Vitamin B12: What You Should Know

Having enough B12 can make a big difference in how well you feel. Here are some quick facts about vitamin B12 that you should know about. Knowledge is power - especially when it comes to your health.  

Dietary Sources

Animal protein like fish and meat

Dairy and eggs

Fortified foods and drinks (e.g. some soy-based meat substitutes and beverages)

Signs and Symptoms of Deficiency

Note: you don’t have to have all of these symptoms to have low B12 levels (you don’t even have to have any of these symptoms).

Fatigue

Abnormal CBC results with blood work – this is often the first way that a B12 deficiency is discovered

Heart palpitations

Tongue inflammation

Pallor  

Changes in the skin like loss of pigment or darkening  

Potential impacts on fertility

In more severe cases it can affect the nerves (numbness, tingling), cognitive function and memory

Who’s Most at Risk for Deficiency

Note: Even if you don’t check off anything on this list, you could still have a deficiency. Also, being at risk does not mean you will definitely have a deficiency.

Patients with stomach and colon issues (e.g. surgeries, auto-immune gastritis, inflammatory bowel disease)

Those using certain medications: metformin, some medications for GERD or stomach ulcers

Vegans and vegetarians

Adults over 50-75 years old

Patients with an H.pylori infection

Testing and Results

The “normal” level for B12 varies widely between countries and even depending on which lab you go to! Anything below 150-220 pmol/L could be considered low. But sitting right at the bottom of the normal range doesn’t feel great for many people. I usually like levels to be comfortably above the low end of the reference range.   

Testing B12 isn’t excessively expensive. If your MD tests it, it’s usually covered by OHIP. If I test it, it’s either covered by your workplace/ private health insurance or it’s around $20 out of pocket.

Note that measuring B12 in the blood isn’t a perfect science. If your levels are normal or low-normal but a deficiency is still suspected, other testing may be warranted to confirm deficiency (i.e. testing methylmalonic acid or homocysteine). This extra testing is on the pricey side.  

Supplements: Oral Versus Injection

In many cases oral supplementation is just as useful as injections. But injections can have faster results and some people only seem to respond to injections. I wouldn’t consider injections as first line in most cases.  

I’m all about getting our nutrients from the diet over supplements but in the case of B12, absorption is often better via supplements than food. So if you’re deficient, supplements may be the way to go. Many B12 products come in a form that you dissolve under the tongue. We don’t know for sure if this is better than swallowing the pill.  

How Long Until You Feel Better?

Many patients feel better within a week of taking B12 but just because you don’t, doesn’t mean you should stop taking it. It can take several weeks (even a couple months) for CBC blood test results to normalize and for symptoms to improve.

For a free list of foods linked to lowering anxiety, click the link below.

When Do I Start Taking Vitamin D?

This is a common question that I’ve been getting lately especially with fall getting closer.

As you may know, we get a good chunk of vitamin d from sun exposure. The Canadian guidelines state that 600 IU of vitamin d is needed daily to keep bones healthy. These guidelines take sun out of the equation. In other words, if you spent minimal time in the sun, your bones would still be fine with 600 IU of vitamin d/day according to these guidelines. One reason why sun exposure was not considered when making these guidelines was because it’s not clear how much things like smog, cloud coverage, skin colour, sunscreen use, time of day and even season affects our ability to get vitamin d from the sun. So “they” decided to play it safe and assume everyone was getting minimal sun.

The guidelines also do not take into consideration how much vitamin d is needed for other health outcomes besides bone health. The research behind how vitamin d affects health beyond the bones is promising, but it was not strong enough to make it into the guidelines. That being said, vitamin d has been shown in studies to play a role in fertility, thyroid health, mood, immunity and other conditions.

Many health care providers (including myself) find that vitamin d levels drop in the winter compared to the summer. Having your vitamin d levels tested is not always necessary but in some cases it’s worthwhile to get your levels tested by your naturopathic or medical doctor to determine if you are deficient in vitamin d – especially in winter.

