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Diabetes and Dementia and B12 Deficiency, Oh My!

Diabetes affects 11.3% of people in the US, and 90-95% of those people have type 2 diabetes. What many people may not know, however, is that all forms of diabetes will increase your risk of dementia. Glucose (sugar) is an essential source of energy for your brain, so when your insulin is not metabolizing it in a way that makes it useful, your brain misses out on important fuel. A pre-diabetic state is marked by insulin resistance, which is when your insulin cells can’t use glucose effectively.

Some early signs of insulin resistance include:

The catch is, even if you try to get your diabetes under control with medications such as metformin, you will still be increasing your chances of getting dementia.

The Misfortune of Metformin 

Metformin may be prescribed as generic, or by brand names such as Fortamet or Glumetza. It is a commonly used drug for type 2 diabetes and has been prescribed to over 120 million people worldwide.

Numerous studies have shown a correlation between use of metformin and chronic vitamin B12 deficiency. Typically within one year of consistent usage of metformin, your ability to absorb B12 becomes compromised and you may experience symptoms of B12 deficiency including:

  • Fatigue
  • Weakness
  • Headaches
  • Vomiting
  • Nausea
  • Dizziness
  • Lightheadedness especially coming from seated to standing
  • Feeling cold
  • Muscle pain or weakness
  • Tingling and numbness in the hands and feet
  • Loss of reflexes, which may progress to depression, confusion, and memory loss

B12, also known as cobalamin, is a vitamin that is essential for brain health and nervous system function. It is needed for the creation of red blood cells, which help distribute oxygen to the rest of our bodies (including our brains). It is no wonder, then, that low B12 levels have been linked to dementia. Researchers Norbert Goebels, M.D. and Michael Soyka, M.D wrote:

“Cobalamin deficiency has been shown to be the most frequent associated physical disease in patients with dementia.”

So, diabetes can lead to dementia, and the medication for diabetes can also lead to dementia. Not to mention the recent national recall for metformin based on a batch containing a carcinogenic (cancer-causing) chemical. Is there no way to win here? Well, our office has a different approach.

What Else Can Cause B12 Deficiency?

Age

Besides medications like metformin, there are other risk factors that can lead to a B12 deficiency. Age is one of these factors. Ten to thirty percent of people over the age of 50 produce too little stomach acid to release B12 from the foods they eat. A certain amount of stomach acid is required to break down the carrier foods and release the B12 vitamin. This could mean that even though you are eating foods that technically contain B12, you may not be breaking the food down enough to actually absorb the B12. The older you get, the less stomach acid you produce, so this risk only increases.

Genes

MTHFR is a gene that helps our bodies convert folate, A.K.A. vitamin B9, to an activated version that our bodies can use. All B vitamins need to be converted to their methylated forms in order for our bodies to use them. What does this have to do with B12?

Our bodies need activated (methylated) folate in order to use B12. So, when there is a mutation on our MTHFR gene, it affects our body’s ability to make activated folate, and therefore our ability to use B12. This creates an interesting dynamic where someone can have completely normal levels of B12 in their blood, but are actually deficient in the vitamin and have the corresponding symptoms.

At Dr. Autoimmune, we are able to order specialized blood tests to detect mutations on the MTHFR gene when Dr. Ian suspects this may be a concern.

Managing Diabetes Naturally

Instead of prescribing medications that increase your risk of dementia, our office seeks to address the underlying cause of your condition and develop a management plan using lifestyle changes and proper supplementation.

One tool we frequently use is a continuous glucose monitor (CGM) to help our clients learn exactly how different foods affect their blood sugar. While we use this tool to manage and make decisions about diet changes, we also dive deeper.

As we mentioned at the beginning of this article, insulin resistance is a precursor to diabetes. Insulin resistance is caused by systemic inflammation in the body. This can be caused by gut dysbiosis, food sensitivities (particularly to gluten), toxin exposure (such as mold), stress, and hormone imbalances, just to name a few.

By identifying and addressing these root causes, rather than managing symptoms with a band-aid medication, our patients find that their bodies have exceptional healing abilities when given the right tools! If you are ready to change your life, click the “Start Your Journey” button at the bottom of this page.

Dr. Ian recently went viral with a video about MTHFR and B12 deficiency related to metformin use. Make sure to subscribe to him on TikTok to get daily health tips and kernels of knowledge!

Lupus and DHEA: A New Approach

Lupus is an autoimmune condition that can cause inflammation and pain in any part of the body. As with all autoimmune conditions, there is no “cure” necessarily, but it stems from imbalances in the body that can be adjusted, so remission from this condition is possible.

Autoimmunity is when the body attacks its own tissue and organs. In lupus, any bodily system can be attacked, so there are a wide range of possible symptoms. Some of the most common symptoms include:

  • Muscle and joint pain
  • Fever
  • Rashes (malar “butterfly” type)
  • Chest pain  
  • Hair loss (alopecia)
  • Sun or light sensitivity
  • Kidney problems
  • Mouth sores 
  • Prolonged or extreme fatigue
  • Anemia
  • Brain fog
  • Memory problems
  • Blood clotting
  • Eye disease
  • Anxiety

One natural method for relieving lupus symptoms that has been showing a lot of positive results is DHEA. DHEA (dehydroepiandrosterone) is a mild male hormone. It can be helpful for reducing lupus symptoms such as hair loss, joint pain, fatigue, and brain fog.

