Vitamin B12, also known as cobalamin, is a water-soluble vitamin you need for good health. Vitamin B12 is needed for (1):
- production of components of DNA
- production of red blood cells
- regeneration of bone marrow and the lining of the gastrointestinal and respiratory tracts
- maintaining the normal function of cells of the nervous system and spinal cord
- prevention of megaloblastic anemia (chronic blood disorder in which the bone marrow produces overly large, immature blood cells.)
Vitamin B12 deficiency can occur in:
- alcoholic/ smoker
- strict vegetarian
- pregnant/ breastfeeding women
- Crohn's/ coeliac disease
Symptoms of Vitamin B12 deficiency can include;
- fatigue/ weakness
- poor memory
- loss of appetite
- weight loss
- vision problems
- low sperm count
According to Havard's blog there was a case report in Harvard-affiliated Massachusetts General Hospital published in The New England Journal of Medicine -- Over the course of two months, a 62-year-old man developed numbness and a “pins and needles” sensation in his hands, had trouble walking, experienced severe joint pain, began turning yellow, and became progressively short of breath. The cause was lack of vitamin B12 in his bloodstream, Furthermore, it could have been worse, a severe vitamin B12 deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence, loss of taste and smell, and more (2).
As we age, our digestive system doesn't produce as much acid which means absorption of Vitamin B12 is decreased. A simple blood test can determine if you have low Vitamin B12 and supplementation can help with bringing Vitamin B12 levels up.
1 , S.B. (2008, February 12). Vitamin B12--State of the Science. National Heart, Lung, and Blood Institute. Retrieved Feb 2016.
2. Vitamin B12 Deficiency Can Be Sneaky, Harmful. (2013, January 30). Harvard Health Blog. Retrieved Feb 2016.
Ginkgo biloba (Ginkgo), a herb supplement has been hailed "the most important single development in Western Herbal Medicine" in recent years. Ginkgo extract, which entered the market in Germany in 1982, is registered for treatment of several diseases and is now used by more than 10 million Europeans annually. It is also government approved and is covered by insurance and the German national health care system (1).
Gingko contains flavonoids and terpenoids -- two phytochemicals known to have healing and antioxidant properties. Today ginkgo is mostly used to help treat circulation problems, boost mood, tinnitus and enhance memory and concentration (in the case of dementia or Alzheimer's).
A recent review has been published on Aug 2015 looking at efficacy of Ginkgo biloba extract EGb 761® in dementia with behavioural and psychological symptoms (BPSD). The pooled analyses provide evidence of efficacy of EGb 761® at a daily dose of 240 mg in the treatment of out-patients suffering from Alzheimer's, vascular or mixed dementia with BPSD (2). In fact EGb 761® is one of the anti-dementia drugs with proven benefits and is recommended by international guidelines for the symptomatic treatment of dementia (3). It preserves and improves mitochondrial function and energy metabolism, promotes hippocampal neurogenesis and neuroplasticity and enhances cerebral blood flow by decreasing blood viscosity (4).
For patients who have memory problems and dementia, the recommended dosage of ginkgo is 120 to 240 mg daily taken in two to three doses. While the dosage in patients with tinnitus and peripheral vascular disease is no more than 160 mg per day and should be taken in two or three doses. An initial period of 6 to 12 weeks is recommended to assess the effectiveness of ginkgo, although results have been as early as 4 weeks. It is important to speak to your health care provider before taking ginkgo as ginkgo anti-seizure medications, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, antihypertensives and antidepressants. Although it is generally safe, it is not recommended in pregnant and breastfeeding mums.
1. Freeman L. Mosby’s Complementary and Alternative Medicine. A Research-Based Approach. Mosby, Inc., 2004: p. 455-460
2: von Gunten A, Schlaefke S, Überla K. Efficacy of Ginkgo biloba extract EGb761(®) in dementia with behavioural and psychological symptoms: A systematic review. World J Biol Psychiatry. 2015 Aug 27:1-12. [Epub ahead of print] PubMed PMID: 26223956.
