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Now let's turn our attention to the water soluble vitamins.
And you might think, oh good, I have B
and I have C. Well, it's not quite that simple.
There's a lot of different B vitamins.
So we're going to dissect that B vitamin category a little bit
and look at a whole bunch of different ones.
And vitamin C is really pretty easy,
so that's one that you're more familiar with
and that'll be kind of fun.
A couple of notes about water soluble
vitamins before we dive into them individually.
I mentioned that vitamins are lost during cooking
and this is particularly true of the water soluble ones
because they can just kind of be washed away.
So, again, a little bit more attention
to how we're preparing foods and we're
able to increase or maintain the vitamin content.
These are easily absorbed by your gut
because we don't have to go through any extraordinary
handling with lipoproteins and the lymph system.
They get right into the blood, they
circulate around the body, and the tissues
that need them can absorb them.
And that ease of transport and absorption
also means that they're going to be easily excreted.
So again, if you don't need them,
if you've taken too much of any one of the water
soluble vitamins, you're just going to excrete it.
Now the big difference between the fat soluble and the water
soluble vitamins is storage.
We have what we call a labile pool in the body,
and this is this little reservoir
of the water soluble vitamins.
So if I were to stop eating all of the water soluble vitamins
right this minute, I wouldn't be deficient tomorrow
or probably even next week.
It's going to take time for those residual amounts
in my body to be used up.
So keep that in mind.
Again, the RDAs for vitamins, really, we're
trying to encourage people to meet them
most days on average over time.
And think about strawberry season.
During strawberry season we probably
eat a lot of strawberries and they're very, very rich
in vitamin C. It's a great source.
But then other times of the year we
don't eat very many strawberries.
So we have a little bit of give and take in our diet.
And that's completely normal and completely fine.
For vitamins that we're concerned about,
we want people to seek out a source of that vitamin
several times throughout the week.
And for most people that's not too difficult
because a lot of the B vitamins are
found in multiple areas in our diet.
So anyone that's on a special meal plan,
if they're lactose intolerant, or gluten free, or celiac,
or vegan, or vegetarian, they're not going to have a problem.
There's only a few that I'm going to mention specifically
that we have risk populations that have to do with the diet
that people are on.
So if they're a vegetarian there are
few that we're really concerned about.
With toxicity, this isn't the same kind of toxicity
that we might see with the fat soluble vitamins.
It tends to be more centered around the gut
so again, nausea, vomiting, diarrhea, those
are the kinds of things that we see when people take
too many or too much of the B vitamins or vitamin C.
It's never really going to happen from food.
So when I'm in strawberry season and I sit down
and I have four or six cups of strawberries, which probably
doesn't really happen, I'm not likely to suffer any GI
consequences related to the vitamin C.
I might make myself sick because that's a lot of strawberries,
but it's not anything to do with the micronutrients.
OK, so keep that in mind.
So even if a child is on a food jag
and they're really just interested in cauliflower,
let's say, or broccoli, they're not
going to make themselves sick, vitamin toxic way.
It's really supplements that we're most concerned about.
So let's dive into vitamin C. I think
this is one that we're pretty familiar with.
We automatically probably think orange juice
and if you look at our food sources
that one's on the top of the list up there,
but look at all of these other sources.
So even if people aren't eating citrus fruits
or drinking orange juice, there are plenty of other sources.
And I really encourage you to move beyond just knowing citrus
as a source of this.
Be a little bit more sophisticated
in your vitamin C knowledge.
So broccoli, I mentioned strawberries already,
but even something like sweet potato,
and this is something people are eating a lot more of now,
in place of regular white potatoes.
So there's no reason really people
should be vitamin C deficient.
There are a few risk populations with this
that we're going to talk about.
Before we get to that, I want to just mention
some of the functions.
You probably think of connective tissue, I hope, collagen.
So with skin or with bones, the protein
that's critically important for maintaining those tissues
is collagen.
You have to have the vitamin C in order
to build that collagen.
It's also an antioxidant, so along with vitamin A
and vitamin E, vitamin C is our third big antioxidant vitamin.
This means that it's going to protect
all of those delicate tissues.
So especially skin, very important there,
because a lot of the effects of aging,
so all the wrinkles we get and all the damage to our skin
is from free radicals in our environment.
It could be from the sun, it could
be from toxins, all kinds of pollution.
Vitamin C has a really active role there
to play, keeping those tissues healthy.
It's also important to keep red blood cells healthy,
so it acts again as that antioxidant for red blood
cells.
And it protects them from being oxidized or damaged.
It works as a partner with vitamin E.
So it protects and it helps vitamin E
get recycled and renewed and do its job.
I think maybe you noticed in our conversation about vitamin E
or in the textbook that vitamin E gets recycled and renewed
by the body.
It only is going to do that if there's enough
vitamin C on board, so that's a pretty important function.
