sayeed I; Stein DG
Department of Emergency Medicine, Emory University School of Medicine, Atlanta,
Georgia 30322, USA.
More than two decades of pre-clinical research and two recent clinical trials have
shown that progesterone (PROG) and its metabolites exert beneficial effects after
traumatic brain injury (TBI) through a number of metabolic and physiological pathways
that can reduce damage in many different tissues and organ systems. Emerging data
on 1,25-dihydroxyvitamin D(3) (VDH), itself a steroid hormone, have begun to provide
evidence that, like PROG, it too is neuroprotective, although some of its actions may
involve different pathways. Both agents have high safety profiles, act on many
different injury and pathological mechanisms, and are clinically relevant, easy to
administer, and inexpensive. Furthermore, vitamin D deficiency is prevalent in a large
segment of the population, especially the elderly and institutionalized, and can
significantly affect recovery after CNS injury. The combination of PROG and VDH in
pre-clinical and clinical studies is a novel and compelling approach to TBI treatment.
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B12
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Vitamin B12 is a B complex vitamin, specifically a cobaltcontaining cobalamin. Vitamin B12 deficiency results in
megaloblastic anemia, peripheral neuropathy, or
dementia.
It is involved in DNA synthesis and regulation, but
also fatty acid metabolism and amino acid metabolism
The reference range of vitamin B12 is 180-914 ng/L,[1,
2] or 150-900 pg/mL.[3
Generally more accepted normal range is 200-220 ng/L
However MMA starts to rise at 400 leading many to
believe anything under
390 should be regarded with suspicion
B12 in the US
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The prevalence of vitamin B-12 deficiency is difficult to ascertain
because of diverse etiologies and different assays, ie, radioassay or
chemiluminescence. Affected individuals may number 300,000 to 3
million in the United States.
Using the radioassay and a value less than 200 pg/mL, the
prevalence of vitamin B-12 deficiency is 3-16%. In a geriatric
population using a radioassay cutoff of 300 pg/mL and elevated
HC and MMA levels, a prevalence of 21% was reported.
Of HIV-seropositive individuals, 11% are vitamin B-12 deficient;
another 12% have levels of 200-240 pg/mL. In a subgroup with
chronic diarrhea, the rate reaches 39%. However, the importance
for vitamin B-12 deficiency in the development of neurologic disease
in these patients remains unclear.
B12 Elsewhere
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In Japan, minimum recommended blood levels of
B12, 500 pg/ml (Jpn. J. Psychiatry Neurol. 1988
Mar:42(1):65–71), are more than twice the
minimum acceptable levels in the U.S., 200 pg/ml
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B12 Testing
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Utility and limitations of biochemical markers of
vitamin B12 deficiency.
Eur J Clin Invest. 2013; 43(3):231-7 (ISSN: 1365-2362)
DISCUSSION: Testing for vitamin B12 deficiency should
start with holotranscobalamin measurement.
Holotranscobalamin between 23 and 75 pM should be
followed by MMA testing that can filter substantial
number of deficient cases in the grey range in
individuals with normal renal function. This diagnostic
strategy may significantly improve assessing vitamin
B12 deficiency.
B12 Deficiency Complications
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Complications of vitamin B12 deficiency are myriad,
ranging from lethargy and weight loss to dementia.
Causes of deficiency include failure to separate vitamin
B12 from food protein, inadequate ingestion,
absorption, utilization, and storage as well as drugfood interactions leading to malabsorption and
metabolic inactivation.
The roles of B12 deficiency in elevated homocysteine
and elevated methylmalonic acid in various disease
states are still evolving. Timely screening and
replacement of vitamin B12 will help prevent many
complications.
B12 and Immunity
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B12 deficiency can cause immune dysfunction
through Neutrophil and macrophage dysfunction as
well as just plain neutropenia
¤ --ie
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RP case above
B12 also plays a role in immunity versus certain
Viruses.
