Beyond B12

Many thanks for your reply, Garry. (Ref. MSG#429) I had actually started doing all the things you mentioned, except for the Vitamin B12. Any particular reason for B12 besides general principles? I'll add the DMSA in a while, if he does OK on small doses of EDTA. I actually started him on 1/8 tsp per day.

Thanks again.

Dear Doctor:
At the ORTHOMOLECULAR MEDICAL SOCIETY conference this month in San Francisco, Dr. Richard Kunin reported that using sophisticated DNA snip testing at Great Smokies (GENOVATIONS) and another lab, he is finding mutations in Folic Acid metabolism in nearly 80% of his patients. Some will need folinic acid to handle this matter, which is not just a risk factor for Cancer but for disorders of HOMOCYSTEINE metabolism also. This then is not just for cardiovascular disease, but a problem for all aspects of health. We also have many common disorders in B-12 metabolism that blood tests fail to reveal, but are revealed with methylmalonic acid testing on urine.

Since problems in Methylation are rampant today, the formula I recommended is not just Vitamin B-12. This sublingual formula gives the power of IM injections without the inconvenience. It has done miracles for everything from depression to Cancer in patients. The Methyl form of Cobalamin is the ONLY one proven to REGENERATE nerve. This is just an effort to improve suboptimal nutrition in everyone you treat so that your other therapeutic interventions will work better. This is no different than understanding that 70% of your patients in most areas of the country are VITAMIN D deficient even if they are getting 400 units from some product!

That is why I recommend everyone take sublingual BEYOND B12 for at least 1-2 months so that our other therapies will wind up working better and faster.

It is nice to see that the NEJM in 2001 supports the concepts that NUTRITIONAL supplementation helps to DECREASE the restenosis rate following coronary artery surgery (reference #8).

Sincerely,
Garry F. Gordon, MD,DO,MD(H)

Bmj.com
Folic acid supplementation- beware of vitamin B12 deficiency 30 January 2004

Stephen DH Malnick, Director, Department of Internal Medicine C Kaplan Medical Center, Rehovot, 76100, Israel, Sorel Goland

Following the review by Lucock on folic acid supplementation, we feel that it is appropriate to add a word of caution regarding possible concomitant vitamin B12 deficiency. While there is no doubt that folic acid deficiency is linked with hyperhomocysteinemia, concomitant vitamin B12 deficiency may also be responsible for elevations of homocysteine. Vitamin B12 deficiency can be subtle, manifesting only as an increase in homocysteine and methyl malonic acid levels in blood and urine, with levels of vitamin B12 at the lower limit of normal (1). There is variation in the levels of vitamin B12 in different populations. In the USA, data from the NHANES III survey found a mean serum B12 level of 518 pg/mL and 3% of the population had a serum B12 of less than 200pg/mL (2). In Israel a deficiency of vitamin B12 is more common than is commonly appreciated. We have reported a frequency of vitamin B12 deficiency of 30% in 130 serial patients undergoing coronary angiography (3), and another group has found a frequency of vitamin B12 deficiency of 22.3% in Ashkenazi Jews and 40 % in patients with Gaucher's disease (4). Furthermore, in a group of 650 hospitalized geriatric patients in Israel, 15% had a vitamin B12 level less than 200 pg/mL and these patients had a higher incidence of cerebrovascular disease (5). As a result, in Israel, the HMOs have responded to the widespread deficiency of vitamin B12 by lowering the normal levels of their laboratories (6).

Since folic acid supplementation may be deleterious in the presence of undiagnosed vitamin B12 deficiency (7), we suggest that vitamin B12 levels be determined prior to administration of folic acid. Another approach may be the use of multi-vitamin tablets. The use of a "folate" supplement consisting of 1 mg of folic acid, 400 µg of vitamin B12 and 10 mg of pyridoxine has been shown to both reduced the levels of homocysteine and decrease the rate of restenosis following angioplasty (8). The cost-effectiveness of these approaches may differ from country to country depending on the prevalence of vitamin B12 deficiency.

1. Green R. Metabolite assays in cobalamin and folate deficiencies. Balliere's Clin Hematol 1995; 8: 533-66.
2. Wright JD, Bialostosky K, Gunter EW, Carroll MD, Najjar MF, Bowman BA, Johnson CC. Blood folate and vitamin B12: United States, 1988-94. Vital Health Stat 11, 1998; 243: 1-78.
3. Goland S, Ayzenberg O, Kuznitz F, Shimoni S, Caspi A, Malnick S. A high incidence of Vitamin B12 deficiency in Israeli patients undergoing coronary angiography. Cardiovasc Drugs Ther. 2003;17(2):191
4. Gielchinsky Y, Elstein D, Green R, Miller JW, Elstein Y, Algur N, et al. High prevalence of low serum vitamin B12 in a multi-ethnic Israeli population. Br J Haematol 2001; 115: 707-9.
5. Shahar A, Feiglin L, Shahar DR, Levy S, Selighson U. High prevalence and impact of subnormal vitamin B12 levels in Israeli elders admitted to a geriatric hospital. J Nutr Health Aging 2001; 5:124-7.
6. Gielchinsky Y, Elstein D, Abrahamov A, Zimran A. How B12 deficiency can impact on the individual and how society can impact on B12 deficiency. IMAJ 2001; 3:672-4.
7. Babior BM, Bunn HF. Megaloblastic Anemias. In Harrison's Principles of Internal Medicine 15th Edition. Eds. Braunwald E, Hauser SL, Fauci AS, Longo DL, Jameson JL, Jasper DL. McGraw-Hill, NY 2001. pp.674-680.
8. Schnyder G., Roffi M, Pin R, Pin R, Hess OM . Decreased Rate of Coronary Restenosis after Lowering of Plasma Homocysteine Levels. N Engl J Med 2001; 345: 1593-600

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