A B vitamin supplement is the cheapest, safest, and
most reliable way to improve your wellbeing and overall mental
abilities. I recommend the Bs to those who wish to improve
their mood, mental clarity, and energy. The effects of the
B vitamins are subtle, especially in the young who normally
have adequate dietary intake of these nutrients. Improvements
in cognitive functions from the B vitamins are particularly
noticeable in middle age individuals and the elderly.
In addition to discussing the B vitamins, this chapter will
review coenzymes—the new, more activated forms of the
B vitamins—and make recommendations on how to reduce
levels of homocysteine, an amino acid derivative that can
be harmful to the cardiovascular and neurological system when
present in excess.
Benefits of B Vitamins
Since B vitamins and their coenzymes play important metabolic
roles in numerous biochemical reactions throughout the body,
they can influence just about every aspect of brain and physical
health. As a rule, individuals who take B vitamins notice
Mood and energy
Learning and memory
Speed of thinking
Concentration and focus
Which Clinical Conditions Do the Bs Benefit?
Because of their wide range of effects, B vitamins and their
coenzymes can potentially be helpful in:
Age related cognitive decline
The Bs in the Brain Get an A
B vitamins help in energy production and deficiencies
lead to fatigue and poor mental functioning. The increased
consumption of refined foods has decreased the amounts of
B vitamins present in our diet. However, on the positive note,
small amounts of B vitamins are regularly added to some food
products, such as cereals.
The question of whether B vitamin supplementation is necessary
in healthy individuals who have a normal diet has been debated
ever since vitamins were discovered. The results of several
studies over the past few years have influenced my decision
in favor of low dose supplementation. There can be cognitive
improvements from taking B vitamins. Back in 1995, Dr. D.
Benton and colleagues, from the University College Swansea,
in Great Britain, gave ten times the recommended daily allowance
of nine vitamins (mostly the B vitamins) to healthy college
students (Benton 1995). The study lasted for one year. The
students reported improvement in mood and feeling more agreeable.
There was also an improvement in cognitive functioning, especially
in regards to concentration. Many of my patients consistently
report that B vitamin supplementation improves their energy,
concentration and mood while helping them handle everyday
For otherwise healthy individuals, supplementation with one
to three times the recommended daily allowance of the B vitamins
is suggested. Higher dosages may be required for individuals
with medical, psychiatric, or neurological disorders.
In the past few years, many of the B vitamins have
become available in their more activated forms known as coenzymes.
For instance, the B vitamin niacin is now available in a coenzyme
form known as NADH. An enzyme is basically a protein that
promotes chemical changes in other substances, itself remaining
unchanged in the process. A coenzyme is a substance that facilitates
or is necessary for the action of an enzyme.
The brain, just like a car, needs fuel. Our primary source
of fuel is through fats, proteins, and carbohydrates in the
diet. After digestion in the stomach, foodstuffs are absorbed
into the bloodstream and circulate to various tissues and
cells where they are broken down into even smaller particles.
One of these particles is a two-carbon molecule known as acetyl.
Enzymes help break down these fats, proteins, and carbohydrates
into acetyl and they then help extract the final energy from
acetyl through a process called the Krebs cycle, named after
the German biochemist who defined it. This energy is in the
form of ATP (adenosine triphosphate). Enzymes also need helpers,
and these helpers are called coenzymes. Most of the coenzymes
in the body are partly made from vitamins, such as vitamins
E, C, lipoic acid, and riboflavin (vitamin B2).
The coenzyme form of a B vitamin often has a significantly
more powerful effect than a regular B vitamin. The coenzyme
forms of the B vitamins are an exiting addition to the field
of nutrition. It is quite possible that the elderly or certain
individuals with a particular biochemical deficiency may not
be able to make adequate amounts of the coenzyme forms of
the B vitamins despite adequate intakes of the individual
B vitamins. Hence, the coenzyme forms should be seriously
considered in those who do not respond to the regular B vitamins.
