Nutrition Q & A
by Dan Lukaczer, N.D.
Question:
Will a blood test detect a vitamin B12 deficiency?
Answer:
Not all blood tests are created equal, and assessment for vitamin B12 is a prime example. Conventional wisdom used to be that unless a specific anemia called megaloblastic anemia was present—easily detected by a simple blood test—then a B12 deficiency did not exist. Later it was thought that measuring B12 blood or serum levels was enough to determine B12 status.
Now it appears that both methods may be insufficient to detect B12 deficiency in all people. Testing for two metabolites in the blood, homocysteine and methylmalonic acid, now appears to be a far more sensitive determinant of a deficiency. Recent evidence suggests that the extent of B12 deficiency in the population is greatly underestimated, particularly among the elderly.1 Even with normal serum B12 levels, many older people may still be B12 deficient.2
What to do? If customers are concerned about their B12 status, they should have a more sensitive test done. Barring that, taking a higher dose of B12, particularly for people older than 65, is prudent, safe and practical. Research suggests that 300-1,000 mcg/day is an effective dose—far more than is available in a typical multivitamin.
Question:
What can you tell me about Indian ginseng?
Answer:
Ashwagandha (Withania somnifera), often referred to as Indian ginseng or winter cherry, is an herbal medicine that comes from the Ayurvedic tradition. Most of the scientific literature and herbal lore on the plant remedy therefore comes from India.
Ashwagandha, which translates roughly as "smells like horse urine," traditionally has been used as a tonic, adaptogen and aphrodisiac.3 The most significant active constituents are thought to be present in the herb's root, and its pharmacological activity is attributed to a variety of alkaloids.4 Using ashwagandha to treat various rheumatic diseases in traditional Ayurvedic medicine has some scientific validation.5 It is contraindicated in pregnancy and may cause gastrointestinal upset.6
Question:
Can niacin relieve arthritis pain?
Answer:
You are probably referring to work done with osteoarthritis and a particular form of vitamin B3 called niacinamide. Arthritis is typically divided into two subsets: osteoarthritis and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease that affects many older people. Surveys show that 80 percent of people older than 50 suffer some pain, discomfort or debility associated with joint wear and tear.
In the 1940s and '50s, William Kaufman, M.D., published detailed observations on many of his patients with osteoarthritis who took high-dose niacinamide. He documented improvements in joint function, range of motion, increased muscle strength and endurance.7 Unfortunately, his findings were termed anecdotal and largely ignored.
A few years ago, Wayne Jonas from the NIH Office of Alternative Medicine in Bethesda, Md., conducted a 12-week, double-blind, placebo-controlled study of 72 patients to assess the validity of Kaufman's earlier observations. Jonas reported that niacinamide at 3 g/day reduced overall disease severity by 29 percent, inflammation by 22 percent and use of anti-inflammatory medication by 13 percent.8 Patients in the placebo group either had no improvement or worsened.
Although these may be considered only modest changes, Kaufman noted that improvement among his patients started after four to 12 weeks—the time at which Jonas' study stopped. He also found that people might continue to improve for up to a year before they plateau.
The recent study showed no significant side effects, but to be safe, customers who opt for long-term niacinamide therapy should have their liver enzymes periodically assessed by a doctor.
Dan Lukaczer, N.D., is director of clinical services at the Functional Medicine Research Center, a division of HealthComm International Inc., in Gig Harbor, Wash.
References
1. Stabler S, et al. Vitamin B12 deficiency in the elderly: current dilemmas. Am J Clin Nutr 1997;66:741-9.
2. Lindenbaum J, et al. Relevance of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994;60:2-11.
3. Kuppurajan K, et al. Effect of ashwagandha (withania somnifera dunal) on the process of aging in human volunteers. J Res Ayurveda Siddha 1980; 1(247):247-58.
4. Duke J. CRC Handbook of medicinal herbs. Boca Raton(FL): CRC Press; 1987.
5. Asthana R, Raina M. Review Article: pharmacology of withania somnifera (linn) dunal—a review. Indian Drugs 1989;26(5):199-205.
6. Lindner S. Withania somnifera. Aust J Med Herbalism 1996;8(3):78-82.
7. Kaufman W. Niacinamide therapy for joint mobility. Therapeutic reversal of a common clinical manifestation of the normal aging process. Connecticut State Med J 1953;17:584-9.
8. Jonas WB, et al. The effect of nia- cinamide on osteoarthritis: a pilot study. Inflamm Res 1996;45:330-4.
