Thread by @KetoCounselor

B12 is an important water-soluble organic compound that plays a critical role in the health of our brains. It is involved in DNA synthesis, methylation, and cellular metabolism, which means it is necessary for the proper functioning of our cells. (1/21)

B12 deficiency is a major concern, as it can lead to megaloblastic anemia and neurological problems. But did you know that inadequate #B12 or subclinical deficiency is also very common? (2/21)

It's seen at all ages but definitely in elderly populations. This can be particularly worrisome for those with Alzheimer's disease (AD), as several studies have shown an association between B12 deficiency and #AD. (3/21)

A retrospective study of patients with familial AD revealed significantly lower serum B12 levels compared to their unaffected family members. (4/21) doi.org/10.1093/ageing…

A similar correlation was found in older individuals with sporadic AD, the most common form of the disease. (5/21)

A population-based longitudinal study in Sweden showed that cognitively intact subjects aged 75 and over with lower B12 levels had twice the risk of developing AD within three years compared to those with normal levels of B12. (6/21)
doi.org/10.1212/WNL.56…

Another study found that subclinical B12 deficiency precedes cognitive decline in elderly populations. (7/21) doi.org/10.1093/ajcn/8…

Interestingly, B12 deficiency in AD is associated with elevated levels of pro-inflammatory mediators, including TNFα and IL-6. (8/21) doi.org/10.3233/JAD-20…

Don't think B12 is just about #energy. It has effects on immune system function. Which means it contributes to underlying immune dysfunctions driving neurodegeneration. (9/21)
doi.org/10.1301/002966…

These mediators can increase hyperphosphorylation of #Tau and induce Aβ synthesis, both of which are pathological features of AD. (10/21)
doi.org/10.2353/ajpath…

Homocysteine is a non-proteinogenic amino acid that is converted from methionine by B12 during #folate metabolism, and its circulating amount can be used as a surrogate marker of B12 levels. (11/21)

Studies have found that patients with AD have significantly higher serum homocysteine levels compared to healthy control subjects, which are accompanied by markedly lower serum B12 and folate. (12/21)
jamanetwork.com/journals/jaman…

A retrospective analysis of plasma samples from the Framingham Study also showed that increased homocysteine levels are a strong independent risk factor for the development of #AD. (13/21) nejm.org/doi/full/10.10…

So what can we do to help those with AD or those at risk for developing the disease? Besides offering them a #ketogenic diet to rescue brain energy and all the support they need to implement it? (14/21)

B12 supplementation has been shown to have beneficial effects on cognition and inflammatory status. (15/21) #inflammation #neuroinflammation

A randomized placebo trial in patients with clinically diagnosed AD found that six months of folate and B12 supplementation improved cognition and decreased serum homocysteine and TNF-α. (16/21) doi.org/10.14283/jpad.…

Do I think supplementing B12 is enough? No. Do I think it should be considered and could enhance the effects of a ketogenic diet? Yes. #opinion #clinicalpractice (17/21)

Do I think it should be taken alone without a B-complex? No. Is it low-hanging fruit that doctors working with aging populations need to know about and help people with? Yes! Absolutely!
Will they? I don't know. So that's why you need to know about it. (18/21) #feelbetter

While the isolated effect of B12 on AD-related cognitive deficit is somewhat questionable, high homocysteine and low B12 may potentially contribute to the disease's progression. (19/21)

It is important to note that the metabolic function of B12 may already be impaired once an individual is diagnosed with AD, which may partly explain hyperhomocysteinemia in AD with further cognitive decline that is independent of plasma levels or dietary intake of B12. (20/21)

So, if you or a loved one is struggling with AD, find someone who knows all the ways they can feel better, and understands that a #ketogenic diet with additional nutritional supports is one of them. (21/21) #nutrition #dementia