3. Janssen IM, Sturtz S, Skipka G, Zentner A, Velasco Garrido M, Busse R. Ginkgo biloba in Alzheimer's disease: a systematic review. Wien Med Wochenschr. 2010 Dec;160(21-22):539-46. doi: 10.1007/s10354-010-0844-8. Review. Erratum in: Wien Med Wochenschr. 2011 Feb;161(3-4):104. Garrido, Marcial V [corrected to Velasco Garrido, Marcial]. PubMed PMID: 21170694.
4. Müller WE, Heiser J, Leuner K. 2012. Effects of the standardized Ginkgo biloba extract EGb 761® on neuroplasticity. Int Psychogeratr 24(Suppl 1):S21–24.
Woke up this morning and saw this topic all over the news. A jury in US state of Missouri has ordered Johnson & Johnson (J&J) to pay $72m to the family of Jackie Fox from Alabama who died of ovarian cancer last year (aged 62) having used the talc for decades.
Ovarian cancer is one of the most common gynaecological cancers, The cause of the disease is not well understood, except that inherited mutations in the breast cancer genes BRCA-1 and BRCA-2 account for up to 10% of all cases while child-bearing, oral contraceptive use and breast-feeding reduce the risk. For years I have known that talcum powder may cause ovarian cancer. Even though the world has deemed the evidences 'inconclusive' but it is hard to dismiss the fact that talcum powder is even related to ovarian cancer in the first place.
How dangerous are things you buy over the counter? Even the ones made for babies, surely they are the safest? Based on a study done back in 1976, out of 20 body powders, baby powders, facial talcums, and also one pharmaceutical talc -- researchers analysed their mineralogical and chemical composition and found 10 of them contained detectable amounts of tremolite and anthophyllite which is part of the asbestos family while some also contained fragmented forms of these minerals (1).
In 1971, British researchers analysed 13 ovarian tumors under the microscope and found approximately 75% of them have talc embedded in them even though they can't find any traces of asbestos (2).
About 20 epidemiological studies have found increased rates of ovarian cancer risk for women using talc in the perineal region, though some studies have found no association (3).
At this point no research has established a causal association between perineal use of talc and ovarian cancer risk. I'm not a fan of talc and even though the talc in modern days are deemed 'asbestos free' and 'safe' as technology advances, I still wouldn't risk it.
1. Rohl AN, Langer AM, Selikoff IJ, Tordini A, Klimentidis R, Bowes DR, Skinner DL. Consumer talcums and powders: mineral and chemical characterization. J Toxicol Environ Health. 1976 Nov;2(2):255-84. PubMed PMID: 1011287.
2. Henderson WJ, Joslin CA, Turnbull AC, Griffiths K. Talc and carcinoma of the ovary and cervix. J Obstet Gynaecol Br Commonw. 1971 Mar;78(3):266-72. PubMed PMID: 5558843.
3. Langseth H, Hankinson SE, Siemiatycki J, Weiderpass E. Perineal use of talc and risk of ovarian cancer. J Epidemiol Community Health. 2008 Apr;62(4):358-60. doi: 10.1136/jech.2006.047894. Review. PubMed PMID: 18339830.
Your gut health is certainly more important than you think. Do you know that your gut flora promotes normal gastrointestinal function, provides protection from infection, regulates metabolism and comprises more than 75% of your immune system?
With so much focus on gut health, researchers are focusing on probiotics as these microorganisms are naturally found in the human digestive tract that improves the balance of healthy bacteria. The most common strains are Lactobacillus and Bifidobacterium.
Probiotics has been known to treat or prevent a broad range of human diseases, conditions, and syndromes such as acute diarrhea, anxiety and depression, irritable bowel syndrome, high cholesterol, high blood pressure, lactose intolerance, psoriasis etc (1).
Where do you find probiotics? Probiotics are normally consumed in fermented foods with active live cultures such as yogurt. They are also available in supplement form as capsules, liquid, powder and chewables.
