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A B-eautiful mind

MagazineJanuary 2015 (Vol. 25 Issue 10)A B-eautiful mind

As one GP discovered, many cases of low mood and depression are caused by a simple vitamin deficiency

As one GP discovered, many cases of low mood and depression are caused by a simple vitamin deficiency.

Dr Joseph Chandy, a 74-year-old general practitioner in County Durham, is convinced he has discovered a cure for many cases of depression, but to the medical authorities, his treatment is dangerous and unproven. For years he's had to pay for supplies out of his own pocket when he couldn't get National Health Service reimbursement for the treatment. In 2006, his local
health authority banned him from using his treatment on his patients. After many months of deliberation, they finally lifted the ban, only to have it slapped on him again by the General Medical Council in June 2014. Despite the testimonials of hundreds of grateful patients, who have even formed a patient group to champion his work, the GMC order also effectively bans him from using the treatment in any private work outside of the NHS and from practising outside his practice, the Shinwell Medical Group, in Horden. What is Chandy's dangerous and unproven
contraband worthy of GMC reprimands, including a court order? Injections of vitamin B12. "This is what happens when you challenge the Establishment," he said. "It is a witchhunt. They
know I am right, but I am challenging the old thinking, the antiquated thinking." The Chandy case highlights yet more evidence that the condition we call 'depression', which afflicts so many of us-especially at this time of year as we take stock of our lives-is something other than a case of inherent chemical imbalance. According to the standard view of modern medicine, depression is the result of an imbalance in the brain chemical serotonin-a theory that's never been proven-and the standard approach is to use drugs like SSRIs (selective serotonin reuptake inhibitors) to slow the process of serotonin being taken up by the body.

But new evidence increasingly points to the fact that any imbalance in the body may have more to do with a simple deficiency of one or more trace elements that are vital for maintaining mood, or may be part of a larger picture of a metabolic disorder related to other degenerative diseases stemming from dietary causes. Although Chandy treats all sorts of cases of 'puzzling'
illness with vitamin B12, including patients with severe chronic fatigue and multiple sclerosis (see box, right), his casebook also includes a number of patients with debilitating depression that turned out to be a simple vitamin deficiency. Jeanette Chapman, aged 42, for instance, was featured in a BBC documentary about Chandy's work. In it she described how B12 injections helped her recover from severe depression, allowing her to stop taking antidepressants. Chandy has even gone on record to say that many cases of depression may be nothing more than a serious deficiency of vitamin B12 and that a low mood often goes hand in hand with B12 deficiency.

Banning B12
Dr Joseph Chandy had his ah-ha moment more than 40 years ago as a young doctor in India, when he wondered whether there was any connection between the general fatigue and malaise
of many of his pale-looking Brahmin patients and their diet. He also noticed that patients improved after a senior doctor at the Thiruvananthapuram Medical College, where he was practising, prescribed them a liver extract. All the Hindus residing in his area were vegetarian and, as the most readily usable form of B12 is found in meat, fish, milk and eggs, vitamin B12 deficiency is
particularly widespread among vegans or vegetarians. Dr Chandy began experimenting with B12 in India and, after moving to the UK and setting up a practice in the former mining village of Peterlee in County Durham in 1970, he continued to research B12 and its importance to health. Ten years later, he began treating his UK patients with the vitamin after delivering the baby
of Glenise Mason, then 26, who complained of pins and needles sensations in her lower limbs and constant tiredness. He ordered a test and discovered she was severely deficient in B12; shots of B12 promptly ended her problems.

To date, Chandy has treated hundreds of patients suffering from multiple sclerosis (MS) and unexplained fatigue, as well as other unexplained conditions like depression. His work has been applauded in his native India (he was awarded the Glory of India award), and he even met with Prime Minister David Cameron to discuss his findings. A BBC documentary about him and his work was made in 2006, and featured many patients claiming to have had their lives turned around by the B12 treatment, including MS sufferers who got out of their wheelchairs after undergoing the treatment. His devoted patients have even formed a patient group-the B12 deficiency Support Group (www.b12d. org). On June 13 this year, he
was not only ordered to stop prescribing the treatment, but also told he must not treat the condition at all by the Interim Orders Panel of the Medical Practitioners Tribunal Service.

