Tag Archives: brain fog

Vitamin B12 – the story continues

Marcus Webb

Observations and comments by Marcus Webb

Vitamin B12 has always been associated with fighting fatigue and supporting nerve function. However, this complex vitamin with many biological functions that new research indicates extend beyond simple physical wellbeing.  

Vitamin B12 has an established key role is the normal functioning of the brain and nervous system as well as for the formation of healthy blood cells and is involved in the metabolism of every cell in the body. For such an essential nutrient it may come as a surprise that the human body is unable to produce its own B12 and is completely reliant on dietary sources. While some may quote authorities who state that our bowel bugs generate some vitamin B12 it has been shown that this tiny trickle is not absorbed from the colon and serves as no real nutritional source. We vitamin B12, albeit in small amounts, but we have to get it from our diet. Some key dietary sources are describe later on but in essence there is no reliable non-animal source of vitamin B12 making it very difficult for strict vegetarians or vegans to obtain significant amounts.

Interestingly, vitamin B12 was initially discovered due to its relationship with the condition pernicious anaemia. This is an autoimmune disease whereby the cells in the stomach responsible for secreting intrinsic factor (IF), which is crucial for the absorption of B12, are destroyed.

Taking vitamin B12

Vitamin B12 is often used to treat nerve pain. In most cases, the reported benefit of B12 is related to the injected form of B12 in people suffering from nerve pains in relation to diabetic neuropathy or shingles pain.

There have been some news stories relating to poor B12 absorption in people taking gastric acid blocking drugs. These drugs take effect on the same cells within the stomach that produce IF. In regular users, regular tablets or capsules of B12 will not help much because the absorption of B12 has become impaired as a consequence of the drug action. This is where the suckable/chewable tablets (B12 Infusion tablets from Enzymatic Therapy) come into their own. Vitamin B12 can be effectively absorbed across the delicate membranes of the mouth in sufficient amounts to readdress any deficiency without the need for injection therapy in most cases. For those with true pernicious anaemia who need regular injections of B12 every 3 months a top-up using the B12 Infusion tablets in the month leading up to the next injection can offer a great ‘lift’ for those who notice a general low energy phase before their next injection. So long as the B12 is in the biologically active form known as methylcobalamin and in a chewable/suckable form dosing up on one tablet per day for a month or so could make all the difference to fatigue or ‘brain fog’. Even if you have not been using the acid-blocking drugs, it may be worth trying a course of sublingual B12 for a month especially if you are over 50 years old or follow a strict vegetarian or vegan lifestyle.

Chronic Fatigue Syndrome, Fibromyalgia and Vitamin B12

Scientific studies into the causes of fibromyalgia (FM) and chronic fatigue syndrome (CFS) are always interesting, especially when they appear to support what we notice in the clinic. In the case of vitamin B12 many FM/CFS sufferers report improved energy and overall well-being following a course of high-dose B12 supplementation over 4-6 weeks. Lending some scientific evidence to this anecdotal observation, a study carried out in Sweden back in 1997 gave support to the use of B12 in FM/CFS cases when it was shown that the fluids surrounding the brain and spinal cord (the cerebrospinal fluid of CSF) was significantly lower in vitamin B12 than expected. Having such a low CSF B12 level was closely associated with increased levels of a metabolite known as homocysteine. This in turn was linked to profound symptoms of fatigue. The study concluded that these findings were probably contributing to the FM/CFS in their study group. Sadly, since then, little work has been performed in this area of vitamin B12 research but a team from Kings College did provide preliminary evidence of reduced functional B vitamin status in CFS patients. It’s not often practical to perform routine blood testing for B-vitamin status in cases of FM/CFS let alone sampling of the CSF, but in the holistic management of this complex spectrum of disorders, a trial of vitamin B12 or a good vitamin B complex often yields impressive results and is well worth considering.

Product link: BioActive B12 infusion 1000mcg vitamin B12 in the sublingual methylcobalamin form


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Helping to combat fatigue and body-energy crises using D-ribose.

What frustrates many people who suffer from fatigue with or without the associated muscular pain known as fibromyalgia is the fact that, on paper, they are too well to be ill. Routine blood tests are typically normal in both situations but the level of pain and fatigue are far from normal and can be life destroying.

Back in August we posted a brief note on the research behind ribose and fatigue. In this post we take it a bit further and explain more of the detail.