Some of the strong benefits of probiotics include treatment in:
- Acute diarrhea. Many studies done in infants or children have reported the use of probiotics to either treat or prevent acute diarrhea (2). Patients who received Lactobacillus GG had decreased severity, shorter duration of illness, shorter hospital stay and were found to have a decreased likelihood of persistent diarrheal illness (3).
- Prevention and Treatment of Atopic Eczema. A study involving 31 infants with atopic eczema who were removed from exposure to cow milk and were given either Lactobacillus GG or a placebo showed that treatment with Lactobacillus GG resulted in a significant improvement in their conditions that was not observed in the placebo group (4).
- Dental Health. Children in a day care center who were given Lactobacillus GG for 7 months and examined for dental caries. The end result, children in the 3–4-year-old age group had significantly lower rates of dental caries and a reduced oral count of Streptococcus mutans (5).
1: Goldin BR, Gorbach SL. Clinical indications for probiotics: an overview. Clin Infect Dis. 2008 Feb 1;46 Suppl 2:S96-100; discussion S144-51. doi: 10.1086/523333. Review. PubMed PMID: 18181732.
2. Allen SJ, Okoko B, Martinez E, Gregorio G, Dans LF. Probiotics for treating infectious diarrhea. Cochrane Database Syst Rev 2003;2:CD003048.
3. Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr 2000;30:54-60.
4. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997;99:179-85.
5. Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res 2001;35:412-20.
How important is Vitamin C? Interestingly even after I have gone through medical school and learnt about myocardial infarction, it has never been mentioned that Vitamin C deficiency could be a risk factor. It is always the more common stuff like smoking, high blood pressure, high cholesterol etc (everything that is bad for your health). What is even more interesting is this study was done in 1997 (way before I did med school) and published in British Medical Journal (BMJ) which is in fact one of the top medical journals in the world.
In 1997, a group of researchers from Finland evaluated 1605 healthy men of randomly selected age of 42, 48, 54 and 60 with no evidence of pre-existing heart disease and they found that men deficient in Vitamin C measured by low plasma ascorbate concentration have a 350% increased incidence of sudden heart attacks compared to those who are not deficient (1).
In fact, they also found that Vitamin C deficiency was associated to raised blood pressure and this is in line with another clinical trial that investigated the effect of antioxidant supplementation on blood pressure in 40 middle aged men where the mean systolic blood pressure decreased by 12.5mm Hg in the supplemented group and by 5.2mm Hg in the placebo group (2).
So what is your Vitamin C level?
1: Nyyssönen K, Parviainen MT, Salonen R, Tuomilehto J, Salonen JT. Vitamin C deficiency and risk of myocardial infarction: prospective population study of men from eastern Finland. BMJ. 1997 Mar 1;314(7081):634-8. PubMed PMID: 9066474; PubMed Central PMCID: PMC2126082.
2. Salonen R, Korpela H, Nyyssönen K, Porkkala E, Salonen JT. Reduction of blood pressure by antioxidant supplementation: a randomised double-blind clinical trial. Life Chemistry Reports1994; 12:65–8.
Interestingly I just came back from a health talk today and the focus was on research translation and it brings back the memories of me attending the 2014 - 3rd annual NHMRC Research Translation Faculty Symposium – "Achieving better health outcomes for Australians living with chronic conditions through more effective research translation". It is very true that although a lot of money has been spent on research and there are abundance of quality and interesting research work being done, the public and the health professionals doesn't necessarily know about it. Just think even if you only learn about 1 research per day, wouldn't that add more value to your life?
I was browsing through one of the hottest topic in research now which is Vitamin D because if you know me personally, the latest project I worked on was on Vitamin D and Type 2 Diabetes. Matter of fact, Vitamin D is also linked to depression!
Depression affects 350 million people worldwide and it is the leading cause of disability. At its worst, depression can lead to suicide and over 800 000 people die due to suicide every year with suicide being the second leading cause of death in 15-29year olds according to WHO. On the other hand Vitamin D deficiency is now a global public health problem affecting a billion people worldwide and studies have found that one third of Australians are Vitamin D deficient. Knowledge on Vitamin D has grown exponentially in recent years with 95% of our current knowledge published in the last 15 years. Interestingly, vitamin D has also been known to be associated with breast cancer fatality rate as shown in my other post.