Let's look a little bit at the deficiency diseases.
So the one here that should come to mind for you is something
called scurvy.
And I really like the Pirates of the Caribbean movies,
and you see the guys there and they've got horrible skin,
their teeth are falling out, and they just look a wreck.
That's scurvy.
So in some ways that movie is accurately
portraying what's going to happen when people don't have
enough of those vitamin C rich foods.
So there are a lot of really, really interesting
historic [? accounts ?] of vitamin C. But what's happening
is that you see this whole constellation of symptoms
with vitamin C. People start to lose their appetite.
If they're children, they're not going to grow very well.
You see loose teeth, and you can see the little picture
of the teeth there, it looks pretty yucky.
Also, with this particular picture here with the skin,
you see these patches here.
And what's happening is that as the vitamin C deficiency
continues, the capillaries in this area
are being degraded because there's not enough integrity
with the collagen and that tissue isn't
able to maintain its normal structure.
So you see a lot of pinpoint bleeding.
Now I've never experienced this but the accounts
I've read of vitamin C and scurvy are
that it is one of the most excruciating
of the vitamin deficiency diseases.
And the bone pain that people experience
is absolutely horrific.
So again, this is an historic thing,
but even if you go back to early Roman times,
the Romans understood this.
They knew that something happened when sailors went out
to see on these long voyages, and they came back
and they didn't have any teeth, or their skin
didn't look very good.
And they kind of understood that there
was something in those fresh fruits and vegetables,
but they didn't know what it was.
It wasn't until about 1925 at UC Berkeley
that they were actually able in a lab to isolate ascorbic acid.
So if you see on a food label, ascorbic acid,
that's just the chemical name for vitamin C.
So I love that really about science and the science
of vitamins that it's really within my grandfather's
generation that we've begun to understand some of this.
And we're not finished, we're still
expanding our knowledge of vitamins
by understanding some of these phytochemicals in foods.
So stay tuned because definitely within your lifetime
you're going to be hearing about a greater
understanding of vitamins, functions in our body,
and even probably a few more that we're actually
going to term vitamins.
There are a couple that are kind of on the fence right now.
And nutritionists are arguing that there's
an important role for them to play in diet,
but they aren't really listed as an essential vitamin
at this point.
So a couple of other people that are risk populations,
beside sailors.
We see elderly folks, and this is really a two pronged issue.
It can be that diets are low in vitamin C rich foods,
but it's also poor dentition.
So if you think about something like broccoli,
it's a little bit hard to chew, so if your teeth aren't
very good or you have poorly fitting dentures
you might avoid those foods or you might over
cook them significantly, thereby reducing the vitamin C status.
We're also of course concerned with anyone
addicted to alcohol and drugs.
And you're going to see that as a consistent theme with all
of these B vitamins and vitamin C.
So these are people that might be more likely to be
at low intake and then there are some synergistic effects
between alcohol and the vitamins.
Also, infants on cow's milk.
So breast milk actually has sufficient amounts of vitamin
C, but cow's milk doesn't.
So when an infant is put directly
on cow's milk or a little bit young before they're
eating other foods that are fortified, like infant cereals,
there is a period of risk for the infant.
Now a few concerns we have.
Again, in our culture we tend to like supplements.
And when we feel a little cold coming on,
maybe we get one of the different preparations that
has vitamin C. Not necessarily a good idea.
And the reason is that these antioxidant vitamins,
if we take extra that our body doesn't need,
there's this twist of nature and they
become what we call a prooxidant, which
means that instead of protecting cells
they actually start damaging cells.
A lot of the research that's done around prooxidants
has been done in labs, but one particular study
showed that when men were having 500 milligrams a day,
which is about five times their RDA,
there were blood markers of extra oxidation.
So they were showing a little bit of this damage
there, so don't think that vitamin C is harmless.
You need what you need and there's not a lot of evidence,
really, that vitamin C is effective in fighting
the common cold.
At this point it's urban myth.
You can find studies that will show you
that it's helpful and just as many
that say it's not helpful or potentially harmful.
I'm also a little bit concerned about people who are smoking,
or who might be exposed to secondhand or even thirdhand
smoke.
So for those folks, the RDA is increased.
So normally for men, an average adult male,
they need 90 milligrams of vitamin C. So a smoker,
about 110.
With women, their normal RDA is 75 milligrams a day,
and that's going to go up 105.
And the reason for this is multifactorial,
meaning that there's exposure to more chemicals
through the smoke and then also the fact
that smoking may destroy some of the status.
And there's a relationship between some of these lifestyle
choices that people make.
It could be around tobacco use, it
could be around alcohol or drugs, or even not exercising.
So there's also a dietary match up in the relationship.
So people who tend to smoke tend to have a certain kind of diet
that may not include vitamin C rich foods,
so it's something to keep in mind.