¤ B12
deficiency can complicate HIV infection
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B12 and Viral Infection
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Serum B12 levels predict response to treatment with
interferon and ribavirin in patients with chronic HCV
infection.
J Viral Hepat. 2011; 18(2):129-34 (ISSN: 1365-2893)
In above decreased response seen at levels less than 260 pm
in non-responder group
Vitamin B12 supplementation improves rates of sustained
viral response in patients chronically infected with hepatitis
C virus.
Gut. 2013; 62(5):766-73 (ISSN: 1468-3288)
B12: Thrombosis and Metformin
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B12 and thrombosis and possible role of Metformin
induced deficiency
Relationship between metformin use, vitamin B12
deficiency, hyperhomocysteinemia and vascular
complications in patients with type 2 diabetes.
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Endocr J. 2013; 60(12):1275-80 (ISSN: 1348-4540)
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Vitamin B12 deficiency, hyperhomocysteinemia
and thrombosis: a case and control study.
Int J Hematol. 2011; 93(4):458-64 (ISSN: 1865-3774)
B12: Neurological and Psychological
Health
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With the defunding of mental Health in SC and the over
dependence on psychotropics w/o first excluding biologic
contributors to these conditions
Hospitalist often are called to “admit” psych hold patient
that have been boarding in ER often waiting weeks for
placement in a state Psychiatric facility.
The basic psych admit work up many of us were taught
on M3 med-school rotation at USCSOM or MUSC is never
done
The Classic work up we ordered was TSH, RPR, B12 +/HIV
I continue to do it and have found all four conditions
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B12: Neurological and Psychological
Health
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Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an
adolescent: case report.
Child Adolesc Psychiatry Ment Health. 2012; 6(1):25 (ISSN: 1753-2000)
Tufan AE; Bilici R; Usta G; Erdoğan A
Assistant Professor, Abant Izzet Baysal University Medical Faculty, Department of Child
and Adolescent Psychiatry, Baysal, Turkey. [email protected].
Vitamin B12 is one of the essential vitamins affecting various systems of the body.
Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and
elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old,
male adolescent who presented with mixed mood disorder symptoms with psychotic
features. Chief complaints were "irritability, regressive behavior, apathy, crying and
truancy" which lasted for a year. Premorbid personality was unremarkable with no
substance use/exposure or infections. No stressors were present. The patient was not
vegetarian. Past medical history and family history was normal. Neurological
examination revealed glossitis, ataxia, rigidity in both shoulders, cog-wheel rigidity in
the left elbow, bilateral problems of coordination in cerebellar examination, reduced
swinging of the arms and masked face. Romberg's sign was present.
B12: Neurological and Psychological
Health
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Laboratory evaluations were normal. Endoscopy and biopsy revealed atrophy
of the gastric mucosa with Helicobacter Pylori colonization. Schilling test was
suggestive of malabsorbtion. He was diagnosed with Mood disorder with
Mixed, Psychotic Features due to Vitamin B12 Deficiency and risperidone
0.5 mg/day and intramuscular vitamin B12 500 mcg/day were started along
with referral for treatment of Helicobacter pylori. A visit on the second week
revealed no psychotic features. Romberg's sign was negative and cerebellar
tests were normal. Extrapyramidal symptoms were reduced while Vitamin B12
levels were elevated. Risperidone was stopped and parenteral Vitamin B12
treatment was continued with monthly injections for 3 months. Follow-up
endoscopy and biopsy at the first month demonstrated eradication of H.
pylori. He was followed monthly for another 6 months and psychiatric
symptoms did not recur at the time of last evaluation. Despite limitations, this
case may underline the observation that mood disorders with psychotic
features especially with accompanying extrapyramidal symptoms lacking a
clear etiology may be rare manifestation of vitamin B12 and/or folate
deficiency in children and adolescents and be potentially amenable to
treatment.
