Vitamin B12 Deficiency: What are the consequences?

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Multiple Sclerosis and Inflammation 

Multiple sclerosis is a common disease of the central nervous system (brain and spinal cord). It an inflammatory condition, which is accompanied by loss of the myelin sheath (demyelination). Myelin is the material that insulates nerves allows the nerves to rapidly transmit its impulses in a smooth and co-ordinated fashion. In multiple sclerosis, the loss of this myelin sheath means that there is a disruption in the ability of the nerves to conduct electrical impulses to and from the brain and this produces the various symptoms of MS. In the places where the myelin is lost little scars (known as plaques or lesions) can appear, which can be seen in brain scans. These multiple scars are described as multiple sclerosis (multiple scaring). 

Symptoms of multiple sclerosis vary from person to person and can change over time in the same person. Most commonly people with MS show signs of fatigue, or muscle weakness, which can also be accompanied by decreased coordination, and eye problems such as blurred, double or hazy vision, with accompanying eye pain. As the disease progresses, symptoms may include muscle stiffness, difficulties thinking and problems controlling urination. 

Evidence suggests that part of the etiology of multiple sclerosis is an inflammatory response in which an immune response occurs to altered myelin basic protein (MBP), an essential protein involved in protecting and maintaining the myelin sheath. Processing of MBP involves methylation of a particular arginine in the molecule, which requires normal levels of folate, methylcobalamin and methionine. If MBP is not properly methylated it leads to MBP with exposed arginine residues. Interaction of these residues with nitric oxide synthase leads to the production of NO, plus the amino acid citrulline. Bouts of MS have now been correlated with increased levels of anti-citrulline-peptide antibodies. It has now been found that there is a strong correlation between MTHFR and/or MTRR mutations and the occurrence of MS. In addition there is now significant evidence that there has been an increase in the incidence of MS with the use of high SPF rated sunblocks, thereby suggesting a significant role for vitamin D in the development of MS.

Vitamin B12 and Multiple Sclerosis 

Many studies have linked the occurrence of vitamin B12 deficiency with an increased incidence of MS. Elevated homocysteine has been correlated with the severity of MS, the levels of which can be reduced by supplementation with methylcobalamin. Whilst it is currently not known why this is, vitamin B12 supplementation has been shown to delay the onset of MS. Prolonged vitamin B12 deficiency can lead to a reduced ability to control of the inflammation associated with MS, thus exacerbating the disease. High doses of vitamin B12 have the potential to reduce the pain and fatigue associated with MS, with minimal side effects. Furthermore, certain analogues of vitamin B12, have been shown to reduce or control inflammation and can provide an energy boost for tired muscles. Vitamin B12 has also been shown to reduce the signs and symptoms of neuritis and as such have the potential to help control the incontinence often associated with advanced MS.T he production of normal MBP (see above) also requires normal levels of methylcobalamin, which may also explain the link between MS and vitamin B12 deficiency. . 

Treatment of Vitamin B12 deficiency and Multiple Sclerosis

By the time a patient develops signs of multiple sclerosis, there has been significant damage to the neurones and vitamin B12 is severely depleted in the liver, but more importantly in the brain and CSF. At this stage standard supplements containing vitamin B12 are not effective in increasing the serum and CSF levels of vitamin B12 and so constant high dose administration of vitamin B12 is required. Recently it has been shown that there is an increased incidence of MS in individuals who have mutations in genes such as MTHFR, MTRR and MTR. The consequence of these mutations it that for MTHFR individuals supplementation will require a combination of 5MTHF PLUS methylCbl. In addition any studies using supplementation on individuals with MTRR mutations or who have low intracellular glutathione levels will be ineffective as these individuals cannot effectively convert CN-Cbl to Ado and MeCbl. Studies have shown that at least with dementia progression can largely be halted by such treatment. A topical form of vitamin B12 has recently been developed that is a specially formulated preparation that is an easy to apply, needle-free delivery system to the skin of the patient with multiple sclerosis. This pain-free form of delivery greatly increases the patient comfort experienced during the administration of the medication and allows for self-medication without the need for medical staff or any special training. It has recently become apparent that oral supplementation with vitamin B12 does not provide enough vitamin B12 to overcome vitamin B12 deficiency due to the limited uptake capacity of the intestine for vitamin B12, hence there is a requirement for higher initial doses of vitamin B12 to be supplied either by injection or via the topical vitamin B12 formulation.  In addition, the topical formulation of vitamin B12 is particularly suited to patients who may have gastro-intestinal problems, such as gastric ulcers, atrophic gastritis, Crohnís Disease and Ulcerative Colitis, or who are on Metformin medication, or who have had bariatric surgery, which can often lead to vitamin B12 deficiency.

Further Information on MS

Check out the following sites for further information on MS

http://www.mult-sclerosis.org/whatisms.html

http://www.msif.org/en/about_ms/what_is_ms.html

Scientific publications on VB12 and MS

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