A longitudinal study found that low vitamin D levels are associated with depressive symptoms, especially in persons with a history of depression (1). Researchers suggested that it might be important to check Vitamin D levels in diagnosed depression cases.
In a randomised double blind controlled trial of 20,000 or 40,000 IU vitamin D per week versus placebo for 1 year on 441 subjects (159 men and 282 women, aged 21-70 years), subjects with serum 25(OH)D levels < 40 nmol L(-1) scored significantly higher (more depressive traits) than those with serum 25(OH)D levels > or = 40 nmol L(-1) on the Beck's Depression Inventory (BDI). In the two groups given vitamin D, but not in the placebo group, there was a significant improvement in BDI scores after 1 year.
Some studies might argue about Vitamin D's controversial theory in aiding depression but overall, being deficient in a vital vitamin for the body is never a good thing so it is very important to make sure your Vitamin D levels are in the normal range to start with.
1: Hoang MT, Defina LF, Willis BL, Leonard DS, Weiner MF, Brown ES. Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center longitudinal study. Mayo Clin Proc. 2011 Nov;86(11):1050-5. doi: 10.4065/mcp.2011.0208. PubMed PMID: 22033249; PubMed Central PMCID: PMC3202994.
2. Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med. 2008 Dec;264(6):599-609. doi:10.1111/j.1365-2796.2008.02008.x. Epub 2008 Sep 10. PubMed PMID: 18793245.
Staying healthy, keeping fit and staying within the normal weight range could be more important than you think. According to an analysis from the Women’s Health Initiative (WHI), postmenopausal women who are overweight or obese have a higher risk of invasive breast cancer than women of normal weight and breast cancer risk increases as a woman’s weight rises beyond obesity (1).
Researchers followed 67,142 postmenopausal women ages 50 to 79 years enrolled from 1993 to 1998 across 40 US clinical centers. After a median of 13 years of follow-up through 2010, 3388 invasive breast cancers were observed.
The researchers then analysed the distribution of breast cancer among different weight classes and calculated the risks for women who were overweight (body mass index, or BMI, of 25 to 30), obese (BMI 30 to 35), or very obese (BMI over 35) compared with women of normal weight (BMI 25 or less). They found that the increased risk of developing breast cancer ranged from 17% in women who were overweight to 59% in those with a BMI over 35. Among women who began the study at a normal weight, those who gained at least 5% of their original weight had a 12% higher risk of developing breast cancer than those who maintained their original weight.
You can calculate your personal risk at the National Cancer Institute website,
1: Neuhouser ML, Aragaki AK, Prentice RL, Manson JE, Chlebowski R, Carty CL, Ochs-Balcom HM, Thomson CA, Caan BJ, Tinker LF, Urrutia RP, Knudtson J, Anderson GL. Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trials. JAMA Oncol. 2015 Aug;1(5):611-21. doi: 10.1001/jamaoncol.2015.1546. PubMed PMID: 26182172.
Is caffeinated coffee the miracle bullet?
An observational study published in Aug 2015 found colon cancer patients who regularly drink caffeinated coffee may be lowering their risk of colon cancer recurrence and death from the disease (1).
Havard researchers followed 950 people with Stage III colon cancer. The participants filled out questionnaires about their dietary patterns during chemotherapy, and then again six months after treatment was completed. The results show people who drank four or more cups of coffee per day were 42% less likely to have cancer return than non-coffee drinkers, and were 34% less likely to die from cancer or any other cause. These findings held up even after accounting for other foods that might impact disease progression, such as sugar-sweetened beverages and carbohydrates.
Researchers added that it's premature to tell patients to drink coffee to reduce their risk of the cancer's return as a randomized trial is needed to show cause and effect. However researchers are encouraged by the results. “Regular coffee intake has been associated with a reduced risk of type 2 diabetes, and it may be that through a similar mechanism, coffee may also improve outcomes for people with advanced colon cancer,” says Dr. Charles Fuchs, senior author on the paper.