Some companies include most of the Bs in their coenzyme form
together in one pill. I think these products deserve serious
consideration, especially for their use in the middle aged
and the elderly.
The Individual B Vitamins and Their Coenzymes:
Thiamin (B1) is necessary for the metabolism of carbohydrates
and amino acids to adenosine triphosphate (ATP), the primary
source of energy in the human body. Thiamin is found in good
amounts in milk, lean pork, legumes, rice bran, and the germ
of cereal grains, but is lost during food processing and cooking.
The current recommended daily allowance (RDA) by government
advisory panels is about 1.5 mg.
Studies indicate that supplementation with thiamin provides
cognitive benefits. Dr. Benton and colleagues gave 50 mg of
thiamin daily to young adult females for a period of two months
(Benton 1997). The women reported being more clearheaded,
composed, and energetic. The taking of thiamin had no influence
on memory but reaction times were faster following supplementation.
Prior to taking the thiamin, the women had normal blood levels
of this vitamin.
Researchers at Princess Margaret Hospital in Christchurch,
New Zealand, measured thiamin levels in elderly individuals
before giving them 10 mg of the vitamin a day (Wilkinson 1997).
Only the subjects with low thiamin concentrations showed benefits.
They had an improvement in quality of life with more energy
and deeper sleep, along with decreased blood pressure and
Thiamin is now sold in its coenzyme form called cocarboxylase
or thiamin pyrophosphate (TPP). Human studies giving TPP to
evaluate cognitive functioning have not yet been published.
Riboflavin (B2) is a yellow-colored nutrient involved in dozens
of metabolic pathways leading to energy production and the
making of fatty acids and sterols. Good sources are lean meats,
eggs, milk, some vegetables and enriched cereals. The recommended
daily intake is about 1.5 mg. You may notice your urine turning
a deeper yellow color after taking riboflavin.
Riboflavin is part of two larger activated coenzymes known
as flavin adenine dinucleotide (FAD) and flavin mononucleotide
(FMN). FMN is now available as a supplement. One product contains
25 mg of FMN per pill. Human studies giving FAD or FMN in
order to evaluate cognitive functioning have not yet been
Niacin (B3), also known as nicotinamide and nicotinic acid,
plays essential roles in a large number of energy pathways.
Perhaps as many as 200 enzymes are dependent on this nutrient.
Nicotinamide is part of the coenzyme known as nicotinamide
adenine dinucleotide (NADH), which is sold as a supplement.
I will discuss NADH later in this chapter since several studies
have been published regarding this coenzyme. Good sources
of niacin are meats, legumes, fish, and some nuts and cereals.
The recommended daily intake is about 15 to 20 mg.
Niacin for diabetics
People with diabetes often have high cholesterol and triglyceride
levels. They also have low HDL (the good cholesterol) levels.
Niacin, a B vitamin, reduces concentrations of triglycerides
and raises levels of HDL cholesterol. However, the use of
niacin in patients with diabetes has been discouraged because
high doses can sometimes worsen blood sugar control. Researchers
at the University of Texas Southwestern Medical Center evaluated
the use and safety of once-daily extended-release niacin in
diabetic patients with triglyceride problems. During a 16-week,
double-blind, placebo-controlled trial, 148 patients were
randomized to placebo or 1000 mg a day of niacin. Many patients
were also receiving therapy with statins. Patients taking
niacin had an average increase in HDL by about 20 percent
and reductions in triglyceride levels by about 20 percent
compared to the placebo group. Rates of adverse event rates
other than flushing were similar for the niacin and placebo
groups. Four patients discontinued participation owing to
flushing. No harm to the liver or muscles was observed. Blood
sugar levels on average rose only minimally. The researchers
conclude that niacin is a treatment option for patients with
type 2 diabetes who have high triglyceride and low HDL levels.