It is true to say that there is no known cause for fibromyalgia with all laboratory tests including muscle samples (biopsies) taken from the most tender regions appearing perfectly normal on specialist examination and analysis. This lack of medical evidence places sufferers in a dilemma; how to manage the problem? Exciting work coming out of America is throwing new light on the issue. The latest in a number of small scale studies confirms what has been observed clinically. A simple sugar-like substance, known as ProRibose (contains pure D-ribose), can be of help. The study in question involved 41 sufferers and was set up to investigate the effects of D ribose on two key end points; improvements in pain relief and easing of fatigue. The average age of the study group was 48 years old and 78% were female. This is in keeping with the typical profile of a fibromyalgia and fatigue sufferer. As with many studies, some people dropped out before the test month was finished but of the 36 who completed the trial 69% reported significant improvements in both of the symptoms being investigated and a 25% improvement in quality of life, as assessed by a special questionnaire. The mechanism behind this exciting set of results is not clear. What is known, however, is that fibromyalgia sufferers have lower levels of the energy molecule called adenosine triphosphate (ATP) and a reduced capacity to make ATP in their muscles. It is also known from previous studies that D-ribose can fuel ATP production. This may, in part, be responsible for the effects of D-ribose supplementation which appears to reduce muscle pain and enhance quality of life for those suffering with fibromyalgia and / or chronic fatigue. D-Ribose, also known simply as ribose, is a simple sugar. Technically known as a 5 carbon monosaccharide, or pentose sugar it is used by all the cells of the body and is an essential compound in energy metabolism. Ribose also provides the structural backbone of our genetic material, DNA and RNA, certain vitamins and other important cellular compounds. If the cellular energy pool is depleted by disease, overwork, or exercise it must be replaced. Supplemental ribose can be viewed as jump-starting the energy manufacturing mechanisms and accelerating the process of energy production. To date D-ribose has been shown to be a safe supplement. Only two side effects have been noted; in very large doses, in excess of 10 grams, loose stools (diarrhoea) has been reported and in similar doses a transient dip in blood sugar levels. However, when using any supplement that contains or influences the blood sugar levels or energy levels it is always recommended that a diabetic patient consults a health professional beforehand. To reduce both of these potential but rare side effects, sensitive individuals should take D-ribose with a carbohydrate meal. Taking D-ribose at the recommended intake of between 2-5 grams per dose is not normally associated with any dose effects. A great advocate of the use of D-ribose in CFS/FM is Dr Jacob Teitelbaum. He has suggested that its critical to use the proper dose for the first 3 weeks, which is 5 grams (5000 mg) three times a day, after which the intake can be dropped to twice a day. Dr Teitelbaum is keen on using D-ribose in CFS/FM patients because he has noted that when people consume D-ribose, their body recognizes that it is different from other sugars and preserves it for the vital work of actually making the energy molecule that powers our hearts, muscles, brains, and every other tissue in the body. With its established association with the energy currency of the cell (ATP) D-ribose provides the key building block of ATP, and the presence of D-ribose in the cell stimulates the metabolic pathway our bodies use to actually make this vital compound. If the cell does not have enough D-ribose, it cannot make ATP. So, when cells and tissues become energy starved, the availability of D-ribose is critical to energy recovery. In his detailed article about D-ribose (available online) Dr Teitelbaum describes how normal, healthy heart and muscle tissue has the capacity to make all the D-ribose it needs. However, when normal tissue is stressed by overexertion, several days of rest will usually allow it to fully recover. The muscle may be sore during recovery, as we frequently see for the three or four days after a hard day of gardening or similar unaccustomed work. Eventually energy levels will be restored and the soreness will disappear. But when the muscle is chronically stressed by disease or conditions that affect tissue energy metabolism, the cells and tissues simply cannot make enough D-ribose quickly enough to recover. Heart and skeletal muscles just don’t have the metabolic machinery they need to make D-ribose very efficiently. The result is chronic, persistent pain, stiffness, soreness, and overwhelming fatigue that may never go away. Given the high level or reported muscular pain in cases of CFS/FM that fit this clinical picture it would appear reasonable to consider a trial of D-ribose following the dose recommendation outlined by Dr Teitelbaum, who as a CFS/FM sufferer himself, takes D-ribose every day. Most natural agents are needed for 4-9 months to help restore deficiencies but if D-ribose works for you its safe to use on a regular basis.

Study supports D-Ribose use

In a very recent study published in the Pain Journal this year, Dr Teitelbaum and colleagues followed 203 diagnosed CFS/FM patients over a 3-weeks course of D-Ribose therapy. They discovered that improvements began in the first week of treatment, and continued to increase at the end of the 3 weeks of treatment. Their findings are summarized below;

61.3 % increase in energy

37% increase in overall well being

29.3% improvement in sleep

30% improvement in mental clarity

15.6% decrease in pain


At the end of the study they concluded that D-ribose resulted in markedly improved energy levels, sleep, mental clarity, pain relief, and well being in patients suffering from fibromyalgia and chronic fatigue syndrome.

Further Information

The study can be view on line (Treatment of Chronic Fatigue Syndrome and Fibromyalgia with D-Ribose– An Open-label, Multicenter Study. The Open Pain Journal, 2012, 5, 32-37).

Useful product link to ProRibose.


