“Vitamin pills to stop dementia a waste of money” ran the Times for their story reporting on the latest research released by the University of Oxford (clinical trial service unit). The University website headlined a conclusion that “Taking B vitamins won’t prevent Alzheimer’s disease”. (link to website item below)
A major focus of the research was in relation to homocysteine levels in the body, and the researchers summary noted “High levels in the blood of a compound called homocysteine have been found in people with Alzheimer’s disease, and people with higher levels of homocysteine have been shown to be at increased risk of Alzheimer’s disease.
Taking folic acid and vitamin B-12 are known to lower levels of homocysteine in the body, so this gave rise to the ‘homocysteine hypothesis’ that taking B vitamins could reduce the risk of Alzheimer’s disease.”
However the conclusion of the researchers was subsequently noted as “Participants receiving B vitamins did see a reduction in the levels of homocysteine in their blood by around a quarter. However, this had no effect on their mental abilities.” Homocysteine is an amino acid that occurs naturally in the body. Elevated levels of blood homocysteine have been linked to increased risks of many common disease conditions.
Elevated levels of homocysteine are commonly caused when insufficient levels of ‘methyl group’ foods, which are typically rich in B Vitamins, are consumed. The research results were greeted with varying levels of dismay and also from some quarters with fierce rebuttal. A number of previous research studies had increased the optimism that suitable levels of B Vitamin supplementation could potentially reduce cognitive health impairment risks such as Alzheimer’s and Dementia. And this optimism was typically focussed on managing homocysteine levels.
Indeed little more than twelve months ago the MRC reported on a separate Oxford University trial with the headline “B vitamins can slow the Alzheimer’s disease-related shrinkage of the brain” and the summary commented “University of Oxford researchers, led by David Smith, Professor Emeritus of Pharmacology, have now found that the subgroup of participants with Mild Cognitive Impairment who had raised blood levels of homocysteine, suffered a rapid rate of shrinkage (atrophy) of particular regions of the brain. This accelerated atrophy was markedly slowed in those who were given the B vitamins and the specific regions protected by the B-vitamin treatment are the same as those that show atrophy in Alzheimer’s disease.” (link below)
‘A Final Answer on this Debate’?
It seemed very surprising that with this latest research the Oxford University website quoted their researchers seemingly so conclusive in their opinion that the research will “offer a final answer on this debate”. And Dr Robert Clarke who led the work is quoted as saying “Our study draws a line under the debate: B vitamins don’t reduce cognitive decline as we age. Taking folic acid and vitamin B-12 is sadly not going to prevent Alzheimer’s disease.”
One would have assumed that this was merely one step in ongoing worldwide research into this vital health matter, but Interestingly the research was not widely reported in the mainstream media apart from the Times. However it drew some fierce criticism too with Graham Keen, Executive Director of the HFMA (Health Food Manufacturers’ Association), as part of a letter to the Times responding:
“A fundamental issue with this study from Oxford University is that in claiming that food supplements do not help with cognitive decline, the trials reviewed actually excluded any persons with a prior diagnosis of Alzheimer disease or cognitive impairment.” said Graham.
“In addition, by looking at this study in isolation it does not acknowledge pre-existing, robust evidence demonstrating the positive impact of food supplements in a range of areas – including cognitive function. For example, there have been less than eight positive EU health claims approved for vitamin B12 alone, including one for Homocysteine metabolism and another for psychological function, each supported by robust research.”
‘Food for the Brain’, a UK non-profit educational charity that “promotes the link between nutrition and mental health” goes into some depth in reviewing the research under the title “’Expert’ group attempts to trash B vitamins for memory prevention”. You can read their assessment via the link to their website further below. Their concerns comprised five key points – a summary of which includes the following:
1. ““Trials in persons selected on the basis of a prior diagnosis of Alzheimer disease or cognitive impairment or depression were excluded because the effects of treatment in people with established cognitive impairment may differ from those in the general population.” In other words, no-one with potential memory issues was included. Also, any study that hadn’t completed by September 2010 was excluded. (The best studies have been in the last five years, not before then.)”
2. “One of the tests used to see if memory had got worse or better was the Mini Mental State Exam (MMSE). The trouble is, it’s a virtually useless test in looking for subtle changes in memory or cognition.”
3. “But, you might wonder, even if the B vitamin takers had no improvement in their MMSE scores, what happened to those not on B vitamins, taking placebos? Of course we need to know. Well, the authors don’t tell you!”