So here’s my answer to the question of “when do I start taking vitamin d”: You need vitamin d year-round. You get it from egg yolks, fatty fish, supplements, fortified foods and sunshine. The Canadian guidelines recommend 600 IU/day year-round to protect your bones. Many health care providers will recommend more. The amount you need and whether you need more during certain times of the year depends on your health history and your vitamin d level.

Vitamin d is an important nutrient. Do not hesitate to ask about whether it’s worth supplementing and/or getting your levels tested.

4 Way to Use Magnesium to Soothe a Troubled Mind

Natural remedies like magnesium are valuable resources to add to your game plan for improving your mood and calming your stress. Some foods that are good sources of magnesium are nuts and seeds, whole grains, dark leafy greens like spinach, beans and lentils.

A 2015 survey done in the U.S. found that half of the population was not getting enough magnesium in their diet. The percentage is even higher for teens and the elderly. Full-blown magnesium deficiency (the type that would lead to severe symptoms) is not very common but many of us are not getting an ideal amount of magnesium from our diets.

Scientists think a lot of us may be walking around with a “sub-clinical” magnesium deficiency. This means that if we were to test our magnesium levels in the blood, they would most likely be normal, but our bodies may still be begging us to get more magnesium into our systems.

This could be why having more magnesium is helpful for so many different conditions – especially mental health conditions. Here are 4 different ways you can use magnesium to help with your mental health:

1. Reduce Depression – Magnesium plays an important role in many chemical reactions in the brain. It’s involved in the activity of brain chemicals (called neurotransmitters) that are key for a happy mood. Numerous studies have found that magnesium is able to improve mood in depressed patients and can potentially help anti-depressant medications work better.

2. Reduce Stress and Anxiety – Magnesium has been found to reduce anxiety is several studies. Of course magnesium can’t change the situations in your life that are causing you stress but many of my patients say they feel a lot more “balanced” and more resilient to stress while taking magnesium.

3. Soothe PMS Anxiety – If you find that your anxiety and mood are worse during PMS, magnesium may be a good fit for you. Studies have shown that it can reduce premenstrual anxiety and I’ve found it to be effective both in practice and personally for premenstrual mood issues.

4. Improve Sleep – Magnesium is a gentle sleep aid. I like to use it to help some of my patients struggling with insomnia. Magnesium does not make you drowsy (hence why it’s fine to take during the day) but it helps you relax, which in turn helps with sleep. I especially like that it doesn’t make you feel groggy the next day like some other sleep remedies.

It’s important to note that the form and dose of magnesium I recommend is different for everyone based on their health history, medications and symptoms. Getting the dose or form wrong can lead to unwanted side effects or a lack of results. I know it can be overwhelming to go to the health food store and see all the options and hear all the opinions about which supplement is the “best”. If you’re confused, talk to a naturopathic doctor. We’re here to help you sort through all that confusion using science, individualized health assessments and our clinical experience.

Take control of your mental health as best as you can. I know this is sometimes easier said than done. Maybe asking a healthcare provider about magnesium will be your first step to reducing your depression, anxiety or stress. If you stay focused, that first step can turn into a revolutionary plan to get you feeling happier, more positive and at peace.   

My Stress Gives me Acne and my Acne Gives me Stress!

Acne doesn’t stop for everyone after high school. I’ve seen plenty of patients in their 20s and older looking for help with their acne. I often hear a similar story from patients: things are really stressful right now, my diet has been off, I’m not sleeping well, my periods have been wonky and I think all this is causing me to break out! And they are usually correct. Acne is often the end result of a lot of things going wrong. That’s why creams, washes and face procedures may help partially but they don’t always completely resolve it. To get good results, acne needs to be treated from the outside and the inside.

Stop the Stress Cycle

Stress is one of the most common acne triggers I’ve seen in my practice. Acne can also trigger a lot of stress. This can make for a cruel stress-acne-stress-acne cycle. Implementing strategies like mindfulness and exercise is important for soothing stress. When that’s not enough, I recommend acupuncture and certain nutrients and herbs to cool down the body’s stress response. Sometimes you may benefit from a cortisol test to see whether this stress hormone is too high or too low. Both scenarios may contribute to acne and they are treated differently.