B12 Deficiency and Dementia
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Does Helicobacter pylori Infection Increase Incidence of Dementia?
The Personnes Agees QUID Study
Claire Roubaud Baudron, MD, MSc, Luc Letenneur, PhD, Anthony Langlais, MSc, Alice
Buissonnière, Francis Mégraud, MD, PhD, Jean-François Dartigues, MD, PhD, Nathalie
Salles, MD, PhD
J Am Geriatr Soc. 2013;61(1):74-78.
Abstract and Introduction
Abstract
Objectives: To determine whether Helicobacter pylori infection was associated with
dementia and risk of developing dementia in a longitudinal population-based
cohort of elderly adults living in the community.
Design: Prospective community-based cohort study.
Setting: The population-based Personnes Agées QUID (PAQUID) Study.
Participants: Six hundred three noninstitutionalized individuals aged 65 and older
living in the southwest of France followed from 1989 to 2008.
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B12 Deficiency and Dementia
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Measurements: A descriptive and comparative analysis including
dementia prevalence, according to H. pylori status (serology), was
made at baseline. Cox proportional hazard models were used to
study the risk of developing dementia according to H. pylori status
assessed on sera samples from elderly adults initially free of dementia
and followed for 20 years. A neurologist diagnosed dementia
according to Diagnostic and Statistical Manual of Mental Disorders
Third Edition criteria.
Results: At baseline, 391 (64.8%) subjects (348 women, mean age
73.9 ± 6.5) were seropositive for H. pylori. Dementia prevalence was
higher in the infected group (5.4% vs 1.4%, P = .02). After 20 years
of follow-up, 148 incident cases of dementia were diagnosed. After
controlling for age, sex, educational level, apolipoprotein E4 status,
cardiovascular risk factors, and Mini-Mental State Examination score,
H. pylori infection was determined to be a risk factor for developing
dementia (hazard ratio = 1.46, P = .04).
B12 Deficiency and Dementia
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Conclusion: This longitudinal population-based study provides additional
epidemiological support to the hypothesis of an association between
dementia and H. pylori infection, which may enhance neurodegeneration.
The theory as to why
These findings support the hypothesis of a potential effect of H. pylori
infection on dementia. It may be that chronic H. pylori infection potentializes
the accumulation of cardiovascular risk factors during aging, leading to
greater risk of developing dementia or worsening cognitive decline.
Epidemiological studies have suggested that H. pylori infection may be an
independent risk factor for ischemic cerebrovascular diseases[23,24] by
increasing atherosclerosis, especially for stroke caused by small-artery
occlusion.[25] In contrast, a prospective cohort study of 9,953 older adults
(aged 50–75) did not confirm an association between H. pylori infection,
chronic gastric atrophy, and stroke.[26] A recent study reported that
individuals with AD with H. pylori infection had more-severe dementia
(lower MMSE score and higher cerebrospinal fluid (CSF) phosphorylated
protein tau level) and a higher cerebrovascular load (Fazekas score).[27]
B12 Deficiency and Dementia
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One mechanism by which H. pylori infection may play a role in
neuron damage leading to dementia is a higher plasma
homocysteine level, leading to endothelial damage, cerebrovascular
lesions, and ultimately neurodegeneration.[28] Chronic atrophic
gastritis due to H. pylori infection could result in low vitamin B12 and
folate levels, causing secondary hyperhomocysteinemia. In addition,
systemic and chronic inflammation leading to atherosclerosis could
increase neuroinflammation. A previous study[29] found that acute
and chronic systemic inflammation were associated with neuron
damage and cognitive decline in humans, regardless of the etiology,
like in animal models,[30] hypothesizing that the degenerating central
nervous system produced an amplified cytokine response to systemic
inflammation. Moreover, it was recently reported that H. pylori–
positive individuals with AD had greater systemic (plasma
fibrinogen) and neuro-CSF (tumor necrosis factor-alpha and
interleukin-8) inflammation.