1: Guercio BJ, Sato K, Niedzwiecki D, Ye X, Saltz LB, Mayer RJ, Mowat RB, Whittom, R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Hu FB, Ogino S, Wu K, Willett WC, Giovannucci EL, Meyerhardt JA, Fuchs CS. Coffee Intake, Recurrence, and Mortality in Stage III Colon Cancer: Results From CALGB 89803 (Alliance). J Clin Oncol. 2015 Nov 1;33(31):3598-607. doi:10.1200/JCO.2015.61.5062. Epub 2015 Aug 17. PubMed PMID: 26282659; PubMed Central PMCID: PMC4622099.
A latest news reported by The Age has confirmed a case of Zika Virus in a pregnant Victorian women after returning from overseas. It is not revealed which country she travelled to as to protect her privacy. However health professionals are advising women who are pregnant or wish to get pregnant to consider postponing travelling to any country with active Zika virus transmission.
According to ABC News Australia, Victoria's Health Department has released a health alert urging Victorians to "get access to good quality information" before travelling to countries where there was a Zika prevalence. The virus has been identified in 25 countries and currently have active transmission in Brazil and other parts of Central and South America.
On top of that according to Victoria's acting Chief Health Officer Roscoe Taylor, Zika Virus could also be sexually transmitted other than being transmitted by mosquitoes.
Symptoms of Zika Virus can include a fever, a rash which is sometimes itchy, and joint pains. However it is important to note that 80% of the time there might not be symptom at all. Hence, pregnant who have travelled to high risk Zika Virus areas and have symptoms should seek their GP for testing.
My heart goes out to pregnant women diagnosed with Zika Virus, it is truly an extremely stressful and anxious period for these women not knowing whether their unborn child is affected.
The inability to lose weight -- a rather frustrating issue -- has been linked to a lack of calcium. Researchers first observed this “antiobesity effect” accidentally during a study in the 1980s that investigated the antihypertensive effect of dairy products in obese African American men (1). Increasing dietary calcium from ≈400 to ≈1000 mg/d through the consumption of 2 cups (≈437 mL) of yogurt daily for 1 year produced expected decreases in blood pressure that was accompanied by an unexpected 4.9kg reduction in body fat
According to animal and human studies, the calcium stored in fat cells helps regulate the processing and storage of fat in the body. Fat cells that contain the most calcium actually burn more fat, leading to weight loss.
A study published in The Journal of the American College of Nutrition in 2002 summarized data from 9 studies (including 3 controlled trials and 6 observational studies) of calcium intake in which body weight could be assessed as a secondary outcome (2). Overall, increases in calcium intake were consistently associated with reduced indexes of adiposity (body weight, body fat, and weight gain); each 300mg increase in daily calcium intake is associated with a 2.5-3kg lower weight in adults and a 1kg less body fat in children. Consequently, they suggested that a 600mg/d increase in calcium intake (2 standard dairy servings) could reduce the risk of overweight by as much as 70%.
Of course, you can’t simply add calcium on to a high-calorie diet and expect weight loss. But if you have trouble shedding pounds, extra calcium-rich foods in addition to your lower calorie diet could be of great benefit. In fact, studies have shown calcium supplementation could give an edge on weight loss especially in women. University of Washington researchers reviewed a decade's worth of data on 5,341 women ages 53 to 57. Increasing calcium intake, in the form of calcium supplements, may be beneficial for weight maintenance, especially in women during midlife. Women currently taking a calcium supplement dose of >500 mg/day had significantly lower 10-year weight gain than non-users.
Consider Calcium supplements coupled with Vitamin D for optimal health!
1. Zemel MB, Shi H, Greer B, DiRienzo D, Zemel PC. Regulation of adiposity by dietary calcium. FASEB J 2000;14:1132–8.
2: Heaney RP, Davies KM, Barger-Lux MJ. Calcium and weight: clinical studies. J Am Coll Nutr. 2002 Apr;21(2):152S-155S. Review. PubMed PMID: 11999544.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research