If a child is around someone who smokes,
more vitamin C for them for sure.
All right, let's turn our attention
to a small class of these water soluble vitamins.
So I'm going to talk about three of them in particular,
and I want you to link them up in your head.
So we have thiamine and then we're
going to talk about niacin and riboflavin.
These are all energy metabolite vitamins,
so in terms of your function keep them grouped together.
Now when we look at some of the sources of thiamine,
what do you notice here?
It's pretty well rounded, right?
There should be no reason that anyone's diet
is low in thiamine because you find it
in all kinds of foods, foods that are likely to be accepted
by anyone on any kind of a diet plan.
As well, we fortify a lot of foods in the US with thiamine,
so it could be a breakfast cereal, it could be flour,
breads, these kinds of things, are fortified.
Even though there are lots of food sources of thiamine,
there is still some potential for deficiency diseases.
And so I want to pay particular attention to one
that we're concerned about somewhat in the US
but definitely globally.
And if you look back historically
at vitamins and the discovery of vitamins,
this is one that will really have
significant conversation in the literature.
So I want to talk about one disease in particular call
Beriberi, and this I believe originates
from a Polynesian word.
And really what it's meaning is "I can't, I can't."
So if you rewind to our discussion
that this is an energy metabolite vitamin,
it should make sense why somebody
says "I can't, I can't" if they're low in thiamine
because they're not having sufficient energy production.
They're not actually able to make that conversion from food
to energy.
So as a result of that, especially
in peasant populations or people that are working in an agrarian
society, who are working very hard in the fields
or whatever kind of labor they're doing,
they're not going to have energy.
And they're going to be saying "I can't do this."
So that should make some sense to you,
that's a good way to remember it.
There are a couple of different forms of Beriberi.
There's one called Wet Beriberi, and what's
happening there is that there's significant amounts of edema,
so the person starts take on a lot of excess body fluid.
Incredibly painful, just a lot of discomfort there.
We also have one called Dry Beriberi, and that one there's
no edema.
Very often you might see something
like abnormal heart rhythms or even significant heart
enlargement.
So that heart muscle gets larger and larger
trying to pump what energy there is around the body.
And there's Acute Beriberi, and this one
is particularly sad in that it affects infants.
So while they're on an appropriate food,
maybe they're being nursed so they're getting breast milk,
then they're put on some kind of a diet that
doesn't have significant thiamine.
And because they're so little they're very, very vulnerable
and they're dead within a few days.
We in the US don't see these forms of Beriberi very often.
There would most likely have to be
some other kind of significant nutritional issue going on.
But we do see thiamine deficiency that's
related to alcohol consumption, and this one
is called Wernicke-Korsakoff syndrome.
And you can look in the book at this or you could Google it.
You'll also see some information about this
in our conversation about alcoholism
and some of the consequences there.
But the particular symptoms that the individual might experience
if they have Wernicke-Korsakoff syndrome or Beriberi
are going to be very similar.
They're going to have tingling in their fingers
and their extremities.
They're going to have a loss of sensation
and weakness and some paralysis.
So they're not able to work and they're
going to be really acutely aware that something is wrong.
Historically speaking again, looking at world populations,
this is something we saw in Southeast Asia
as people started moving from a wild rice or a whole grain
rice, to something called polished rice or refined
white rice, because the thiamine was
in the stuff they removed from the rice.
So there's a lot of really, really good studies looking
at the chickens that were raised in these peasant communities
where there was a lot of Beriberi.
The chickens would get all of the stuff that
was removed, the husks.
They didn't have Beriberi but the people did.
So that was that how they were able to figure out
that it's something in the whole grain.
Let's turn our attention to riboflavin.
And, again, this is one of those energy metabolites,
just like the thiamine.
And in a minute we're going to talk about niacin, which
is our third of these energy metabolites.
If you look at this you're going to see
that meats are a particularly good source,
but also it's varied.
So someone that is having dairy products but not consuming meat
products shouldn't have a problem.
Also, spinach and enriched cereals.
Again, it's widespread in the diet.
This should not be a problem for anyone.
Now there's some deficiency symptoms
but this is one that your book doesn't talk about.
It's called ariboflavinosis, and this only really occurs
in individuals who are also suffering
from other micronutrient deficiencies.
So we don't very often-- or it would
be incredibly rare-- to see ariboflavinosis
in an individual without other kinds
of vitamin deficiency issues.
So if you just know that it's an energy metabolite,
it's widespread in the diet, that's
really sufficient with this one.
There are some roles to talk about.
So we mentioned that it's an energy metabolite.
So when we do see deficiency it's really very rare
but it's generally going to ride along with thiamine deficiency.
Because these two B vitamins are found in similar food sources,
if the person isn't having enough of the thiamine,
it's really unlikely they would have enough riboflavin.