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B12 and Chronic Cough
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How about those Patients you can not get to stop coughing? Stopped ace
added PPI controlled asthma and still cough it might be B12.
Vitamin B12 Deficiency Implicated in Chronic Unexplained Cough
Jacquelyn K. Beals, PhD
December 15, 2009 (Buenos Aires, Argentina) — Results of a new study
show that sensory neuropathy due to deficiency of vitamin B12 might be a
factor in unexplained chronic cough and dysfunction of the pharynx and
larynx. Vitamin B12 supplements improved histamine thresholds and
significantly raised the cough threshold in patients with vitamin deficiency,
but had no effect on control subjects.
The study, presented here at the World Allergy Organization XXI World
Allergy Congress by Giuseppe Guida, MD, from Allergy and Clinical
Immunology, University of Turin and Mauriziano Hospital in Italy, examined
the effect of histamine on the cough threshold and the upper and lower
airway responsiveness in patients with unexplained cough.
B12 and Chronic Cough
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There are different causes of the chronic cough, said Dr. Guida in his
presentation. Among 302 patients with chronic cough seen at their clinic,
causes included adverse drug events, cough reflex sensitivity,
gastroesophageal reflux disease, and allergic rhinitis; chronic cough of
unknown origin comprised about 15% of the patients.
The team of investigators asked whether chronic cough and extrathoracic
airway dysfunction might be manifestations of neuropathy. Vitamin B12
deficiency had been previously found to cause peripheral sensory neuropathy
in many older patients, said Dr. Guida. Thus, this deficiency was pursued as a
possible cause of unexplained chronic cough.
The current study looked at 40 patients with chronic unexplained cough. Of
these, 25 were found to have vitamin B12 deficiency (serum levels
<300 pg/mL); the control group consisted of 15 chronic-cough patients with
no detected nutritional deficiency.
Vitamin B12 deficiency is more common in older individuals, Dr. Guida told
Medscape Allergy and Immunology. "Generally, you can find these lower levels
of vitamins in older people because they can have some problem with their
nutrition."
B12 and Chronic Cough
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Vitamin-deficient and control subjects were evaluated with spirometry, and
their exhaled nitric oxide was measured. Histamine inhalation was used to
assess the bronchial, extrathoracic airway, and cough thresholds. The
histamine challenge test can stimulate the airway enough to cause violent
coughing. The test causes bronchoconstriction, and patients with
hyperresponsive airways react to lower doses of histamine. For this study,
hyperresponsiveness was defined as threshold values below 8 mg/mL.
Patients deficient in vitamin B12 were found to have significantly lower
threshold values for extrathoracic airway and cough, but bronchial
thresholds did not differ from those of control subjects.
B12 deficiency is also known to be accompanied by higher levels of nerve
growth factor (NGF), possibly leading to neurogenic inflammation of the
airway. Analyses of oropharyngeal biopsies obtained from 6 B12-deficient
patients and 3 control subjects revealed significantly higher NGF levels in
the epithelial cells of vitamin-deficient patients than in control subjects (P <
.02). A graph of the data showed an inverse relation between NGF values
and the log of the serum concentration of vitamin B12 (pg/mL).
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B12 and Chronic Cough
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Vitamin B12 supplementation improved histamine thresholds
(reduced hyperresponsiveness) in vitamin-deficient patients
without significantly changing them in control subjects. This
improvement was found in bronchial (P < .01), extrathoracic
airway (P < .001), and cough (P < .01) thresholds.
"Supplementation is certainly very easy to perform . . . by
intramuscular injection," Dr. Guida told Medscape Allergy
and Immunology. "So, theoretically, there is a good way to
treat this disease."
Dr. Guida and Dr. Pizzichini have disclosed no relevant
financial relationships.
World Allergy Organization XXI World Allergy Congress
(WAC): Abstract 290. Presented December 8, 2009
B12: Falls and Fractures
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Falling due to vitamin B12 deficiency.