As a GP practising in the same district for 33 years, he has cared for a number of generations, and as a consequence, has discovered that this deficiency can even run in families. Over the years, he has personally funded its successful use to treat hundreds of patientswith depression. One such patient, a woman in her mid-30s, was visiting her mother in Horden from York. She had been
diagnosed with extreme endogenous depression and was on a cocktail of drugs. Although college educated, she'd been unable to work. After Chandy took a blood sample, results showed a severe B12 deficiency. He began to give her regular B12 injections. "Within weeks she started to feel better, and within a month I was able to take her off all drugs," he says. "She ended up getting another degree and now has an important job with the government." A simple lack The B vitamins play a central role in regulating levels of important neurotransmitters like serotonin and
dopamine, which are involved in feeling happy. B12 is vital for the formation of red blood cells, and its deficiency can lead to what is termed 'pernicious anaemia', characterized by mood swings, depression and other conditions often mislabelled as psychiatric problems. New scientific evidence is emerging to show how important B vitamins like B12 are to a buoyant mood. One Finnish study, carried out at 20 different medical centres across Finland, involving more than 400 patients with depressive symptoms was one of the first to discover that levels of vitamin B12 tracked he level of depressive symptoms: those with the highest levels of B12 [331 +/- 176 pmol/L (picomoles per litre)] suffered no symptoms of melancholy, while those with general depressive symptoms had average levels of 324 +/- 135 pmol/L and those with the worst symptoms-or 'melancholic depression'-had the lowest levels of B12 (292 +/- 112 pmol/L).1 A US study of women aged 65 and over found that those who were deficient in B12 were twice as likely to be depressed as those with adequate levels,2 while a population study of nearly 4,000 elderly men and women with depressive illness discovered that those with poor B12 status were 70 per cent more likely to be depressed.3 While it isn't clear why exactly B12 is so central to depression, several theories based on animal models suggest that it has to do with the interaction of B12 and S-adenosylmethionine (SAMe). Found naturally in nearly every cell of the body, SAMe is involved in, among other things, the production and breakdown of brain chemicals like serotonin, melatonin and dopamine- the neurotransmitters involved in regulating mood- and not having enough B12 or folate can reduce levelsof SAMe. This is supported by the fact that a few clinical trials have shown that doses of 200-1,600 mg/day of SAMe were better than a placebo and worked as well as
tricyclic antidepressants in easing depression.4 The important role that micronutrients like B12 play in staving off depression can be seen in the complex and interesting link between depression and an unhealthy diet. There's also evidence linking depression to the same metabolic syndrome-including inflammation, insulin resistance and mitochondrial dysfunction- that underlies many degenerative conditions like heart disease and diabetes. A history of depression is often a marker of future heart disease, which we now know invariably results from inflammation. In one study of nearly 900 people, those who suffered bouts of major depression and mood swings were twice as likely to have a heart attack as those who were not depressed.5 Women with a history of depression are three times more likely to die of a cardiovascular disease and 14 times more likely to die from a heart attack, with men 2.4 times and 3.5 times more likely to die, respectively.