Just keep that in mind that they're related in that way.
There could be some risk for individuals globally,
not so much in the US, but more globally, related
to maybe not having enough dairy products or enough protein.
It is conceivable that you might see it in elderly populations,
but not necessarily.
I wouldn't expect it to be very common.
I would think it would be a very, very rare situation,
especially if someone is living in a long term care facility.
When I talk about the elderly, or aging adults
that might be a risk, it's the folks
who are living on their own who maybe are suffering
different kinds of mental health or emotional issues, access
to food, this whole constellation of problems that
result in nutritional deficiencies.
The treatment for this is pretty simple.
You can just give people riboflavin.
And the same thing is true of niacin and also with thiamine,
so it's very easy to bring somebody back up to health
with these particular vitamins.
The last of our energy metabolites is niacin.
And niacin, let me tell you, this
has a very checkered history.
If you want to talk about scandal in early science,
niacin is one to check out.
This one, again, it's fairly widespread in the diet.
Meat is a very good source, enriched cereals,
and some different kinds of grain products,
and potatoes, things like this.
It's an energy metabolite, so keep that in mind.
But what I want you to focus on with this one that's
particularly unique and very interesting
are the deficiency diseases.
So the deficiency disease here is something called Pellagra.
You'll also hear it pronounced "Pallegra."
Either way is absolutely appropriate.
And it's really characterized by the four Ds.
So we have diarrhea in the early stages of deficiency,
and then we go on to a particular type of dermatitis.
And this has always struck me as very, very interesting.
So if we look at-- we can look at this food here--
and it's a little bit difficult to see,
but it's something called a scaly dermatitis.
And it's very characteristic and you'll see it on feet.
You'll also see it on the face and this neck
region, a little bit on the chest, and on the hands.
So if you're a detective here, if you're playing "Colombo,"
you might think, well what's unique
about those particular sites on the body?
And it's that you have exposure to sunlight.
So one of the early researchers, somebody named Casal,
was noticing this.
And we actually call this presentation Casal's collar
because he really noticed that it was a photosensitive issue.
And so people have this dermatitis.
So that's one of the things we see
that's one of our second symptoms.
And we also see dementia, so we see
people suffering cognitive issues.
And then we move on to the big D, death.
And maybe you've never heard of Pellagra
but this was an epidemic in the US post Civil War.
And it had to do in the south, where
fields had been decimated.
People were living in absolute poverty
and the typical diet during this time period for very, very
poor people was something called fat back.
So it's like a piece of pork fat and it
might be used to flavor baked beans now,
people might use it that way, in soup or something.
But it's basically just a hunk of fat.
And then they would have molasses and corn.
None of those particular foods are good sources of niacin.
So you saw a lot of people with these issues and hundreds
of thousands of people died, estimates around 600,000 people
dying of Pellagra, but you've probably never heard of it.
And I said that this has a checkered history.
One of the researchers, somebody named Goldberger,
was doing research in orphanages,
looking at these little girls that had Pellagra.
And what he noticed was that if he gave them meat
the Pellagra symptoms went away, because meat
is a very good source of niacin.
Take away the meat, the girls get sick and die.
Give them meat, they get better.
And he went back and forth a few times
before he really realized the connection.
So again, the history of vitamins
is phenomenally interesting and we're still learning,
so keep that in mind.
So the people currently considered
at risk for Pellagra worldwide would
be people that maybe have alcohol addiction, also
very poorly nourished people who don't have access
to foods that are good sources of niacin.
And globally we often think of protein sources
as being a concern, so people that don't have access to meat,
who are eating vegetables that may not have a lot.
Or maybe they're even consuming polished rice
or some kind of a refined grain.
You still do see that in Africa and Asia.
Your book has a very nice conversation
about something called niacin equivalents.
So if I were to look at someone's diet
I could measure the amount of preformed niacin,
so how much actual niacin is in their diet.
But I can also look at a couple of other things
to tell me about their potential for Pellagra.
I can look at an amino acid called tryptophan.
And maybe you've heard of this one.
It's a sleepy amino acid, people like to think of it that way.
It's in turkey and it's in milk, and lots
of other kinds of proteins as well,
but it's a very high amount in those two.
So after Thanksgiving dinner people
feel a little bit sleepy, or if they have a warm glass of milk.
So we can use tryptophan, and we have to combine it with B-6,
so tryptophan and B-6 will actually
allow us to make niacin in the body.
So if I was looking at someone's diet
and they didn't have a lot of preformed niacin,
I would then want to dig a little deeper
and understand how much tryptophan they had available
in the diet, and also if they had adequate B-6.
So that can be pretty important.
Now looking at toxicity, this is one
that we have some toxic concerns.
You do see people self doctoring with niacin
for a variety of reasons.
Sometimes people will hear that it
will help their athletic performance.
Not true.
