TIP # 1: Oh the Magic of B12

I can sing it’s praises all day long.  Vitamin B12 is a mood booster, it makes you smarter, it creates energy and motivation, it restores red blood cell production.  It’s the Sham-Wow! of the vitamin world — I know, because I am no stranger to a persuasive infomercial.  And on an unrelated note, don’t check my closets, attic space, basement or glove compartment.

So, what’s so special about Vitamin B12?

Random side note: Did anyone notice the image for this post is a bunch of orange slices that honestly have nothing to do with B12 or dense breasts?  I was just craving oranges last night….Back to our regularly scheduled programming.

B12 is involved in practically every function in the body….

  • It powers our cell metabolism by converting carbs into usable glucose for fuel.  It’s the proverbial fuel in the tank.
  • It creates energy.  This is arguably also the fuel in the tank.
  • It is required for DNA synthesis (think cell growth and repair)
  • It is needed for nerve conduction and neurotransmitter communication (think mood, memory and focus)– studies show that low B12 is associated with cognitive impairment and dementia.   Low levels are associated with Alzheimer’s disease, Parkinson’s and dementia related to blood vessel disease in the brain.  Low levels are also associated with memory, attention and learning issues.
  • It reduces depression and anxiety — by producing an important substance called SAMe (S-adenosyl methionine).
  • It is required for better digestive function–B12 supports beneficial bacterial growth and may reduce pathogenic strains from taking over.  it also supports digestive enzyme production.
  • It’s great for healthy skin and hair–B12 can reduce dryness, inflammation, redness and acne break-outs.  It can also help reduce eczema and psoriasis.
  • It is important for liver detoxification — it’s a cofactor in phase 1 and 2 detoxification.
  • It creates hormone balance
  • It maintains heart health — B12 lowers homocysteine levels, a substance in blood that is associated with increased risk of heart attack and stroke.
  • It may help prevent cancer by supporting immune system function, particularly colon, cervical and prostate cancers.
  • It prevents anemia

Because it has so many diverse and critical roles in our body, a vitamin B12 deficiency can show up in many different forms with wide-ranging symptoms.

Symptoms can include:

  • chronic fatigue
  • muscle aches
  • joint pain
  • shortness of breath
  • mood changes like depression and anxiety
  • chronic stress
  • feeling run down and low energy
  • poor memory
  • lack of focus
  • the inability to load a dishwasher, place clothing into a hamper or replace the cap on a tube of toothpaste.  All men and children should be screened for B12 deficiency.

According to the NIH (National Institute of Health’s) Dietary Office up to 15 % of people in the US are B12 deficient.  

And that is not taking into account people who are not optimal, which is a separate story.   In my opinion, you never want to be at the bottom 20th% of the supposed “normal range” — it’s like scoring a 65% on a final exam.  Did you pass?  Yes.  Does that mean you have mastery over the material?  Not so much.

The range for B12 is about 250 to 1200 ng/ml.  Some studies suggest that levels lower than 600 are associated with signs and symptoms of B12 deficiency.  So, try to find out your level, ask for your number, and work from there.

Spoiler alert!!! Serum B12 levels may not give you the full story.

Studies suggest that about 50% of patients with B12 related diseases have “normal” B12 levels when tested.  Why is THAT? It’s a long and drawn out story, but blood levels of B12 are not necessarily reflective of what your tissue is seeing.  Wha????

You heard me, BLOOD levels are not reflective of TISSUE levels. So if you suspect you might have a B12 deficiency, ask your doctor to include serum homocysteine levels as well as Methylmalonic Acid (MMA) markers.  These 2 add-on tests will give you the full picture.  Higher levels of homocysteine and MMA may indicate B-12 deficiency in the tissues.

Who’s at risk for B12 deficiency?

I’m going with ALL OF YOU.  But, that’s only because I want everyone to consider B12 supplementation or nutrient support.  Beef liver HERE WE COME!!!   The textbook answer is that you are at risk if:

  • You are elderly (since digestion goes a bit south in older patients)
  • You have low stomach acid (little purple pill users and other acid blocking medication lovers)
  • You are vegan or vegetarian and don’t eat many animal products
  • You are a smoker (as nicotine can block absorption)
  • You are an alcoholic (which is defined as someone who drinks more than I do)
  • You are anemic (low red blood cell levels)
  • You have digestive issues like someone with Crohn’s disease or Celiac Disease — but I would also consider IBS, chronic heartburn, chronic constipation in those categories.

Best supplement sources for B12 — try to find forms of B12 that are bioavailable, a fancy term meaning, it gets into your bloodstream and is readily available for use by your cells. Certain forms are better than others….

Look for methyl-cobalamin, hydroxy-cobalamin or S-adenosyl cobalamin.

Avoid CYANO-cobalamin.  You can remember this because CYANO sounds a lot like CYANIDE.  PLEEEZE read labels on your supplements.

In addition, in order to get the benefits of B12 you need the acid in your stomach to “uncouple” the B12 from the protein in your food a la Gwyneth Paltrow and Chris Martin.  Your stomach needs to combine this freed up B12 with a coupling protein known as Intrinsic Factor.  This coupling with Intrinsic Factor allows B12 to get absorbed into the bloodstream for use. And don’t worry, I will not be using the term “uncoupling” again in this post.