According to the authors, one ofthe culprits included increased serotonin binding in the brain due to persistent stress.6 Depression is also related to high levels of C-reactive protein (CRP), an indicator in the blood thatinflammation is somewhere in the body, although the jury is still out as to whether inflammation causes depression or depression causes the rise in CRP markers.7
Depression is also linked to raised levels of homocysteine,3 and it's known that a vitamin B12 deficiency allows the buildup of homocysteine. The byproduct of the normal
breakdown of protein in the body, this amino acid is a predictor of arterial disease and heart attack, and high levels significantly increase the risks when cholesterol is normal or even low.8
Indeed, high levels of homocysteine can increase the risk of cardiovascular disease fourfold.9 The biggest ever heart-health investigation, the US Framingham Heart Study, revealed that the higher the levels of blood homocysteine, the greater the extent of narrowing (stenosis) of the carotid arteries, while the higher the levels of folate and vitamin B6, the less carotid stenosis.10 What's more, new data shows that a number of nutrients like B12 affect the mitochondria within cells, the 'powerpacks' responsible for each cell's energy production, which also play a vital role in neurotransmitter signalling in the circuits that help to regulate mood. Researchers from Yunnan University in China at the forefront of research into the role of stress and high levels of cortisol on mitrochondrial function have discovered that high levels of cortisol (our flight-or-fight hormone) can cause oxidative damage to mitochondria, so also affecting neurotransmitter Ditch dairy and wheat If your vitamin levels check out but you are still depressed, think twice about dairy and wheat. Nutritionists have discovered morphine-like substances called 'exorphins'-derived from the incomplete digestion of proteins in cereal grains and dairy products-which may be a possible cause of depression. The evidence reveals five distinct exorphins in the pepsin digests of gluten, and eight other exorphins in the pepsin digests of milk.1 These foods can also inhibit the takeup of nutrients like B12. Exorphins act like depressants, and it's now thought that the immune reactions that arise from eating these foods include a number of psychiatric symptoms, even simple 'brain fog'. Depression has also been linked to allergies and coeliac disease, where the inner lining of the small intestine (the mucosa) is damaged after eating gluten-containing grains like wheat, rye, oats and barley.2 According to a recent review, as many one-third of adult coeliacs
suffers from various vitamin deficiencies and neurological changes, including depression.3

References

1 J Biol Chem, 1979; 254: 2446-9
2 Am J Gastroenterol, 1999; 94: 839-43
3 Iran J Neurol, 2012; 11: 59-64
signalling. Nutrients that protect against such oxidative
damage include vitamin B12 and folate, omega-3 fatty
acids, vitamin C, zinc and magnesium.11

Other deficiencies
This new Chinese evidence suggests that a lack of B12 may be only part of a complex picture of deficiencies in a number of nutrients. B vitamins like folate, B6 and niacin play a role in the synthesis of the neurotransmitters involved in mood, and new evidence has discovered a relationship between depression and low levels of folate.12 According to animal research, B6 levels may also affect rates of serotonin synthesis by 20 to 60 per cent.13 Besides the B vitamins, there's evidence that vitamin C plays a role in depression. Dr Hugh Riordan, anAmerican doctor of orthomolecular medicine, describes a patient of his who had been so profoundly depressed with severe fatigue that she'd barely been able to hold down her job as a teacher. Three years of
psychotherapy had made no impact on her condition. After testing her levels of various nutrients, Dr Riordan discovered she had a vitamin C deficiency. He prescribed 500 mg/day of vitamin C, an extremely modest supplementary level by his usual standards. A few weeks later, she returned to his office, claiming a miracle had happened: her mood had entirely lifted.
Other patients in his case files have been helped by zinc, another antioxidant. People who suffer from depression may also lack the proper balance between omega-3 and -6 fatty acids. One
review of the literature on essential fatty acids (EFAs) showed that such imbalances, particularly as we age, can impede the communication between neurons and not only impair cognitive function, but also affect mood, causing depression.14 There's also evidence that omega-3 fats are natural anti-inflammatories that can counteract depression. In a study of 432 adults with major depression, those who took a fish-oil supplement for eight weeks reported significant improvement in their condition compared with those given a placebo.15 Women in the last stage of pregnancy experience a sudden increase in inflammation, which one researcher at the University of New Hampshire says is a major contributor to postnatal depression after giving birth.
Breastfeeding the newborn will lower the possibility of triggering the body's inflammatory response-as will supplementing with omega-3s, the author says.16 Deficiencies of vitamin D, which are widespread in northern climes, including the UK, have also been linked to general depression by affecting neurotransmitters, inflammatory markers and other factors related to depression.

