Ilia Volkov

Effectiveness of Vitamin B12 in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: The frequency of recurrent aphthous stomatitis (RAS), the most common oral mucosa lesions seen in primary care, is up to 25% in the general population. However, there has been no optimal therapeutic approach. Our objective was to confirm our previous clinical observation of the beneficial treatment of RAS with vitamin B12. Methods: A randomized, double-blind, placebo-controlled trial was done using primary care patients. A sublingual a dose of 1000 mcg of vitamin B12 was used in patients in the intervention group for 6 months. Results: In total, 58 patients suffering from RAS participated in the study: 31 were included in the intervention group and 27 were included in control group. All parameters of RAS among patients in the intervention group were recorded and compared with the control group. The duration of outbreaks, the number of ulcers, and the level of pain were reduced significantly (P < .05) at 5 and 6 months of treatment with vitamin B12, regardless of initial vitamin B12 levels in the blood. During the last month of treatment a significant number of participants in the intervention group reached “no aphthous ulcers status” (74.1% vs 32.0%; P < .01). Conclusion: Vitamin B12 treatment, which is simple, inexpensive, and low-risk, seems to be effective for patients suffering from RAS, regardless of the serum vitamin B12 level.

Modern Society and Prospects of Low Vitamin B12 Intake

Background: Vitamin B12 deficiency can occur in individuals with dietary patterns that exclude animal foods and patients who are unable to absorb vitamin B12 in food. Material and Method: Our clinic serves a high-income population living in Southern Israel. We hypothesize that a tendency to decrease of level of vitamin B12 in our population is caused by a premeditated decrease in consumption of animal products. We analyzed 512 medical histories of patients undergoing blood tests for vitamin B12 level for various reasons. Result: The level of vitamin B12 in 192 patients (37.5%) was less than 250 pg/ml. Conclusion: As a result of media information disseminating the relationship between meat, cholesterol and cardiovascular diseases, consumption of meat, particularly beef, has decreased. Changes in life style among segments of the population with high socioeconomic level, on one hand, and the existence of poverty, on the other, are two main factors in the decreasing consumption of animal products. This causes a decrease in the level of vitamin B12 in the general population, and as a consequence, this will increase pathology due to vitamin B12 deficiency. In lieu of these possible developments and in order to prevent serious health problems, vitamin B12 fortification should be seriously considered and discussed.

Cognitive Dysfunction: Part and Parcel of the Diabetic Foot

OBJECTIVE The presence of a foot ulcer increases the self-treatment burden imposed on the individual with diabetes. Additionally, this condition increases the cognitive demands needed for adherence to medical recommendations. A potential gap could exist between medical recommendations and the individual’s ability to implement them. Hence, the goal of this study was to examine whether the cognitive profile of people with diabetic foot ulcers differs from that of people with diabetes without this complication. RESEARCH DESIGN AND METHODS This was a case-control study. Ninety-nine individuals with diabetic foot ulcers (case patients) and 95 individuals with type 2 diabetes (control subjects) (age range 45–75 years), who were matched for diabetes duration and sex, underwent extensive neuropsychological evaluation using a NeuroTrax computerized battery, digit symbol, and verbal fluency tests. A global cognitive score after standardization for age and education was computed as well as scores in the following six cognitive domains: memory, executive function, reaction time, attention, psychomotor abilities, and estimated premorbid cognition. RESULTS Individuals with diabetic foot ulcers had significantly (P < 0.001) lower cognitive scores than individuals with diabetes without this complication, in all tested cognitive domains, excluding estimated premorbid cognition. Individuals with diabetic foot ulcers demonstrated a significant difference between precognitive and current cognitive abilities, as opposed to the nonsignificant difference among control subjects. The differences persisted in multivariable analysis after adjusting for depression and smoking. CONCLUSIONS Individuals with diabetic foot ulcers were found to possess fewer cognitive resources than individuals with diabetes without this complication. Thus, they appear to face more self-treatment challenges, while possessing significantly fewer cognitive resources.

The Effects of Pilates Training on Balance Control and Self-Reported Health Status in Community-Dwelling Older Adults: A Randomized Controlled Trial

OBJECTIVES To evaluate the effect of a group-based Pilates training program on balance control and health status in healthy older adults. DESIGN A single-blind, randomized, controlled trial. SETTING General community. PARTICIPANTS A total of 88 community-dwelling older adults (age 71.15 ± 4.30 years), without evidence of functional balance impairment, were recruited and allocated at random to a Pilates intervention group (n = 44) or a control group (n = 44). INTERVENTION The Pilates intervention group received 36 training sessions over three months (3 sessions a week), while the control group did not receive any intervention. OUTCOME MEASURES Standing upright postural stability, performance-based measures of balance, and self-reported health status was assessed in both groups at baseline and at the end of the intervention period. RESULTS Compared with the control group, the Pilates intervention did not improve postural stability, baseline functional measures of balance, or health status. CONCLUSIONS The results suggest that because Pilates training is not task specific, it does not improve balance control or balance function in independent older adults.