Best food sources of vitamin B12

  • Beef and chicken liver top the list and before you are all, “ewww, gross”  check out some really tasty paleo liver pate recipes.  My favorite is from Diane Sanfillipo’s Practical Paleo Cookbook.
  • Salmon, herring, mackerel, sardines, tuna
  • Lamb
  • Yogurt and raw milk (good luck getting THAT)
  • Feta Cheese or Cottage cheese
  • Grass-fed beef
  • Eggs

How to fix B12 Deficiency

  1. Eat natural food sources listed above
  2. Take a probiotic daily to improve your gut’s ability to absorb B12
  3. Heal your gut.  Many times low B12 is not just about low intake, but more about poor absorption in the gut
  4. Take a high quality B12 supplement as discussed above
  5. Consider B12 injections particularly if you have numerous B12 deficiency symptoms, have digestive concerns that may limit your ability to absorb oral B12 or if you want a quick pick me up.  Also be sure you are getting bioavailable forms of B12 as injection.

Don’t be too worried about taking more B12 than you need.

  • B vitamins are water soluble and will be flushed out in the urine if you are taking higher than needed amounts.
  • Some people may experience headaches, swelling, or anxiousness as a reaction to taking in too much vitamin B12, though this is generally very unlikely.

Okay everyone — let’s get on board the B12 train!!! Check a level, eat more B12 containing foods, get a b12 shot (my favorite) or take a worthwhile supplement.

Tip # 2 What’s the Story with Dense Breasts?

Recently the FDA proposed establishing rules for radiology facilities to inform women if they have dense breasts on mammography.   Why the fuss? Well there are 2 reasons why women should know about breast density.

ONE: the mammography images are not as useful when breast density is high.   Dense breasts basically make it harder to see a cancer, thus can delay diagnosis if it is there in the first place.

TWO: dense breasts may increase the risk of breast cancer

Now before we get all bent out of shape about dense breasts, consider this:

  • Breast density is very common. MANY women have dense breasts: upwards of 75% of women in their 40’s and 60% of women in their 50’s.
  • It is not considered a high risk factor for developing breast cancer, but is one factor that a woman should consider along with other risks.

What should you do if you have dense breasts?

Most physicians will recommend doing additional testing.

3D mammogram

  • Pros:
    • detects 1 additional cancer per 1,000 women screened
    • may reduce the need for call back testing
    • may improve detection in evaluating dense breast tissue
  • Cons:
    • exposes the breast tissue to more radiation

Breast MRI

  • Pros:
    • detects 14 additional cancers per 1000 women screened
    • no additional radiation exposure
  • Cons:
    • increases risk for getting a biopsy in a area that ultimately is NOT found to be cancer (high false positive rate)
    • requires contrast injection
    • very expensive and not covered by insurance unless you are at high risk of cancer

Breast Ultrasound

  • Pros:
    • detects 2 to 4 additional cancers per 1000 women screened
    • no additional radiation
  • Cons:
    • increases risk for getting a biopsy in a area that ultimately is NOT found to be cancer (high false positive rate)
    • exam quality is dependent on the person performing the scan

When to consider additional screening:

First of all, don’t panic.  Most women who receive mammography will be told that they have dense breasts.  I suggest that you scoot on over to a handy dandy “breast cancer risk calculator” that takes into account breast density and other personal risk factors to help determine your personal risk for developing breast cancer in the next 5 years.

Note: this calculator is NOT applicable to women who meet any of the following criteria:

  • Younger than 35 or older than 74
  • Previous diagnosis of breast cancer or DCIS
  • Previous breast augmentation
  • Previous mastectomy

What you can do to reduce your risks:

I would love it if women gave as much thought to preventing breast cancer as they did to trying to find it.  I will expand on 5 steps to prevent breast cancer in our next installment.  But let’s start here……

Prevention Tip  #1 — HYDRATE

  • Minimize alcohol intake to none or at most 1-2 glasses/week
  • Why? Women who had 2 drinks a day had a 51% greater risk of developing breast cancer compared to those who never consumed alcohol

Let’s Prevent Breast Cancer starting right now.  It is as easy as drinking more water to decrease your risk by as much as 51%. Whaaattt?!!

Check out what my good friend Mary Ann Jones has to say about making a habit change stick!

Habit Change Health Coach Tips from MaryAnn Jones, HFHC

Make hydration a habit. We all know we should drink more water but why aren’t we? The secret is putting it on autopilot by creating hydration reminders.

  • You wouldn’t think of starting your day without coffee, place a glass next to the coffee maker and drink the water first
  • Every time you empty your bladder head straight to your water bottle and fill yourself back up
    • Dr. A footnote: perhaps avoid this on public transportation or if you minimal access to a bathroom or if you have anything else to do that day other than pee. 
  • Drink water before, between and after any consumption of alcohol— not only do you reduce your risk of breast cancer but you also save calories and avoid hangover symptoms WIN, WIN, WIN

There are 5 action steps to reduce breast cancer risk significantly.  Check out the Prevent with Five Brochure for more details regarding lifestyle steps to prevent breast cancer.