When we hear B-vitamins, we often think of vitamin B12 and rightfully so, because this is an essential B vitamin for many functions in our body - see Part 1 for some more details and fun facts on vitamin B12 deficiency. However, there are 8 vitamins that make up the complex - these are essential for our cellular, nerve, cognitive, mood, immune health and resiliency! Also, recently I've seen many patients taking high doses of active B-vitamins, this can be problematic - more details to follow.

Folate (aka Vitamin B9): Folate is essential for healthy tissues as it is required in the synthesis of DNA and nerve formation. Deficiency is associated with neural tube and other birth defects in newborns. In the past several years genetics has been found to be a significant factor in human folate levels. There are many genetic variants or mutations that increase need for active or methylfolate in the body. There are common variants, however, some people have a number of these that can lead to a function deficiency of this important B vitamin. However, the solution is not always to supplement with loads of it either. While we need active folate for DNA repair, cellular healing, and detoxification, too much of it can promote pathways of growth that can promote cancer. Both deficiency of folate and excessive supplementation can promote cancer. The same goes for vitamin B12 and excessive supplementation with vitamin B12 as methylcobalamine. One of the most common genetic variants that involves folate is methylenetetrahydrofolate reductase (or MTHFR, and my patients have a few other nicknames for this). MTHFR is a common genetic variant, with at least 50% of the population having at least one genetic variant. When there are two or more variants the risk for issues including elevated homocysteine (which can lead to cardiovascular disease) increase as well as mental health concerns of anxiety, depression, and even schizophrenia. Just because one has a variant or even two of MTHFR does not mean that they need to supplement with methylfolate. It is important to look at the totality of variants related to methylation and to also consider clinical signs and symptoms. Small amounts of active or methylfolate as in a multivitamin or prenatal vitamin are likely safe, but amounts over 1 gram I have not seen to be clinically useful or helpful for the majority of my patients. On multiple occasions I've seen higher doses cause aggravations of anxiety and a few occasions I've even seen the amount in a multivitamin be aggravating. Rarely, there are patients whose genetic need does require a higher dose of supplementation. The bottom line is that it is important to consider genetic methylations in totality, rather than just looking at a single variant to inform possible supplementation and work with a provider who has some training around this. Additionally, lifestyle, including a wholefoods diet, adequate sleep, positive outlook, and exercise all have positive impacts on genetic function, and should be the foundational approach to wellness generally. Folate takes its name form foliage, and green leafy vegetables, along with asparagus, broccoli, and brussels sprouts are all great sources of folate along with legumes. Heating foods does cause significant looses of folate. 

Thiamin (aka Vitamin B1): Thiamin is extremely important for blood sugar regulation in the body and a healthy nervous system. Thiamin is require for formation of its coenzyme, thiamin pyrophosphate (TPP), which helps to convert sugars and ketones into energy. I have seen this to be consistently deficient in patients with Type I diabetes, and in many patients with Type 2 and pre-diabetes. I have additionally seen deficiencies in those who consume alcohol daily or regularly. Patients on dialysis, tube feeding, and those with chronic infections are also at risk for deficiency. The main food sources of thiamin are unrefined grains, meats, nuts, and legumes. Deficiency, as I've seen it clinically, typically presents with cognitive deficits (brain fog, memory loss, easily confused) and neuropathy in the hands or feet. Cardiovascular symptoms such as edema or swelling and rapid heart rate can also occur with deficiency. When the blood sugar is elevated we can end up with neurologic issues from cellular damage - thiamin is an important, but often under-considered B vitamin in blood sugar management and amid such symptoms. As with many of our B vitamins genetics can play a role in how well we bind TPP - so some folks who are at high risk for deficiency due to genetics will be at even higher risk for deficiency and related neurologic deficits with regular alcohol consumption.

Niacin (aka Vitamin B3): is essential for the synthesis of coenzymes required for the energy production cycle. Simply stated, without this we cannot produce energy. Thankfully, I rarely see deficiency of this in practice, as it is widely available from common meat, fish, poultry, vegetable (tomatoes, mushroom, corn, and potatoes), grain (wheat, barley, rice) sources and peanuts. Because of the importance of niacin, along with riboflavin, niacin and iron and the fact that the milling of grains results in a loss of it, in the early 1940s the US government established enrichment standards for processed grain products such as bread, pasta and cereals. I recommend wholefoods as the primary source of food, then loss of nutrients at least through processing, is not such a concern.

Riboflavin (aka Vitamin B2): Like niacin, riboflavin is essential for the synthesis of coenzymes required for the energy production cycle. I rarely see severe deficiency of riboflavin in practice. Common food sources are dairy products, enriched grains, meat and eggs, with smaller amounts in some vegetables (spinach, mushrooms, soybeans). Those on vegan diets are more at risk.

I will write more about one of my favorite B vitamins, pyridoxine (vitamin B6), and another favorite pantothenic acid (vitamin B5), as well as biotin (vitamin B7), in my next blog.

I highly recommend working with a provider who is specifically trained in nutrition, including nutritional supplementation. While it may seem harmless to take an over-the-counter, generic vitamin supplement, nothing beats sage advice from a skilled provider. Naturopathic doctors are the only healthcare providers specifically trained in drug-herb and drug-nutrient interactions.

Sarah Giardenelli is a naturopathic doctor and acupuncturist with over 10 years of experience. She enjoys working with patients to solve their complex health concerns. She is a considers the whole picture, recommends the least invasive, natural approaches first and considers lifestyle approaches as foundational for health for her patients at Collective Health Center.