You will also hear them talking about it
being used in what we call pharmacological doses,
so as a drug they're using this niacin
to treat high levels of cholesterol, serum cholesterol.
And this is true.
Doctors can do this but it's not something
we want patients to do on their own at home.
You increase your risk for something called niacin flush.
And what happens with niacin flush
is that your face and parts of your chest turn bright red
and you get this kind of burning sensation.
If you're lucky, it goes away in a few hours.
If you're unlucky it could last several days.
And so you'll talk to people who maybe
have had this kind of an experience
and it doesn't take that much for you
to have this kind of a reaction in your body.
So if you look at some of those energy preparations,
like a 5-hour Energy, pay particular attention
to how much niacin is in it.
I talk to people who have inadvertently given themselves
niacin flush from this and they're not
using 5-hour Energy anymore.
Once was enough, because it's really quite uncomfortable.
Now in order for this to be effective,
these pharmacological doses of niacin
at lowering your serum cholesterol,
you have to be pretty close to this level of intake.
So that's why it's really advisable
to consult with a doctor.
Again, we want low cholesterol levels,
but not at the risk of causing niacin toxicity.
Let's look at one particular vitamin that I absolutely love.
I think there's just a lot of opportunity
here for education around folate, especially
when we talk to women of childbearing age.
So if we look at our chart of folate
you'll see that this is pretty widespread in the diet.
The word folate actually comes from foliage.
So yes, I want you to eat leaves.
I want you to eat things like spinach, I want you eat greens.
They're an excellent source of folate.
And you can find it in other kinds of foods
if you're not eating those greens, that's fine.
You can find it beans, you can find it in orange juice.
There are lots of sources.
So you would think we wouldn't have a folate problem,
but unfortunately we do.
And one of the particular issues that we see with
folate we're going to talk about in a minute.
But we have to understand what it does in our body
to then appreciate the potential risk of not having
enough folate.
So if you look at the roles of folate,
it's important for DNA synthesis.
So this is genetics, right?
This is cell proliferation, and cell development,
and maturation.
And then it's also in making amino acids, which
are those building blocks of protein.
So for people that are low in folate
it's probably not going to cause a whole lot of problems.
But when we start to see people having very low folate status,
anemia comes to mind, also diminished immunity.
There is also some digestive issues
they could come into play.
We're going to talk about neural tube defects in a minute.
One of the other things that there's
a new body of research about with folate and its partner
folic acid, which I'm going to talk about in a minute,
is that people who have chronically low folate intakes
tend to have increased risk for different kinds
of chronic disease.
Heart disease, also cancer, so we
want people to be eating all those foods that
are rich in folate.
Now we talked about deficiency and there
are several reasons why this may come up.
It could be inadequate intake, people
just not eating those foods that are rich in folate.
There are some different illnesses
that people may have which can restrict absorption,
so they're not actually able to make
use of the folate rich foods they're eating.
Increased excretion, this can also happen,
where people are ridding their body of some
of that important folate.
And medications, and so if you're
on some of these medications you want
to pay particular attention to the implications
of folate status.
And most doctors are very, very good
at alerting their patients about it.
We also see that alcohol can play a role in this.
So people who are having alcohol consumption levels outside
of what we would consider moderate consumption-- one
drink for women, two drinks for men--
they have concerns about folate status.
Because that alcohol can really, really destroy folate status.
Another reason why we would never
want people to be drinking during pregnancy,
because folate it is critical during pregnancy.
So I've already mentioned that there was some increased
risk for chronic disease.
So I talked about cardiovascular risk
and then I want to break it down a little bit and just mention
colon cancer and cervical cancer as being
two that seem to be fairly well linked.
But, again, there's some evidence
but the story is not completely told here, still ongoing.
So neural tube defects.
I want to talk a little bit about this
because one of the concerns we have
and one of our big risk groups in the US
is women of childbearing age.
So if you think about, well what is this childbearing age?
It's from the time of menarche, when
a girl gets her first period, up until age of menopause,
or when a woman goes through menopause.
And during this time period women
need to be very, very concerned about their folate status
if they're at all at risk of getting
pregnant, unintended or intended pregnancies.
Now I want to show you a couple of slides
and then I'm going to go back just in a second,
but when we talk about a neural tube defect
I think it's important to really have
a picture in your mind of what's happening.
So when we talk about the neural tube, what we're talking about
is the spinal tissues here, so your spinal cord and also some
of the brain tissues as well.
So basically your central nervous system.
And here's a cross section.
And you can see we have a vertebrae here
and this is where the spinal cord is, here,
and then some other kinds of tissue.
You have a lot of cerebrospinal fluid.
This is just a hydration medium, I guess you could say.
It has other purposes as well.
What can happen if there isn't enough folate early
in the pregnancy, this happens quite early,
because this is something that-- usually before a woman even
knows she's pregnant-- this neural tube is actually
forming.