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Battling the Brain-fog of chronic fatigue

All of suffer from lapses of memory from time to time but when true brain-fog hits its normally accompanied by some other underlying problem such as chronic fatigue. However, if you can say yes to 7 or more of the 10 key features of brain-fog you may find some value in reading on.

1. Forgetfulness, especially with short term memory
2. Lack of focus with occasional disorientation
3. Difficulty in finding the right words and loss of mental agility
4. A reduced ability to problem solve and learn / retain new skills
5. Poor concentration
6. Phases of confusion
7. Aspects of depression / anxiety
8. Occasional feelings of ‘being spaced out’
9. Difficulty in judging depth and distance
10. Reduced ability to thing creatively or plan for the future

For sufferers of chronic fatigue syndrome (and fibromyalgia) one of the most difficult aspects to deal with is the issue of bran-fog. So many sufferers experience a severe impairment of their cognitive (thought processing) functions to the point where they fear they are loosing their minds. There are as many theories as there are remedies for the brain-fog issue but one theory that looks to stand the test of science relates to an enhancement of the cognitive functions by improving the ability of neurons (nerve and brain cells) to communicate with each other. For this to happen, tiny gaps between nerve cells, known as synapses, require chemical messengers to be released that bridge the gap to allow nerve-to-nerve communication to occur. These chemical messengers are called neurotransmitters and the most abundant neurotransmitter in the body is known as acetylcholine (Ach). Because Ach is not exclusively found within the brain it also influences many aspects of nerve and muscle activity as well as organ and blood vessel function. Within the brain itself Ach is a vital neurotransmitter involved in the formation and maintenance of memory and the ability to learn. It has also been associated with influencing maintaining emotional health.

Overcoming a biological barrier

A problem faced by many key nutrients required by the brain and nervous system is actually getting to the brain to start with. The internal brain environment is protected from toxins by a special circulatory system that forms a selective biological sieve known as the blood-brain-barrier (BBB). In essence, this is composed of a tightly fitting cell lining within the blood vessels of the brain that does not occur in other regions of the body. The end result is an ingenious way of keeping certain chemicals and other compounds within the circulation and available to the body but away from the delicate environment of the brain. Getting substances to cross the BBB has presented drug developers with considerable challenges but many naturally occurring nutritional compounds appear not to be affected by this toxin filter. One such nutrient, known as acetyl-L-carnitine (ALC), happily crosses the BBB and has been attracting considerable attention from researchers because of it’s ability to improve certain aspects of energy metabolism as well as enhancing neurological and brain functions. Interestingly, ALC is structurally very similar to the bodies own Ach and it is known that the neurons that respond to Ach are also receptive to direct ALC stimulation. Because ALC crosses the BBB it’s potential to assist brain function is now becoming apparent. Another key aspect of ALC’s ability to assist neurological health lies in it’s ability to supply the required building blocks for Ach production. Supporting this is a controlled study in which 481 elderly people with memory impairment showed improvement after 90 days of 1500mg ALC. While no one is saying that this is a cure for age related memory loss or Alzheimer’s, the study did illustrate the ability of ALC to enhance cognitive function, an action that may benefit those with CFS/FM related brain-fog. Keeping in mind the observation highlighted by the CFS/FM expert Dr Jacob Teitelbaum who reported on the discovery of low ALC in the blood and muscle of CFS/FM sufferers by two independent research centers, a case for a trial of ALC supplementation may be reasonable.

Acetyl-L-carnitine vs placebo

In the spirit of good science what people report and what can be proved to actually happen needs testing using a placebo study. In this type of study, a non-active but otherwise identical pill is given to one group while the other group takes the real pill. However, none of the subjects know is they have the ‘read deal’ or the dummy (placebo) pill!
The study, using 102 patients who met the criteria for being diagnosed as having fibromyalgia, looked at the effects of a course of acetyl-L-carnitine (ALC) over 10 weeks compared to placebo. To establish the effects of ALC the researchers measured tender points and assessed fatigue, depression, sleep and other common FM symptoms using well established and tested questionnaires. At the end of the 10 week trial the total number of tender points had declined significantly along with an improvement in overall pain and mood in the group taking the ALC supplement. In their conclusion, the researchers commented; “The results indicate that ALC may be of benefit in patients with fibromyalgia, providing improvement in pain as well as the general and mental health of these patients.”

Intake and safety

From the literature there has been a wide range of intake levels recommended, ranging from 1000mg (1 x 500mg taken 2 x day) up to 2000mg (2 x 500mg taken 2 x day) taken in divided doses twice a day. As a supplement, it should not be used by anyone taking drugs that alter blood clotting such as warfarin or acenocoumarol. Because of the lack of data ALC can’t recommended during pregnancy or breast feeding and there has been some cautions against using if you suffer from seizures or take thyroid hormones.

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