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Ned Tijdschr Geneeskd. 2013; 157(2):A5132 (ISSN: 1876-8784)
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Jansen L; van der Linden CM
Catharina Ziekenhuis, afd. Klinische Geriatrie Eindhoven, the Netherlands.
BACKGROUND: Ataxia due to a vitamin B12 deficiency can be a cause of
falls in elderly patients.
CASE DESCRIPTION: An 86-year-old woman presented with functional decline
and gait problems. She had been falling regularly. The patient's gait was
ataxic and she was unable to stand without support. Additional laboratory
tests showed a volume macrocytic blood picture and a severe vitamin B12
deficiency, as well as antibodies directed against intrinsic factor and parietal
cells. We diagnosed her as having falls and ataxia caused by vitamin B12
deficiency. Vitamin B12 supplementation resulted in improvement of gait.
CONCLUSION: Ataxia due to vitamin B12 deficiency is a rare problem which
in 20-25% of cases is not accompanied by anaemia. Prompt treatment
reduces the chance of neurological sequelae.
B12 and Bone
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Not only does low B12 cause your patients to fall but also may make the
bone more prone to fracture.
Vitamin B12, folic acid, and bone.
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Curr Osteoporos Rep. 2013; 11(3):213-8 (ISSN: 1544-2241)
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Swart KM; van Schoor NM; Lips P
Vitamin B12 and folic acid deficiency are associated with a higher serum
concentration of homocysteine. A high serum homocysteine is a risk factor for
fractures. Both vitamins play a role in the remethylation of homocysteine to
methionine. The pathophysiology from a high serum homocysteine to fractures
is not completely clear, but might involve bone mineral density, bone turnover,
bone blood flow, DNA methylation, and/or physical function and fall risk.
Genetic variation, especially polymorphisms of the gene encoding for
methylenetetrahydrofolate reductase may play a role in homocysteine
metabolism and fracture risk. It is uncertain whether supplementation with
vitamin B12 and folate can decrease fracture incidence. One double blind
clinical trial in post-stroke patients showed that these B vitamins could
decrease hip fracture incidence, but the results of further clinical trials should
be awaited before a definite conclusion can be drawn.
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B12 and Bone
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Nutrient patterns and risk of fracture in older subjects:
results from the Three-City Study.
Osteoporos Int. 2013; 24(4):1295-305 (ISSN: 1433-2965)
Samieri C; Ginder Coupez V; Lorrain S; Letenneur L; Allès B;
Féart C; Paineau D; Barberger-Gateau P
Department of Nutritional Epidemiology, Inserm U897,
Bordeaux, 33076, France. [email protected]
UNLABELLED: We investigated the association between
nutrient patterns and risk of fractures in 1,482 older subjects.
Patterns associated with higher intakes of Ca, P, vitamin B12,
proteins and unsaturated fats, and moderate alcohol intake,
provided by diets rich in dairies and charcuteries, were
related to a lower risk of wrist and hip fractures.
B12 and Bone
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INTRODUCTION: The purpose of this study was to investigate the relationship between
patterns of nutrient intake and the risk of fractures in older subjects.
METHODS: Among 1,482 participants from the Bordeaux sample of the Three-City
(3C) Study who completed a 24-h dietary recall and a food frequency questionnaire,
we examined the association between patterns of nutrient intake derived from
principal component analysis and 8-year incidence of self-reported fractures of the
hip, the wrist, and the vertebrae.
RESULTS: A "nutrient-dense" pattern rich in Ca and P, iron, vitamins B including B12,
vitamins C and E, alcohol, proteins, and unsaturated fats, and characterized by a
higher consumption of fruits and vegetables, meats and fish, cheese and milk,
charcuteries, cereals, rice, pasta, and potatoes, was associated with a 19% (95% CI
2-34%, P=0.03) lower risk of wrist fractures. The same pattern was associated with a
14% (95% CI 2-25%) lower risk of fractures at any site. A "south-western French"
pattern rich in Ca, P, vitamins D and B12, retinol, alcohol, proteins, and fats-including
unsaturated fats; poor in vitamins C, E, and K, carotenes, folates, and fibers; and
related to a higher consumption of cheese, milk, and charcuterie and a lower
consumption of fruits and vegetables was related to a 33% lower risk of hip fractures
(95% CI 3-39%, P=0.03).