Dr. Sahelian says: Some diabetics may get benefits with a
lower dose of niacin, such as 200 to 500 mg a day, which would
reduce the incidence of flushing. An extended release form
of niacin seems to be a good option.
Pyridoxine (B6), also known as pyridoxal, is widely available
in most foods including vegetables, legumes, nuts, seeds,
and animal products. The coenzyme form of pyridoxine is pyridoxal
phosphate (PLP) and at least 100 different metabolic reactions
are helped by PLP. PLP is a necessary co-enzyme in the production
of brain chemicals: It helps the conversion of 5-HTP into
serotonin, tyrosine into dopamine and norepinephrine, and
the production of other neurotransmitters such as histamine
and GABA. The recommended daily intake is about 1.5 mg. Deficiencies
in B6 can lead to low mood.
Human studies with PLP in mood disorders and depression have
not yet been published. PLP is available in pills ranging
from 5 to 20 mg. Some individuals notice the difference between
regular B6 and the coenzyme form. Joan, a 53-year old patient
from Beverly Hills, California, says, "I've taken good
quality B vitamins for a few years. Recently I tried the pyridoxal
phosphate form of B6. It really has increased my energy, mood,
Pantothenic acid (B5) is essential for biological reactions
involving acetylation and energy production. This vitamin
helps in the formation of acetylcholine, the metabolism of
fatty acids, and the incorporation of fatty acids into cell
membrane phospholipids. Pantothenic acid is also involved
in making steroid hormones, vitamin A, vitamin D, and cholesterol.
Good sources are egg yolk and fresh vegetables. The recommended
daily intake is about 5 mg. Pantothenic acid is sold over
the counter in dosages ranging from 5 to 250 mg.
My patients report that pantothenic acid helps improve their
mood and energy. Personally, I notice an improvement in alertness,
concentration, energy, and visual clarity with dosages ranging
from 100 to 250 mg. I do experience insomnia, though, when
I take more than 250 mg, even if I take it in the morning.
Benita von Klingspor, a nutritionist in Marina Del Rey, California,
says, "Pantothenic acid is one of my favorite nutrients.
I know the effects of this nutrient extremely well since I’ve
been taking 100 to 250 mg most mornings for more than thirty
years. I often recommend it to many clients with low energy.
Pantothenic acid increases their alertness and focus, improves
their mood, and enhances their joy in life. They begin to
have more interest in whatever they’re doing. However,
if people take too much pantothenic acid, they can become
overstimulated, wired, and easily aggravated."
Pantothenic acid is available in its activated form known
as pantethine. Pantethine, itself, is part of coenzyme A,
a very important substance that participates in the metabolism
of carbohydrates, amino acids, fatty acids and dozens of other
important chemical reactions. Cognitive effects of oral pantethine
administration to humans have not been published. Pantethene
is sold over the counter in dosages ranging from 5 to 50 mg.
In my experience, a lower dosage of pantethine provides similar
effects as a higher dosage of pantothenic acid.
Folic acid, also known as folate, generally functions in cooperation
with vitamin B12 in many metabolic reactions, including the
synthesis of DNA. Folic acid helps reduce levels of homocysteine,
a substance that can increase the risk for atherosclerosis
(discussed later in this chapter). This vitamin functions
as a methyl donor. Folic acid is found in almost all foods
and the recommended daily intake is about 400 micrograms.
The coenzyme form of folate is called tetrahydrofolate.
Cobalamin (B12), or cyanocobalamin, has a number of important
roles in metabolism, including the synthesis of DNA. This
function is particularly crucial when it comes to making new
red blood cells. Hence, a deficiency of B12 leads to anemia.
The formation of myelin—the white sheath surrounding
nerves—is partly dependent of B12. Deficiencies in B12
intake lead to nerve damage, memory loss, poor coordination,
low mood, and mental slowness. This nutrient, along with folic
acid and B6, helps lower levels of homocysteine. High homocysteine
levels are suspected in being one of the factors causing hardening
of the arteries.
