CRS is, of course, an acronym for can't remember stuff. Memory is the second thing to go when we age; I used to know what the first one was, but I can't think of it right now. As a practitioner you have no doubt run across older patients who have problems with memory and concentration; and some who have actual dementia.
Mark Goodman Ph.D. believes that many patients diagnosed with Alzheimer's disease actually have dementia caused by a lack of vitamin B12. Dr. Goodman has an accredited Ph.D. in behavioral medicine (with a specialization in clinical neuropsychology) from the University of Maryland School of Medicine.
Dr. Goodman is quoted in an interview by Kirk Hamilton that appeared in Clinical Pearls. Dr. Goodman says, " I initially suspected vitamin B12 limits were too low, when I encountered on consultation, geriatric patients admitted with Alzheimer's diagnosis whose frontal lobe functioning was obviously intact. This is inconsistent with Alzheimer's diagnosis. They were exhibiting other global neuropsychological deficits with a systemic/metabolic profile. They were all following cardiac lipid- lowering diets."
He went on to say that he believed that there are many elderly individuals who are sub clinically B12 deficient. Many times these patients have normal blood levels of B12. He points out that people who are B12 deficient experience neurological changes before there is changes in their blood count (pernicious anemia) and that a good dietary history is an important part of the evaluation. According to Dr. Goodman, "In the convalescent facility diet there is little red meat due to expense and the desire to have residents on a lipid lowering regime. Also, there is a normal increase in gastric atrophy in the elderly which reduces vitamin B12 absorption. Thirdly, there is a down-regulation of the enzymes required for the formation and the manufacture of vitamin B12 when less vitamin B12 is consumed." Dr. Goodman points out that if there is no frontal lobe degeneration, the dementia is not Alzheimer's disease.
Dr. Goodman says that high doses of vitamin B12 are without any serious adverse side-effects. Some reports of reversible symptoms of diarrhea, cutaneous rash, polycythemia and possibly peripheral vascular thrombosis, but these are minor and reversible.
Vitamin B12 deficiency is fairly common in older people. Even when the tests for B12 levels are normal, symptoms like forgetfulness, fatigue and depression respond to B12 supplementation. Dr. Goodman's point is that the symptoms of this deficiency can be so severe that the patient is often diagnosed with Alzheimer's disease-even when the blood tests are normal.
Very commonly, poor concentration, forgetfulness or even depression in an older individual is due to a need for vitamin B12. Dr. Goodman has recommended B12 injections for patients needing B12. If you do not have a license that lets you inject your patients with vitamins, this often presents a problem. When I was first in practice I frequently sent elderly patients to their doctor to get a B12 shot. More often than not, the doctor would test B12 levels and tell the patient that the shot was unnecessary. There has, however, been research that shows that high oral doses (more than 3 milligrams per day) can be used to effectively restore vitamin B12 levels. I use a lozenge that has 2 milligrams of B12 and 800 micrograms of folic acid. It is a good idea to give the folic acid with the B12, because they cover similar neurologic territory.
Dr. Goodman's information has been valuable; it gives some scientific validity to a nutritional approach to a common problem. But like so many things in natural health care, we take some science, add some common sense and some clinical experience and come up with something really amazing.
The best stuff I ever learned about B12, I learned from Dr. Harry Eidenier who is a chemist and a bit of a clinical genius. Since deficiencies of vitamin B12 and folic acid can lead to a macrocytic anemia. So why wait until the MCV is over 100 to realize that there is a problem. A person isn't normal one day and suddenly their cells just swell up. Sure enough, if someone comes in with CRS, fatigue, poor attention span or depression, a simple CBC might show you the reason for the problem. An MCV higher than 90 may mean a need for vitamin B12 and folic acid.
It is worth mentioning depression here; Americans spend about $3 billion each year on antidepressants. I remember one patient who was severely depressed and had tried four different antidepressants without any success. The next step was electro-shock therapy. It was the late 1980s and I was shocked that they were still doing this. He had some lab work with him and his RBC was below 4 and his MCV was 97(still "normal" according to his doctors). He responded to the B12 and never did receive the shock therapy.
Another thing that you might see with a B12 deficiency is a low neutraphil count. Sometimes the whole WBC count is low and the percentage of neutraphils is low. If you see the forgetfulness, fatigue or depression and a high MCV, you might be looking at a B12 deficiency and not an immune problem or a chronic infection.
The other thing that Dr. Eidenier pointed out to me is that if an individual needs B12, it is likely that he or she is not producing enough HCl in the stomach. If a person doesn't produce enough HCl, he or she is likely to be deficient in various amino acids (many of which are precursors to neurotransmitters) and most minerals. This is the patient who has gas and bloating after meals. Interestingly enough, the patient may have gastric reflux. Fingernails break easily and bad breath is common.
As we get older, we produce less stomach HCl. So while Dr. Goodman states that the problem many older people have is that they do not eat meat. The truth is that they may not get the nutrients out of the meat even if they do eat it. People tend to develop a sweet tooth as they get older because protein becomes hard to digest. Very often the high cholesterol that Dr. Goodman speaks of is from a metabolic syndrome type of situation caused by eating too much sugar and starch.
A trace mineral, rubidium, is valuable for treating memory and concentration problems. I also learned this from Dr. Eidenier, who cited research that found high levels of rubidium in people who remained youthful late in life. I have to mention a particular company here, because I don't know of anyone else who makes a rubidium supplement. The combination of HCl, B12, and rubidium is a powerful combination that helps people who have too many "senior moments".
There are a number of studies that show the importance of antioxidants (both those found naturally, and in supplementation), DHA and omega 3 fatty acids in general to help protect from dementia. To quote Edward Zamrini, MD "A large body of evidence implicates oxidative damage in Alzheimer's disease pathogenesis." (March 21, 2006 issue of Geriatrics and Aging). In a study, published in the journal, Neurology (March 2000;54:1265-1272) showed that vitamin C and E supplementation could protect against vascular dementia. Also there is research that shows that pesticides create neurologic damage. Of course the presence of aluminum in the plaques associated with Alzheimer's disease has many looking at aluminum in cookware, antacids and antiperspirants. Aluminum is one of the most plentiful elements on the planet. If may be wise to look at other heavy metals, especially mercury. Mercury can actually interfere with the body's ability to detoxify and get rid of other metals-maybe this is at the root of the aluminum accumulation. To protect against Alzheimer's disease get plenty of antioxidants, consume DHA and omega 3 oils, and remove metals and toxins from the body. The oils are especially important, there are studies that show consumption of fish or fish oil seems to protect from dementia.
Curcumin is an antioxidant found in turmeric. Turmeric is a perennial plant, botanically related to ginger that is native to India, China and Indonesia. It is a component of curry powder and prepared mustard. It is used in traditional Chinese medicine and in Indian (Ayurvedic) medicine for its anti-inflammatory properties. The lowest incidence of Alzheimer's disease in the world is in villages in India. Only about 1% of Indians over the age of 65 get the disease. So, perhaps the consumption of curry may be the reason that there are so few cases of Alzheimer's disease. Curcumin, found in turmeric, has been shown to fight the build up of the amyloid plaques found in Alzheimer's disease. Dr. Sally Frautschy, of the University of California, Los Angeles, presented these findings at the 2005 annual meeting of the Society for Neuroscience in San Diego, California. Her paper was entitled: Curcumin Reduces Oxidative Damage and Amyloid Pathology in an Alzheimer Transgenic Mouse.
So the things that work for keeping the mind sharp are the same things that work for everything else. You need fresh produce as a source of natural antioxidants, good essential fatty acids, avoid trans fats, exercise and eliminate toxins.
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