B12 and Bone
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CONCLUSIONS: Higher intakes of Ca, P, vitamin B12,
proteins, and unsaturated fats and moderate alcohol,
provided by dietary patterns rich in cheese, milk, and
charcuteries, were related to a lower risk of wrist and hip
fractures in our cohort.
Other studies mixed but have basic design problems like
not actually looking at patients who are Vitamin deficient
or who have elevated Homocysteine. They just add
supplements to patients with fractures whether deficient
or not
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10/7/2014
B12 and Hip Fracture
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Plasma homocysteine, folate, and vitamin B 12 and the risk of hip
fracture: the hordaland homocysteine study.
J Bone Miner Res. 2007; 22(5):747-56 (ISSN: 0884-0431)
Gjesdal CG; Vollset SE; Ueland PM; Refsum H; Meyer HE; Tell GS
Department of Public Helath and Primary Health Care, University of
Bergen, Bergen, Norway. [email protected]
Homocysteine and related factors were evaluated as risk factors for
subsequent hip fractures among 4766 elderly men and women. High
levels of homocysteine and low levels of folate predicted fracture,
whereas vitamin B12 and genotypes were not related to fracture risk.
High homocysteine may be a modifiable risk factor for hip fracture.
INTRODUCTION: Elevated plasma total homocysteine (tHcy) and
deficiencies of folate and vitamin B12 are associated with risk of
osteoporosis and fracture. We examined whether plasma levels of
tHcy, folate, and vitamin B12 and the methylenetetrahydrofolate
reductase (MTHFR) 677C-->T and 1298C-->T polymorphisms
predicted hip fracture.
B12 and Hip Fracture
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MATERIALS AND METHODS: This was a population-based prospective study of 2639
women and 2127 men who were 65-67 yr at enrollment in 1992-1993. Information
on hip fracture was obtained from computerized records of discharge diagnoses from
all hospitalizations in the region in the period between enrollment and November 30,
2005. Cox proportional hazard regression was used to estimate fracture risk
according to levels of plasma tHcy, folate, and vitamin B12 and for different
genotypes.
RESULTS: Over a median follow-up period of 12.6 yr, hip fracture was recorded in
184 (7.0%) women and 90 (4.2%) men. The adjusted hazard ratio (95% CI) for
fracture in subjects with high (>or=15 microM) compared with low levels (<9.0
microM) of tHcy was 2.42 (1.43-4.09) among women and 1.37 (0.63-2.98) among
men. Dose-response analyses indicated a positive association between plasma tHcy
and risk of fracture in both sexes and a negative association between plasma folate
and risk of fracture among women only. Plasma vitamin B12 level or MTHFR genotype
was not significantly related to risk of fracture after adjustments for confounding
factors. The association between tHcy and risk of hip fracture was only slightly
weakened by adjustments for plasma levels of vitamin B12 and folate.
CONCLUSIONS: tHcy seems to be a predictor for hip fracture among elderly men and
women. Folate was a predictor among women only, whereas vitamin B12 and MTHFR
genotype did not predict hip fracture. Our data corroborate the hypothesis that
homocysteine may play a role in the pathogenesis of osteoporotic fractures.
In Conclusion
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Vitamin B12 and 25-hydoxy Vitamin D levels are
very importants factors in health
Especially when we will be gauged on readmissions
A single Vitamin D level and B12 level during an
admission is probably more reasonable than all the
daily CBC’s, BMP, and Mag’s that are ordered.
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