In this Issue....

- B12 deficiency from antacids too often overlooked
- Vitamin E shows more promise for Alzheimer treatment than common drug, at least in  early stages
- Carnitine decreases statin-induced muscle toxicity
- Study sheds light on mechanism behind magnesium deficiency and bone loss
- A simple multivitamin doesn't help cognitive function, says study
- Review blasts vitamin C research methodology

CLINICAL UPDATE – B12 deficiency from antacids too often overlooked

In this large study, over 210,000 patients were evaluated for B12 status and duration of antacid use. For patients taking a proton pump inhibitor antacid, the chances of having a vitamin B12 deficiency was 66% higher than not having a B12 deficiency. For those people taking a histamine 2 receptor antagonist antacid, their chance of B12 deficiency was 24% higher than not becoming B12 deficient.

This occurs because an acid environment is required to activate proteolytic enzymes that cleave B12 from food. The intrinsic factor, a protein required for B12 absorption, does not work in low acid so intuitively an antacid would potentially cause B12 deficiency, which this study confirms.

Also, the longer the person took antacids or the higher the dose, the higher their chances of becoming B12 deficient, leading researchers to conclude that antacid use “was significantly associated with the presence of vitamin B12 deficiency. These findings should be considered when balancing the risks and benefits of using these medications.”(Journal of the American Medical Association, December 2013)

LINK to ABSTRACT
Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency

CLINICAL UPDATE – Vitamin E shows more promise for Alzheimer treatment than common drug, at least in early stages

613 patients with mild to moderate Alzheimer disease were divided into four groups: (1) vitamin E only, (2) memantine only, which is a drug that acts on receptors in the brain (NMDA receptors) that control memory and cognition, (3) vitamin E plus memantine or (4) placebo. After five years, only the patients taking vitamin E showed significant improvement. Specifically, the vitamin E group showed 19% less clinical decline, which the authors translated to a delay of 6.2 months in functional daily decline, thus decreasing caregiver burden.
(Journal of the American Medical Association, January 2014)

LINK to ABSTRACT
Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAM-AD VA cooperative randomized trial.

CLINICAL UPDATE – Carnitine decreases statin-induced muscle toxicity

Damage to skeletal muscle, reported clinically as myopathy or rhabdomylosis, is a common side effect of statins, which directly affect mitochondrial energy production in muscle. In this study, coenzyme Q10 levels in muscle cells treated with a statin were reduced by 44% and an increase in peroxide free radicals occurred. When these cells were treated with carnitine, the mitochondrial abnormalities were decreased. Researchers concluded that “independently of Co-Q10 levels, L-carnitine prevented the toxic effects of simvastatin.”

In a similar, but unrelated study, carnitine, when co-administered with lipoic acid, another nutrient that plays a key role in mitochondrial function, improved liver enzymes and function in animals with non-alcoholic fatty liver disease.
(Frontiers in Physiology, May 2013)
(Nutrition Research, November 2013)

LINK to ABSTRACT
Protection of rat skeletal muscle fibers by either L-carnitine or coenzyme Q10 against statins toxicity mediated by mitochondrial reactive oxygen generation. LINK to FREE FULL TEXT
LINK to ABSTRACT
 Acetyl-L-carnitine and lipoic acid improve mitochondrial abnormalities and serum levels of liver enzymes in a mouse model of nonalcoholic fatty liver disease.

CLINICAL UPDATE – Study sheds light on mechanism behind magnesium deficiency and bone loss

This in vitro study demonstrates that an intracellular magnesium deficiency will increase the formation of osteoclasts, which are specialized bone cells that resorb bone (vs osteoblasts, which are specialized bone cells that make new bone). The researchers concluded that “altered osteoclast numbers and activity may contribute to the skeletal phenotype as seen in magnesium deficient patients.”
(Journal of Nutritional Biochemistry, August 2013)

LINK to ABSTRACT
Magnesium deficiency results in an increased formation of osteoclasts.

CLINICAL UPDATE – A simple multivitamin doesn’t help cognitive function, says study

In the large Physicians’ Health Study II, over 5900 male physicians were given either a daily multivitamin or placebo for twelve years and evaluated for cognition and memory. There was no difference in cognitive function between the multivitamin and placebo groups although the authors of the paper did explicitly state that limitations of the study included that fact that doses may have been too low or the population may be too well-nourished to benefit from a multivitamin. This study also supports the conclusion that targeted supplementation may have much more clinical relevance than broad low dose “blind” supplementation.
(Annals of Internal Medicine, 2013)

LINK to ABSTRACT
Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial

CLINICAL UPDATE – Review blasts vitamin C research methodology

One of the foremost researchers on vitamin C published this 23 page review that outlines the specific reasons why most studies done on vitamin C are inherently flawed. Some of the reasons cited and explained in detail include but are not limited to the following:

(1) a lack of understanding of the redox nature of vitamin C
(2) culture media that reacts with vitamin C
(3) endogenous vitamin C synthesis in animals that preclude extrapolation of results to humans
(4) interaction of vitamin C with other nutrients when evaluated in a randomized controlled trial
(5) inaccuracy of food frequency questionnaires when evaluating vitamin C intake
(6) lack of correlation between vitamin C intake and blood levels due to inefficient gut absorption
(7) plasma levels not accurately reflecting tissue levels
(Nutrients, December 2013)

LINK to ABSTRACT
Myths, artifacts, and fatal flaws: identifying limitations and opportunities in vitamin C research. LINK to FREE FULL TEXT