It's also important to make sure you’re going to bed at a reasonable time and getting enough hours of sleep. This is key for the health of your skin cells and for keeping inflammation and your stress hormones in check. If you struggle with sleep, there are many natural options for improving the quality of your sleep.

When you’re more stressed, you’re more likely to pick at those pimples. That means spreading more acne-causing bacteria around your face and worsening your acne. We’ve all been there. Quelling stress can help you break those nervous habits that are worsening your skin.

Don’t Forget the Rest

Lowering stress is important for reducing acne but there is also other work that needs to be done. I work with my patients to optimize skin-essential nutrients, reduce foods that trigger inflammation in the skin and test and treat hormone imbalances like estrogen and testosterone abnormalities. Combining all of these approaches makes for a powerful punch against acne.

Facial Acupuncture

To reduce acne scarring, even out skin tone and improve the health of the skin I recommend facial acupuncture to some of my patients. I like to combine it with regular, traditional acupuncture which is especially powerful for reducing stress. Like I said before, acne needs to be treated from the outside and the inside.

So if you’re longing for that dewy, fresh skin, let's make it happen. Treating acne may seem superficial but once it’s under control you would be amazed at how much your confidence can soar. Once you feel confident, you feel more excited about heading out into the world and facing work, social situations and life in general.

How to Tell if You're Low in a Vitamin or Mineral

Severe nutritional deficiency is not something that everybody sees all the time. The symptoms of extreme malnutrition are intense and easier to spot. Milder deficiencies are less obvious. Many of you may have these less-than-optimal levels of some vitamins and minerals.

Below I list a few vitamins and minerals and some of the symptoms you can get when you don’t have an ideal amount of them. Some of these nutrients can be tested for. For other nutrients, I usually rely on symptoms rather than testing.

Magnesium

Symptoms of sub-optimal levels: PMS, anxiety and panic attacks, depression, chest tightness, burnout, insomnia, headaches, poor memory, heart palpitations, muscle cramps or twitches, restless leg syndrome.

Testing your levels: Most readily available testing (e.g. blood and hair tests) are not reliable as they do not reflect the levels of magnesium stored in your body.

Zinc

Symptoms of sub-optimal levels: Poor healing of cuts and wounds, weak immune system, hair loss, infertility, acne.

Testing your levels: Blood, urine, hair, saliva and taste tests are not reliable unless deficiency is extreme.

Iron

Symptoms of sub-optimal levels: Fatigue, palpitations, feeling cold, shortness of breath, heavy periods, weakness, depression, anxiety, anemia, dizziness, inability to concentrate, hair loss, restless legs, getting sick often, indigestion.

Testing your levels: a panel of blood tests can be easily done and is reliable.

Vitamin D

Symptoms of sub-optimal levels: Decreased bone density, muscle weakness, pain, fatigue, depression, asthma, eczema, thyroid disfunction, infertility.

Testing your levels: Blood tests are reliable. Sometimes the test fee is covered by OHIP when done by your family doctor or specialist but most of the time it is not covered.

Vitamin B12

Symptoms of sub-optimal levels: neuropathy, fatigue, memory issues, anemia, palpitations, shortness of breath, dizziness on standing.

Testing your levels: Blood tests are reliable.

Other B-vitamins

Symptoms of sub-optimal levels: depression, irritability, nerve and muscle pain or discomfort, fatigue, weakness, anxiety, insomnia, headaches, shortness of breath, anemia.

Testing your levels: Blood or urine tests are possible. For some of the B vitamins, many types of testing are not reliable or necessary. I will often simply recommend B-vitamins and monitor symptoms.

This is certainly not a complete list but it goes over some common symptoms. You’ve probably noticed that a lot of nutrient deficiencies have similar symptoms. It may seem confusing at first. Sitting down with a naturopath to go over your full health history can help with sorting what nutrition support is best for you. If you would like a nutritional assessment, go ahead and book an appointment or free 15-minute consult.