So that's why we're so interested in folate status.
You can see this-- it's almost like a bubble or a kind
of a little blister-- and you see this formation outside
of the normal cavity.
And so this particular neural tube defect
we call spina bifida.
There are other ones that we're going to talk about as well.
So let me just go back a little bit here now.
So it can be a slight problem, this is a continuum.
So we can have somebody that has a neural tube defect that
is easily rectified through a surgical intervention.
Or it's just very, very slight up until you
see extraordinary consequences, so paralysis,
mental retardation, you can even see death from spina bifida.
Also from some of the other neural tube defects
that we see, spina bifida is the most common,
but then you also see things like anencephaly,
where the baby is born basically without a brain.
And this is something that we're really trying very, very hard
in public health and in nutrition to prevent.
Because if we have enough folate on board,
our risk of a neural tube defect goes down dramatically.
So I mentioned that we have an opportunity
to really reduce our risk of neural tube defects.
And one of the ways that the government has really
interceded in this, because we had pretty high rates
in about the 1990s, is that we started fortifying our food
supply with folic acid.
Earlier I mentioned that folate and folic acid are partners.
And the difference here is that folate
is a natural form of the vitamin that's found in foods,
so you may find it in your black beans or in lettuce
or whatever it is you're eating.
Folic acid, on the other hand, is the supplement form.
Folic acid has a few advantages and one of the most marked
is that it's 40 times more easily absorbed.
So that really highlights this opportunity for the government
to intercede and start fortifying our food supply
with folic acid.
And you can see this chart here of neural tube defects,
and we've got the rate is this particular purple line.
After fortification we saw still an uptick
while people were really learning about fortified foods
and what it meant to use these.
And then about five years after fortification
we see this dramatic downward trend
in the number of neural tube defects.
We really want women to consume these fortified foods.
There's a lot of advantages for preventing neural tube defects
but that isn't really the end of the story.
We also want people to have a folate rich diet,
so they really need to go together.
So go ahead, have the fortified shredded wheat, or Raisin Bran,
or whatever it is.
But also eat those green leafy vegetables
and all of those other foods.
OK, so one of the concerns is sometimes
you hear raised, because if you think
about the function of folic acid or of folate,
it's for cell proliferation and cell growth.
So think about cancer, that's exactly what we're
talking about.
We're talking about these cells that have gone rogue,
they've gotten "mavericky."
And they're multiplying in these ways
that are completely abnormal.
So if you have a little tiny cancer growth
and you feed it lots of folate, it's
going to grow more rapidly.
So after fortification there is an uptick
in some forms of cancer and it had
to do with the fortification.
The reason I bring this up is that you
have to understand that when the government chooses to fortify
the food supply with anything, whether it's
a vitamin or a mineral, there are going to be benefits
but there are also potential consequences.
And this has to be weighed very, very carefully.
OK, and the same thing can really
be said for supplements in a lot of ways,
because you're fortifying your own personal food supply.
So, again, you really need to understand,
if you're going to use supplements, what the pros
and cons are, because they're always going to be there.
Now, since fortification we've actually
seen a decrease in those types of cancer.
They are being diagnosed maybe earlier,
so you're seeing fewer cancer deaths.
And one of the reasons is that folate tends to be protective.
So if you don't have cancer growth,
really folate is very, very important, it's your friend.
If you are going through cancer treatment or have cancer,
one of the things that is commonly used
are antifol medications, which actually
strip the folate status of the individual
to try and control cellular growth.
So just a little bit more information that's interesting.
Let's look at B-12.
That's our folate story.
B-12 goes along with this a little bit,
and I'll kind of explain that in a minute.
But be very, very clear on the sources of B-12.
So if you look at this you might say,
well there are lots of different sources.
But a closer examination will show you
it's only found in animal products.
It could be meat, it could be cheese, it could be eggs.
It has to come from an animal to have B-12.
The exception to that is something called nutritional
yeast but purists would also say, well,
that's coming from an organism, right?
So our big risk group here is going to be vegans.
I'm going to repeat that several times during our conversation
about B-12 and explain why that is a little bit.
The role of B-12 is pretty clear,
and this is something we want to pay attention to.
B-12 is really important for nerve health, OK?
And it has a relationship with folate
also, so B-12 and folate act in concert with each other
to do their actions.
So maybe you've heard of myelin around nerve cells.
That myelin is really a result of having enough B-12.
That B-12 is able to make sure that protein is sufficient
and that it's maintained properly
to protect that nerve impulse.
Because that myelin is like an insulator.
It makes sure that nerve message gets to its intended target.
Without myelination you see all kinds
of consequences related to paralysis, neuropathy,
tingling.
There's just a lot of issues.
With absorption, this one's a little bit different.
