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B vitamin deficiency tied with higher incidence of depression.

Older adults who have low intakes of vitamin B6 and B12 are more likely to suffer from depression, according to a study published in The American Journal of Clinical Nutrition (AJCN). The researchers found that higher total intakes of vitamin B6 and B12 from foods and supplements were associated with a decreased likelihood of depression, based on data collected from more than 3.000 adults age 65 or older who participated in the Chicago Health and Aging project.

"Vitamins B6 and Bl2, along with folate, another B vitamin, are involved in reactions that produce monoamine transmitters like serotonin and dopamine that are deficient during aging and depression," says Helen Lavretsky, MD, a geriatric: psychiatrist at UCLA. "Also sleep disturbances may occur with vitamin B12 deficiency, because B12 may be involved in the regulation of the sleep-wake cycle by the pineal gland through melatonin production."

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Why deficiency may occur. "It isn't uncommon for older adults to come up short on their B vitamin intake, especially B12," says Susan Bowerman, MS, RD, CSSD, assistant director of the UCLA Center for Human Nutrition. "Vitamin B12 absorption is sometimes reduced in older people. As people age, their stomachs do not always produce as much stomach acid as when they were younger, and this acid is necessary for adequate absorption of vitamin B12. Similarly, those who use antacids frequently could have impaired vitamin B12 absorption." Common medications also may interfere with absorption, such as proton pump inhibitors (Nexium, Aciphex, Prilosec), H2 antagonists (Tagamet, Pepcid, Zantac), and metformin, a medication used to treat diabetes.

Many factors can affect dietary intakes among older people, so their daily intake of nutrients may not be ideal. "Sometimes cost is a factor. Also, older people tend to spend less time preparing foods, so they might be eating more convenience foods and processed grain products, which would be lacking in these nutrients," explains Bowerman.

Food sources. The best sources of vitamin B6 are beans and peas, meats, fish, and poultry, green leafy vegetables, and some fruits and vegetables. Vitamin B12 is found naturally only in foods of animal origin (meat, fish, poultry, milk products, eggs). Shellfish, fish, beef, and lamb contain the highest amounts of vitamin B12. Some foods, such as ready-to-eat breakfast cereals, are fortified with both B6 and B12.

Should you supplement? It's always best to try to get your nutrients from foods, especially in the case of these important vitamins, because they are found in so many healthy foods, like lean proteins, fruits, and leafy vegetables, that are the foundation of a healthy diet. These foods are also good sources of many other vitamins, minerals, and, in the case of plants, phytonutrients and fiber," says Bowerman. "That said, a daily multiple vitamin supplement is wise 'nutritional insurance.' Just remember that supplements are just that--they're meant to supplement a healthy diet, not be a replacement for poor dietary intake."

About depression. In addition to vitamin B deficiencies, many factors may contribute to depression in older adults. "The presence of multiple stressors and losses (financial. caregiving, loss of partners/spouses), along with coexisting medical conditions, such as cardiovascular or cerebrovascular disease and cognitive disorders, raise the risk of depression," says Dr. Lavretsky. "Other possible factors include the use of multiple medications, disability from underlying medical illnesses, and a family and personal history of depression."

Symptoms of depression that are common in older adults include anhedonia (the inability to enjoy anything), apathy (lack of energy and motivation), high levels of anxiety, inability to handle complex decisions (executive dysfunction), along with suicidal thoughts and attempts.

If you think you or a loved one may be suffering from depression, Dr. Lavretsky advises seeking professional help immediately for evaluation and treatment. Several preventive techniques can be employed to reduce your risk of depression. Dr. Lavretsky suggests stress reduction in the form of meditation or exercise, accompanied by proper nutrition and other important health behaviors such as smoking cessation and weight reduction. "Supplementation with B vitamins may also be protective, as the AJCN study has shown," she adds.

MEASURING VITAMIN B12

According to Dr. Lavretsky, the lowest acceptable level for vitamin B12 in blood is about 200 picograms per milliliter (pg/mL). However, recent research has found that B12 deficiency may occur at B12 concentrations in the blood as high as 500-600 pg/mL She says that elevated serum homocysteine and methylmalonic acid levels are considered more reliable indicators of B12 deficiency than the concentration of B12 in blood. Approximately 10 percent of patients with vitamin B12 levels between 200-400pg/mL (in the "normal" range) will have a vitamin B12 deficiency on the basis of elevated levels of homocysteine and methylmalonic acid levels.
MEETING YOUR VITAMIN B6 AND B12 NEEDS THROUGH DIET

The Recommended Dietary Allowance (RDA) for vitamin B6
for men age 50 and older is 1.7 milligrams (mg) and 1.5
mg for women age 50 and older.

B6 sources in milligrams per serving

Whole grain TOTAL, 3/4 c      2.0     Chickpeas, 1 c    1.1

Wheaties, 1 c                 1.0     Tuna, yellowfin,  .88
                                      cooked, 3 oz

Potato, baked, with skin,     .63     Pork loin chops,  .60
one                                   cooked, 3 oz

Prune juice, 1 c              .56     Bananas, raw,     .55
                                      1 c

Beef, top sirloin,            .54     Chicken           .52
cooked, 3 oz                          breast/roasted,
                                      1/2breast

The RDA for vitamin B12 is 2.4 micrograms for all people age
14 and older.

B12 sources in micrograms

Clams, cooked, 3 oz           84.1     Oysters,        13.3
                                       cooked, 3 oz

King crab, cooked,             9.8     Blue crab,       6.2
3 oz                                   cooked, 3 oz

Whole grain TOTAL, 3/4 c       6.0     Wheaties, 1c     6.0

Trout, cooked, 3 oz            4.2     Lamb, cooked,    2.2
                                       3 oz

Beef, top sirloin, 3 oz        1.4     Cottage cheese,  1.4
                                       low-fat, 1 c
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Title Annotation:NUTRITION
Publication:Healthy Years
Date:Aug 1, 2011
Words:968
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