The recommended daily intake of B12 is about 3 micrograms,
but much higher dosages are well tolerated. B12 is found mostly
in meats and fish. Vegetarians can become deficient in this
vitamin if they don’t take supplements. B12 deficiency
can occur in the elderly due to malabsorption from the intestinal
tract. If you have gastritis, absorption problems, autoimmune
disorders, insulin dependent diabetes, certain thyroid disorders,
or take antacids and other medicines that reduce stomach acid,
you could have problems in maintaining adequate B12 levels.
Hence, monthly B12 shots, in a dose of 1mg (1,000 micrograms),
could well provide you with positive cognitive benefits. Sublingual
forms of B12 are also available.
There are two coenzyme forms of B12, adenosylcobalamin and
methylcobalamin. Adenosylcobalamin is sold over the counter
as dibencozide, in a dose of 10,000 micrograms, which is a
large dose. Human studies evaluating its role in cognitive
disorders have not been published. It’s quite possible
that with age, nutritional deficiencies, or enzyme deficiencies,
some individuals may not be able to convert B12 into its coenzyme
Biotin is involved in the metabolism of carbohydrates and
fats. It is widely available in foods, particularly egg yolk,
soybeans, cereal, legumes, and nuts. Bacteria in the gut also
make it. The RDA ranges from 30 to 100 micrograms.
All of the B vitamins are important and supplementation
would probably benefit most everyone. For healthy individuals,
taking one to three times the RDA of the Bs would be sufficient.
You will find B complex supplements that say B50 or B100 on
the label. This means that many of the B vitamins, such as
thiamin and riboflavin, are found in dosages of 50 or 100
mg per pill. The RDA for thiamin and riboflavin is about 1.5
mg. The average, healthy person does not need to take these
high dosages. However, biochemical individuality certainly
does exist. Dr. David Benton, Ph.D., who researches the influence
of B vitamins on cognition says, "There can be enormous
differences in the needs of vitamins. It wouldn’t be
unusual for some individuals requiring 20 times the amount
of a particular vitamin compared to others in a similar age
Vitamin B12 deficiency can often be treated with oral supplements
instead of giving an injection. B12 deficiency is common in
patients with reduced acid secretion because acid is required
to release cobalamin from food. But these patients can absorb
oral supplements because the cobalamin is in the crystalline
form and not bound to food. Treatment of pernicious anemia
can be done with oral B!2 at 1000 mcg per day.
A Daily Dose of B Vitamins Keeps the Cardiologist Away
Scientists at the University of Michigan in Ann Arbor say
that people might live longer if they take daily multivitamins
containing recommended doses of folic acid and B12.
Both nutrients help lower blood levels of homocysteine - a
common substance found in the body that can harm blood vessel
walls and encourage blood clotting and hardening of the arteries.
Up to 10% of all heart deaths are thought to be associated
with high levels of homocysteine. Clinical trials have not
yet demonstrated precisely how much benefit can be derived
from lowering levels of the substance, but even a small amount
of benefit would make it worth taking vitamins. A computer
analysis looked at the hypothetical balance between cost and
benefit under several different scenarios, based on what is
known about homocysteine and the effects of folic acid and
vitamin B12. One scenario assumed that reducing homocysteine
levels could reduce heart disease risk linked to the substance
by 40%. The team found that in this situation about eight
life-years could be saved per 1,000 men, and almost four life-years
per 1,000 women.
It did not matter if vitamins were given to all at-risk people,
or just those with elevated homocysteine blood levels. Dr.
Sahelian says: Homocysteine is gradually becoming accepted
as another risk factor similar to high cholesterol levels
in causing hardening of the arteries. A daily dose of folic
acid and B12, in amounts normally found in a multivitamin
supplement, can make a significant impact in reducing a person’s
risk from heart disease.
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