Although it's a B vitamin and we've
talked about how B vitamins and other water soluble vitamins
don't need any extraordinary means to be absorbed,
B-12 is an exception here.
You need something called intrinsic factor, which
is made in your stomach by the parietal cells.
Those also make hydrochloric acid.
So just putting that a little bit into perspective.
What's going to happen is that that intrinsic factor
is going to bind to the B-12, and then it
travels as a little component, those
two pieces down to the intestines where
it can be absorbed.
If you don't have intrinsic factor
the B-12 makes its way alone and can't be absorbed.
So you have to have that intrinsic factor.
As we age this becomes a problem because those parietal cells
start to get really tired and wear out,
and we aren't making enough of that intrinsic factor
to absorb the B-12.
So vegans are an issue, potentially,
because they aren't eating meat products or animal products.
But then older folks, elderly or aging populations,
are also a concern because they don't
have enough of that intrinsic factor as they age.
A quick way to deal with this is--
for vegans you could use supplemented foods because they
have the intrinsic factor and they can absorb it.
For aging populations you can't give them
a supplement because they aren't going to be able to absorb it.
You really have to give them preformed B-12,
so you give it to them as the shot
or you can give them a tablet we call sublingual,
so it's going to go right under the tongue.
And that's a very, very efficient way
to absorb it right into the blood.
And there's a lot of evidence that people, as they age,
historically have been underdiagnosed with the B-12
deficiency.
So the symptoms that we would see in that population of older
folks, I talked about some of the issues with paralysis
and tingling and a neuropathy or a numbness.
But you can also see some more cognitive issues.
You can see dementia, you can see confusion.
If you think about your average nursing home population,
that's a lot of folks, right?
So at one point they figured about one third
of people who are diagnosed with dementia
were actually B-12 deficient.
So now doctors are very hip to this.
They completely understand this connection.
But if you are caring for a grandmother or grandfather
or someone else in your life who is an aging adult,
it might be worth a conversation to talk to them about B-12
and have they mentioned this to the doctor.
So again, our risk population-- vegetarians,
and really we're talking about the sub-population of vegan,
who are having no animal products.
A vegan diet is very, very healthy, if it's done properly.
So an unplanned or poorly planned
vegan diet could be catastrophic,
especially for young children.
There are some studies coming out of Japan, maybe about five
or 10 years ago, looking at vegan populations
who didn't quite understand this B-12 and where to get it.
Because there was a lot of evidence that you get
B-12 from algae or a spirulina and some of these other seaweed
products.
And that's truth, there is B-12 in those products,
but it's not the form that's absorbed by our body.
So I could test it in a lab and it said,
yeah, B-12, no problem.
But then actually when it's in our body,
in vivo testing shows that we're not able to absorb it.
It passes right through the body.
So these young children, as a result of their parents
relying on seaweed in Japan, they
ended up with catastrophic muscle and neurological issues,
to the point of paralysis.
So again, vegan diets are great, just
we want to make sure that they're really, really
well planned.
We also are concerned about people
that have malabsorption issues or people who
might be on medications that disable those parietal cells.
So if they're taking some kind of an acid reducer
to turn off what they call those acid pumps,
those parietal cells, you just want
to make sure that you're really having
a conversation with the doctor about B-12 with that as well.
OK, so now we can talk about B-6.
Now B-12 and B-6 actually do have names
but most people just want to know them
by B-6 and B-12, that's fine.
With the other B vitamins you really need to know the name.
So you don't want to know that B-1 is thiamine.
It's not going to do you any good.
You want to know it as thiamine.
So B-6, know it as B-6, and that's not a problem.
When you look at the food sources of this
you're going to see that it's really
quite widespread in the diet.
There are lots of different foods
that can supply B-6 for you, so this should not
be a problem for anyone on any kind of a diet plan.
And when we look at some of the functions here-- let
me just show you this long list of functions--
there's quite a few here.
This is kind of a jack-of-all-trades vitamin.
I've particularly underlined or you can notice a few changes
in our font, so when I talked about the tryptophan conversion
to make niacin.
I told you earlier that you have to--
if you're not getting enough preformed niacin you
can use the amino acid tryptophan,
but you have to have that B-6 there.
It's also important, and I didn't particularly
mention it by changing the font, but there is a lot of evidence
that B-6 is involved in mood stabilization
and there may be some relationship with depression.
Because it's important to have B-6 in order
to make a particular neurotransmitter
called serotonin.
And maybe you've heard of serotonin, if you watch TV
and they're advertising some of these different kinds of drugs
that are thought to be very helpful for depression.
So look at all those different functions,
there's a lot of them.
Make sure you really understand the relationship
with tryptophan and niacin.
Let's look a little bit at some of the deficiencies.
Now, this is quite rare in the US to have a B-6 issue
because it's in all those different foods.
But still it's important to understand a little bit
about what might happen potentially.