Why Food Fortification with Vitamin B12 Is Needed

There are many articles indicating the increasing prevalence of low vitamin B12 (also called cobalamin) status in different segments of the general population [1–7]. The early detection of vitamin B12 deficiency is essential in order to prescribe opportune treatments, and there is evidence that such deficiencies are more common than would be expected. Vitamin B12 deficiency frequently occurs in individuals with dietary patterns that exclude animal food products and patients who are unable to absorb vitamin B12. Vitamin B12 deficiency has many causes, and pernicious anemia has been described as a widespread cause of this. Recent studies on vitamin B12, including the description of novel etiologies of vitamin B12 deficiency, have added to our understanding of this essential dietary component. For example, vitamin B12 deficiency can arise not only from insufficient dietary intake [8] but also from food-cobalamin malabsorption syndrome [9]. The latter is characterized by the failure to release vitamin B12 from food or a deficiency of intestinal vitamin B12 transport proteins or both, due to chronic overgrowth of Helicobacter pylori [10] and intestinal microbial proliferation. Changes in gut flora can arise from antibiotic treatment, long-term ingestion of biguanides (metformin) [11, 12], and antacids, including H2-receptor antagonists and proton-pump inhibitors [13] (mainly among patients with Zollinger–Ellison syndrome [14]). There are also genetic vitamin B12 metabolism diseases as Imerslund–Grasbeck syndrome which is a selective vitamin B12 malabsorption with proteinuria [15]. Chronic alcoholism, surgery (e.g., bypass surgery for obesity), and partial pancreatic exocrine failure can also contribute to vitamin B12 deficiency. Overall, this demonstrates that new approaches to the identification and treatment of subjects with vitamin B12 deficiency may be needed.

The Critical Role of Vitamin B12

Abstract Vitamin B12 affects the peripheral and central nervous systems, bone marrow, skin and mucous membranes, bones, and vessels, as well as the normal development of children. Although there is undoubtedly an association between vitamin B12 and homocysteinemia, their relative influence on cardiovascular events is controversial. Some large studies confirm that a supplementation with group B vitamins did not reduce the risk of major cardiovascular events or all-cause mortality in patients with vascular disease. The outcomes of these and similar trials could have been different had the researchers considered the following points: Using vitamin B12 or B-complex as secondary prevention of cardiovascular events for patients with irreversible changes of blood vessels is probably in error. Rather, vitamin B12 or B-complex should be used as primary prevention. Also, using high doses of vitamin B12 will probably be more effective than using low doses of “group B vitamins.” The effect of vitamin B12 on the proliferation of malignant cells has been examined in vivo and in vitro in numerous studies. Their results indicate that methylcobalamin inhibits the proliferation of malignant cells and propose the possibility of methylcobalamin as a candidate of potentially useful agents for the treatment for some malignant tumors. There are many articles indicating the increasing prevalence of low vitamin B12 level in different segments of general population. In order to prevent serious health problems, vitamin B12 routine fortification should be seriously considered and discussed.

What are the recommended guidelines for checking vitamin B12 by primary practitioners

Vitamin B12 deficiency is a common problem that affects the general population. Early detection of vitamin B12 deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. If the disorder is untreated, complications may cause significant morbidity and irreversible neurological deficits (1). There are no generally accepted guidelines for the definition, diagnosis, treatment, and follow-up of cobalamin (vitamin B12) deficiency. Persons with the deficiency may be asymptomatic, but a high index of suspicion of B12 deficiency is required in patients presenting with myelopathy, cognitive decline, neuropathy, psychiatric disturbances, or specific hematologic signs and symptoms. Total serum vitamin B12 may not reliably indicate vitamin B12 status. Probability of ‘‘functional’’ vitamin B12 deficiency decreases with increasing level of vitamin B12. To get more specificity and sensitivity in diagnosing vitamin B12 deficiency, the concept of measuring homocystein (HCY), methylmalonic acid (MMA), and holotranscobalamin II (holoTC)*a sub-fraction of vitamin B12*has aroused great interest. HoloTC, as a biologically active vitamin B12 fraction, promotes uptake of its vitamin B12 by all cells. However, diagnostic algorithms using vitamin B12, MMA, and HCY measurements reflect studies in some academic centers, and their negative predictive values have not been established; therefore, this problem remains controversial (2). One of the purposes of this study was to understand reasons for checking vitamin B12 by primary physicians, and to try to evaluate sensitive clinical and laboratory predictors of vitamin B12 deficiency.