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A senior citizen in his early seventies, Kumar was a diabetic but he did not have any other illnesses. He had been feeling low for the past several months. Recently, he lacked interest in everything, got tired easily and was awake through the nights, feeling listless and anxious for no particular reason.
After much persuasion from his wife and family, he finally agreed to seek psychiatric help. But when he heard this query from the doctor, he felt unsure of his decision. "Most vegetarians have Vitamin B12 deficiency which can cause symptoms like yours," explained Chaugule. Sure enough, Kumar hardly ever ate any meat and his blood level of vitamin B12 turned out to be 180; lower than the required level of 200-600 picograms per milliliter.
Chaugule advised oral supplements of vitamin B along with some other medications, and Kumar reported feeling better within a few weeks of starting this treatment.
Another middle-aged patient came to Chaugule complaining of severe fatigue, for no obvious reasons. Yet another gentleman was very disturbed because he could not sleep peacefully at night. And an elderly person with unmistakable psychotic behavior was brought by his distressed family.
All these people shared two common factors: none of them had a family history of psychiatric illness and they were all vegetarians. Lab tests of all of them revealed decreased vitamin B12 levels.
Chaugule treated all of them with B12 supplements and their complaints resolved in no time.
Many studies over the past decade show that there is a positive association between levels of vitamin B12 and psychiatric disorders, especially in the elderly.
A study published in the journal Age and Ageing in June last year examined 1,000 elderly people in Banbury town in the United Kingdom. Almost 13 percent of them had low vitamin B12 levels. The same people also suffered more from memory loss and depression.
The Department of Psychiatry at Kuopio University Hospital of Finland published a study in BMC Psychiatry in December 2003 which showed that patients suffering from depression showed better treatment outcome when their B12 levels were high.
Doctors from the Department of Internal Medicine at the Faculty of Medicine and Health Sciences in the United Arab Emirates University randomly selected 225 acutely ill hospitalized patients and gave them nutritional oral supplements containing B vitamins. After six weeks, they noticed these patients showed marked improvement in depressive symptoms, as against those who were denied the nutritional supplements. This study was published in the journal Clinical Nutrition in October last year.
Vitamin B12 is a water-soluble vitamin that cannot be manufactured by animals or plants. Bacteria, especially those that live inside our gut, can synthesize it but it is of no use to us as we cannot absorb it into the blood. It is all thrown out with our feces.
Animals get their B12 by eating foods contaminated with feces and B12. We derive ours by consuming meat of these animals. Liver, meat, eggs, fish, shellfish, milk and milk products are rich sources of B12. In some countries, foods like breakfast cereals are fortified with the vitamin, for the benefit of strict vegans.
B12 plays a vital role in manufacturing normal red blood cells, normal DNA and maintaining healthy nerve cells. A small quantity of 2 micrograms daily is required for carrying out these functions. Excess B12 is stored in our liver and hence most of us get by without any deficiency complaints even if we do not consume it every day.
Doctors in the West have observed that the aged living in homes for the elderly often suffer from deficiency of this vitamin, due to dietary deficiencies or problems in absorbing it from food. Alcoholics, whose livers are damaged, are often B12 deficient. Indians, who are mostly vegetarians, also have low B12 levels.
The exact relation of B12 deficiency with psychiatric symptoms is still a mystery. But scientists know that vitamins B12 and B6 play a role in the metabolism of a sulphur-containing amino acid called methionine. Deficiency of these B vitamins disturbs its normal metabolic pathway and causes build up of a substance called homocysteine.
High levels of homocysteine are known to be harmful to our body. It has been implicated in causing heart diseases and injury to the brain matter.
Studies have revealed that levels of this chemical are elevated in people with low levels of B12 and B6. Also, elevated homocysteine values are observed in patients with depression, anger attacks and dementia. Perhaps this explains how B12 deficiency causes mental and behavioral disorders.
Dr. P. J. Rogers from the Department of Experimental Psychology at the University of Bristol in the United Kingdom proposes that diet, and its nutritional value, has a very strong impact on the moods and cognitive functions of individuals. Nutritional components like antioxidant vitamins, B6, B12 and omega-3 fatty acids affect not just the physical but also the mental health of individuals.
Some physicians feel that nutrition is an important factor to be considered particularly during periods of stress. Pregnancy and breast feeding are times of nutritional strain for women and they are more likely to go into depression in this period if they do not eat the right foods. People recovering from major illness, especially after ICU admission, also fall into the susceptible category. Perhaps a deficit of vitamins and antioxidants can explain the depression they suffer during recovery.
Deficiency of B12 is often unrecognized and it is rarely investigated. It can occur in men and women; adults, elderly and even children; and in rich and poor alike. The clinical signs are quite vague and very subtle. In a country like India, where a very small percentage of patients has health insurance, estimating the blood levels of B12 in every suspected case may not be financially feasible.
Vitamin B supplemental tablets are comparatively much cheaper. They are also safe as toxicity with tablets has not been reported. Taken under medical supervision, they can prevent B12 deficiency and avert conditions like nerve damage, dementia, mental disorders and severe anemia.
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(Dr. Pradnya Kulkarni is a clinical pathologist from India. She worked as a consultant pathologist in a private laboratory in Pune before moving to Hong Kong with her husband and young daughter. She is also a freelance writer, focusing on medical issues of public concern. ©Copyright Pradnya Kulkarni.)