You're going to see all of these different symptoms
that, if I went to the doctor and I talked
about these symptoms, the doctor is not necessarily
going to point to B-6 as being an issue.
And this is true with a lot of the different vitamins,
so diagnosing vitamin deficiency can be very, very difficult.
You'll see all the different deficiency issues
and then we want to look just a little bit at toxicity.
And the reason I want to isolate the toxicity in particular
is that there's a new body of research looking
at the connection between B-6 and arthritis symptoms.
So we're starting to see some people self- doctoring.
And, again, with sufficient knowledge that might be OK,
but there are a lot of concerns.
So one of the studies they did, and I
don't remember what year this was conducted,
they took women who were exhibiting symptoms of PMS
and they started giving these women extraordinarily high
amounts of B-6, so over two grams, and that's a lot of B-6.
And what they saw was that these women
started having different kinds of issues
related to paralysis and numbness.
And that should sound somewhat familiar, right?
We're seeing some of the deficiency issues and toxicity
issues being related.
And that's true with a lot of the vitamins,
so if you understand function that's
going to tell you a little bit about what happens
in deficiency, and if you understand the deficiency
you'll understand what might happen
if you have too much of it because they're often
very related.
So with these women in this PMS B-6 study, some of them
actually ended up paralyzed, where
they couldn't move an arm or something like this.
And they did recover over time, but again it
highlights that opportunity for us
to do significant damage through supplements.
If these women had been taking a lot of B-6 rich foods
this would not have happened.
And for the women who did experience paralysis
in the study, they were able to restore normal function,
but for some of them it took up to a year.
So that's significant.
OK, so let's look at biotin.
I really like biotin.
It's kind of a sleeper, you've probably never heard of it.
It's one of our B vitamins that's
involved in a million different things.
A couple of things that we want to particularly look at
are energy metabolism.
And then it's involved in this whole group of enzymes
and how they work in the body, especially converting food
into fuel.
Deficiency is incredibly rare.
This isn't really going to be something we ever see.
We can induce biotin deficiency pretty easily
in people through a particular mechanism that I enjoy,
but it's rare.
It's going to go along with other diseases
that people might have.
So I said that I could induce deficiency.
And I say it's fun but it's actually horrible.
We wouldn't want to do this to someone.
Our risk population here are athletes, actually.
So you'll notice that the book talks
about the opportunity for people to be including
raw egg whites in their diet.
There's a protein in raw egg whites called avidin.
And this avidin binds the biotin,
and it's going to hold onto it so you can't absorb it,
and it gets excreted from the body.
And you might think, wow, 24 raw egg
whites, that's an awful lot.
Not for a bodybuilder.
It might be somewhat routine for people to be using that amount.
Some studies point to it being 12 raw egg whites,
and again that's not very much.
I had a bodybuilder friend in graduate school
and she would come in with about 16 ounces of raw egg
whites every day for lunch.
So you see people doing this and there's a lot of reason
not do it.
Besides biotin, salmonella poisoning,
other kinds of issues.
You can still get the benefits of egg whites by cooking them,
and that's going to completely negate
the risk of biotin deficiency.
Bison is widespread in food, you don't need to seek it out.
It's just going to be there in your diet.
OK, and the last one I want to talk about
is something called pantothenic acid.
And again, you've probably never heard of this one either,
and that's fine.
It's widespread in the diet.
The only reason I'm going to just mention it
is that I think it's one of those vitamins
that maybe you'll see on a food label
or you'll see it on a nutrition facts panel
and you'll just wonder what it is.
It's important in energy metabolism
and it's also, just like biotin, involved
in lots and lots of different enzymatic activities.
It also is involved in lots of these different chemicals
that we produce in our body, so hormones,
and neurotransmitters, and things like that.
Deficiency is only going to be seen in very rare diseases,
just like with biotin.
And unlike biotin I can't induce deficiency with egg whites.
So again, this isn't something people have to seek out,
really.
Those are our water soluble vitamins.
Keep in mind the ways that water soluble vitamins
differ from the fat soluble vitamins.
And make sure again that you know the vitamins by name, not
just number, with the exception of B-12 and B-6.
Make sure that when you're looking
at some of the food sources of these vitamins
that you know several sources.
So I've mentioned this earlier, specifically with vitamin C,
not just to know citrus but to know
that it's found in red peppers and green peppers
and lots of other fruits and vegetables.
And also you'll notice that many of these vitamins, especially
the fat soluble ones, are also found in liver.
If you don't eat liver routinely you
can't claim that as a food source, OK?
I want you to know these other areas where
we can get these vitamins, and I particularly
encourage you to link up those vitamins with the foods
that you actually eat.
And not just know that fortified cereal is going to have them.
Where are they found naturally?
So that you can make really good choices, especially when you're
trying to increase your consumption of whole foods
in your diet.