A diet to beat the blues

o Consume a varied wholefood Mediterranean diet, which has been shown to help manage depression.1 This should include liberal quantities of vegetables and fruit, fish, legumes, whole grains and olive oil. Don't cook with or use polyunsaturated oils.
o Eat four to six small meals a day if you're hypoglycaemic (low blood sugar).
o Cut out processed foods, as they contain trans fats and omega-6 fatty acids, which can be inflammatory.
o Limit sugar, which could be causing oxidative stress and insulin resistance.
o Consider supplementing with hydrochloric acid (HCl) if tests show you're low in stomach acid and not digesting your food properly, as this has been linked with B12 deficiency.
Suggested daily dosage: 1 or 2 HCl capsules plus pepsin at the start of every meal
o Get your B12 status checked(see box, page 26).
o Take the entire B complex.Suggested daily dosages: 300 mcg biotin, 100 mg B6 (if over 100 mg, get medical supervision), at least 1,000- 8,000 mcg B12 as methylcobalamin
(better uptake in the body thancyanocobalamin), 400-800 mcg methylfolate (better absorbed than folic acid), 50 mg B1, 50 mg B2, 500 mg pantothenic acid Don't forget other nutrients,
such as:
o Vitamin C. Suggested daily dosage: at least 1-2 g
o Vitamin D. Suggested daily dosage: 1,000-8,000 mg
o Magnesium. Suggested daily dosage: 400-2,000 mg
o Zinc. Suggested daily dosage: 30 mg
o Omega-3 fatty acids, to maintain an ideal ratio of less than 4:1 omega-3s to omega- 6s.
Suggested daily dosage: at least 1,000 mg
o Coenzyme Q10. Suggested daily dosage: 100-200 mg
o l-Carnitine. Suggested daily dosage: 1,000 mg
o Multivitamin/mineral supplement, one that includes calcium, iron, copper, selenium, chromium and potassium.

References 1 Public Health Nutr, 2006; 9: 1104-9

D is for dietary imbalance

By isolating B12 as a treatment for so many diseases, Dr Chandy may have inadvertently stumbled upon a new way to view depression: as not so much a case of inherent brain imbalance as dietary imbalance, the result of our increasingly nutrient-deficient, overly processed Western diet. Although increasingly the scientific literature supports Chandy's clinical findings, the Medical
Establishment, which remains far more trusting of dangerous drugs like SSRIs than of food or vitamins, has chosen to willfully ignore this evidence and has employed a Gestapo-like tactic in an attempt to crush an inexpensive and promising answer to depression and a doctor dedicated to a non-drug approach. This despite the fact that B12 is one of the only nutritional supplements found to be safe at any level, according to a 2004 European Union Report on Nutritional Supplement. Although any nurse in the UK can administer the vitamin to a patient, Chandy is no longer allowed to diagnose or treat any condition with B12. In response, Chandy's patients have set up an online petition to make B12 injections available over the counter (to sign it, see ww.change.org/p/ ian-hudson-please-make-our-life-saving-injectablevitamin- b12-hydroxocobalaminavailable- over-the-counter). Some of his patients even plan to go to Parliament to campaign for the ban to be lifted, and Graham Morris, the local Labour MP and a member of the Health Select Committee, has approached the GMC on Chandy's behalf. Chandy says he is "taking it on
the chin right now", but he's also writing up his findings behind the scenes. "Everyone knows I speak the truth. In India, my work is spreading and there are no such idiotic restrictions there."
Depression can be a multifactoral problem, arising from a mix of diet, lifestyle, life events and even hormonal imbalance. But before embarking on expensive talking cures or taking powerful drugs with potentially damaging side effects, it may make sense to check whether your low moods result from a simple vitamin deficiency like B12. This may be one instance where there is such a thing as a magic bullet.

Lynne McTaggart

References
1 BMC Psychiatry, 2013; 13: 145
2 Am J Psychiatry, 2000; 157: 715-21
3 Am J Psychiatry, 2002; 159:
2099-101
4 Am J Clin Nutr, 2002; 76: 1158S-61S
5 Psychophysiology, 2011; 48:
1605-10
6 Arch Gen Psychiatry, 2011; 68:
1135-42
7 Biol Psychiatry, 2012; 71: 15-21
8 Eur J Cardiovasc Prev Rehabil,
2009; 16: 150-5
9 N Engl J Med, 1997; 337: 230-6
10 N Engl J Med, 1995; 332: 286-91
11 Crit Rev Food Sci Nutr, 2014; doi:10.1
080/10408398.2013.876960
12 J Affect Disord, 2012; 138: 473-8
13 J Neural Transm Gen Sect, 1995;
102: 91-7
14 Neurobiol Aging, 2005; 26 Suppl
1: 98-102
15 J Clin Psychiatry, 2011; 72: 1054-62
16 Int Breastfeed J, 2007; 2: 6


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