4. “But they don’t do the most obvious thing with that data, given that it is already established that those with mild cognitive impairment and homocysteine above 11mcmol/L get better on B vitamins. That is to divide the study population into those starting with a high, medium or low homocysteine level. For example, while overall there was no significant improvement in MMSE scores what happened to those who started with higher homocysteine levels?”
5. “In the final page they (Oxford University) say “the claims that lowering homocysteine can prevent cognitive aging within just a few years of treatment are not supported by the present meta-analysis.” These are the three unquestionable studies (Durga, De Jager, Douaud and also Smith) that showed significant effects on memory in those given B vitamins. These were not ‘claims’. They were actual study results. These authors specifically showed that in those with raised homocysteine, supplementing B vitamins at the right dose both substantially slows cognitive decline and the rate of brain shrinkage.”
One in three Alzheimer’s cases preventable
The release of this Oxford research was just one of several important studies to be published this month specifically in the field of Alzheimer’s. Much more widely reported was the University of Cambridge research, with the BBC (for example) leading with the headline “One in three Alzheimer’s cases preventable, says research” and a summary:
“One in three cases of Alzheimer’s disease worldwide is preventable, according to research. The Cambridge team analysed population-based data to work out the main seven risk factors for Alzheimer’s disease. These are: Diabetes, Mid-life hypertension, Mid-life obesity, Physical inactivity, Depression, Smoking, Low educational attainment. They worked out that a third of Alzheimer’s cases could be linked to lifestyle factors that could be modified, such as lack of exercise and smoking.”
In addition the ‘Food For the Brain’ website provide an excellent summary of related and linked research from the USA. This highlights the relevance of five key areas comprising education, smoking, physical activity, omega 3 or fish ingestion and homocysteine levels. So again the importance of homocysteine levels are highlighted in helping reduce the risks of Alzheimer’s? (relevant links below include the ‘NCBI’ link). The Food For the Brain summary includes:
“A major review this week of 247 studies, working out how much each risk factor, if dealt with, could reduce Alzheimer’s incidence, concludes that “The strongest evidence thus far is an increased risk of elevated plasma homocysteine or lower educational attainment and a lowered risk with increased physical activity.” The authors estimate that “on average, one in five to one in three cases of Alzheimer’s disease can potentially be averted if those risk factors were eliminated from populations.’”
The Multifactorial Aspects of Health
Taking a ‘step back’ for a moment, for those reading this article who would like more background details on the B-Complex Vitamins and homocysteine, we provide links to relevant Cytoplan blog articles below. This includes an overview of the importance of B-Vitamins for our health and specifically cognitive health, and pertinent details on some previous research in the field of Alzheimer’s and related cognitive health issues.
It is also imperative to stress that there are many varied and interlinked factors that can impact on cognitive health and the potential for increased risks from cognitive impairment such as Alzheimer’s. Our brain needs nutrition throughout our lives, and specific nutrients are more important than others in this respect. So the brain needs B-Vitamins for the maintenance of the nervous system, psychological function and mental performance. The brain also needs minerals such as Zinc, Magnesium and Iodine. Plus suitable levels of antioxidants and Omega 3 essential fatty acids too – the latter of which has the permitted health claim of ‘contributes to the maintenance of normal brain function’. These are all good examples of a longer list of nutrients important for cognitive health.
Then there are other factors too which impact on our health and particularly cognitive health – from preconception stages onward. Do we have a genetic predisposition (Polymorphism) that may negatively affect the body’s assimilation of certain B-Vitamins? What additional modern environmental factors affect each of us dependant on our lifestyles such as stress and pollution (e.g. airborne and ingested toxins).
Returning to raised homocysteine levels, where these occur they are an indication in an individual that something is not quite right. This is typically an indicator, simply put, of unwanted inflammation that if it continues, and is not addressed, can lead to serious health complications. And this could be caused by a combination of factors such as stress, depression and diet (for example).
The multi-factorial nature of predisposition to ill health, whether cognitive or other parts of the body, is highlighted by the previously noted research that cites lack of exercise, poor Omega 3 intake, and smoking as examples of factors that solely and jointly increase risks.
The Importance of B-Vitamins
Returning to the Oxford University research, surely not only do many questions remain as to whether this research is “a final answer on this debate” regarding the potential for B-Vitamins helping to reduce cognitive risks? Equally importantly our concern is that the research may give the perception to some people of diminishing the importance of these vital nutrients (B-Vitamins). Current pertinent issues we would raise, for example, are:
- Note the multitude of current permitted EFSA (European Food Safety Authority) health claims for B-Vitamins and cognitive health – such as maintaining physiological health, nervous health and mental performance
- The need for ongoing research specifically in relation to this health matter yet deploying differing research protocols (as highlighted by the ‘Food for the Brain’ review)
- Maintaining low homocysteine levels is indisputably a good health marker, and good B-Vitamin ingestion is a key factor in moderating or reducing such levels (again note the numerous permitted health claims to this effect)
- Similarly good B-Vitamin levels are needed for health (period). Simply note the numerous permitted EFSA health claims relating to the eight B-Complex vitamins
- The B-Vitamins are primarily ‘water soluble’ and thus need continually replacing. Therefore they need to be obtained from foods or supplements, or a combination of both
- Factors such as genetic impairment, excess alcohol, stress, illness, injury, pregnancy and childbirth, poor diet, restricted diets, ageing, robust exercising (etc.) can all negatively impact on our B-Vitamin levels and supplementation in the appropriate form may provide important nutritional support
- Deficiency in certain B-Vitamins is unfortunately not an isolated occurrence, and this includes the UK. Such deficiencies can cause serious, and sometimes permanent, health complications. Examples include nerve damage, anaemia and B12 deficiency
- UK Government recommendations remain in place for B-Vitamin supplementation and preconception, pregnancy and breastfeeding
Food Supplements – Forms and Dose
The last major point in relation to the research would focus on supplement form and dosage. So for example previous research specifically in relation to B-Vitamins and cognitive health honed in on a daily dosage of 500mcg of vitamin B12 per day as potentially being an optimally beneficial dose for adults. This is a dose significantly higher than the current European recommended daily allowance. However in this specific example many health professionals argue it is the optimal and safe dose based on current information. However in general high doses of specific nutrients on a regular basis are not typically recommended, unless advised by a doctor or health professional.
In addition vitamin B12 (as an example) can come in the supplement form of ‘Cyanocobalamin’ or ‘Methylcobalamin’. We would always recommend the latter as Cyanocobalamin needs to be enzymatically converted to Methylcobalamin in the body. Furthermore B12 can come in a tablet to be swallowed or for sublingual use (dissolves beneath the tongue). Frequently the latter option may be recommended as it allows the vitamin B12 to be absorbed into the blood vessels and thus avoid the problems frequently associated with digestive tract uptake.
A further example is the important B-Vitamin Folic Acid. Folic Acid as ‘Methylfolate’ has more recently emerged as a food supplement option for anyone who needs to supplement with Folate/ Folic Acid. Methylfolate (also known as 5-MTHF and L-Methylfolate) is the most stable, safe and bioeffective form of Folate. It is ideal as a supplement and the form we would recommend.
So with the above examples it would be important to understand what forms and dosages of B-Vitamins researchers used. Such considerations are equally important for us all when contemplating taking food supplements such as a multivitamin. Professional advice should always be sought and our age, gender and pre-existing medical conditions are some of many factors to evaluate.
On this final point the Oxford University research press release contained one further quote that to us seemed most perplexing:
“’Taking supplements like B vitamins doesn’t prevent heart disease, stroke or cognitive decline,’ says Professor Clarke. ‘About 25–30% of the adult population take multi-vitamins, often with the idea that they are also good for the heart or the brain, but the evidence just isn’t there. Much better is to eat more fruit and vegetables, avoid too much red meat and too many calories, and have a balanced diet.”
We would wholeheartedly agree with a healthy and balanced diet rich in fruit and vegetables. However as we have previously noted many permitted health claims exist for nutrients commonly found in multivitamins – for example select B-Vitamins and cognitive health. Moreover, just as one further example, the ‘EPA’ and ‘DHA’ essential fatty acid content of Omega 3 have the permitted health claims of contributing to the maintenance of normal cardiac function and the maintenance of normal blood pressure.
If you have any questions regarding this article, any of the health topics raised, or any other health matters please do contact me (Amanda) by phone or email at any time.
Amanda Williams, Cytoplan
email@example.com, 01684 310099
NCBI: Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis (National Center for Biotechnology Information, U.S. National Library of Medicine)
MRC: B vitamins can slow the Alzheimer’s disease-related shrinkage of the brain (Medical Research Council, May 2103)
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