In blood tests, DHEA levels tend to be lower in people who have inflammatory diseases such as lupus, rheumatoid arthritis (RA), and inflammatory bowel disease. The more severe a person’s symptoms are, the lower their DHEA levels are. So, the hypothesis is that the higher we can get the DHEA levels, the less symptoms that person will experience! Experiments with mice and clinical trials with humans have both shown that DHEA supplementation can, in fact, reduce symptoms of lupus.

How Does it Work?

While it theoretically makes sense that if low DHEA = more symptoms, then high DHEA = less symptoms, we need to know how this works in order to be sure that it isn’t just a random connection. 

You may have heard of a “cytokine storm” in relation to the recent pandemic. It is basically a state of systemic inflammation. Cytokines are proteins that are important for communication between cells. Some cytokines are actually anti-inflammatory, but many are pro-inflammatory, meaning that they cause inflammation, as they do in a cytokine storm.

Studies have shown that DHEA may help regulate cytokine production and reduce the amount of pro-inflammatory cytokines that are created, therefore reducing overall inflammation. The relationship between cytokines and DHEA may also explain why DHEA levels are lower in people that have chronic inflammatory conditions, such as lupus and RA. Pro-inflammatory cytokines actually suppress the enzymes that are needed to make DHEA. So there is a bit of a “chicken and the egg” situation here, since it is not exactly clear which comes first. But we know that there is a vicious cycle:

DHEA can reduce autoimmunity, but it also increases resistance to infection. How can it both amp up and calm down your immune system? The answer is in its ability to regulate. The key to resolving autoimmunity is not to suppress the entire immune system, which leaves your body vulnerable to infection, but to regulate the immune system so that it works properly. DHEA seems to be an important factor for immune system regulation. The biggest factor though, of course, is T-regulatory cell function- literally named for their job of ‘policing’ the immune system.

Side effects of DHEA can include acne, facial hair growth, oily skin, and excessive sweating. In one study, even though every patient who continued to take the DHEA for 12 months showed significant improvement, 16% of the participants dropped out of the study early due to side effects. This goes to show that this medication may not be the best option for everyone (doses tended to be high so this may have led to side effects).

DHEA can also lower good cholesterol (HDL cholesterol) in women and raise estrogen levels in postmenopausal women. (Learn more about the importance of healthy cholesterol levels here and the issues with estrogen dominance here.) There have been concerns raised about the long-term effects due to lowered HDL cholesterol, so it is important to talk with a doctor about DHEA rather than attempting to use it by yourself.

At Dr. Autoimmune, we use a functional medicine approach to identify the root cause of your condition and develop a custom plan using diet, supplementation, and lifestyle change to help you reach your health goals. We are unique because we also address the brain through functional neurology, which is especially helpful for lupus patients struggling with brain fog and memory loss. With an 85% success rate, we are confident that we can get you the results you are looking for. If you’re ready to be brave to change, click the “Start Your Journey” button at the bottom of this page.

What is Sjögren’s Syndrome?

April is Sjögren’s awareness month, so we thought it would be a great time to shed some light on it. Sjögren’s (pronounced show-grens) syndrome is a common autoimmune condition where moisture-secreting glands are attacked. This usually happens first in the eyes and mouth, so dry eyes and mouth are the most common symptoms.

Other symptoms can include:

  • Dry eyes
  • Dry mouth
  • Vaginal dryness
  • Dry nose, recurrent sinusitis, nosebleeds
  • Dry or peeling lips
  • Dry skin
  • Fatigue
  • Joint or muscle pain
  • Inability to focus or ‘brain fog’
  • Respiratory issues like shortness of breath, dry cough, or recurrent bronchitis
  • Anxiety and depression
  • Memory loss
  • Dysautonomia 
  • Headaches (most commonly tension-type or migraines)
  • Mouth sores and dental problems
  • Swollen or painful salivary glands
  • Difficulty swallowing
  • Acid reflux
  • Raynaud’s phenomenon
  • IBS

Sjögren’s syndrome can develop at any age and in any sex, but it is most common in women (9 out of 10 patients are women) and people over 40. It is considered a widely underdiagnosed condition, with the Sjögren’s Foundation estimating that over 2.5 million patients are currently undiagnosed.

Sjögren’s can occur on its own, but it often shows up alongside other autoimmune conditions like lupus, rheumatoid arthritis, inflammatory bowel disease, Raynaud’s phenomenon, fibromyalgia, pernicious anemia, and thyroid conditions such as Hashimoto’s and Graves’. This useful graphic below (by the Sjögren’s Foundation) uses percentages to show the overlap of each of these conditions with Sjögren’s.

How Does Sjögren’s Start?

Like all autoimmune conditions, Sjögren’s requires 3 things to develop:

  1. A genetic predisposition
  2. Leaky gut (intestinal permeability)
  3. Environmental trigger

The genes associated with Sjögren’s aren’t known yet, but we can’t control those anyway. What we can have some control over, though, is whether those genes are expressed. Our genes basically can be turned on and off with the right environmental factors. This is why gut health and removing triggers are more important than our genes.

In functional medicine, we use diet change and supplementation to heal the gut while working with you to find out possible triggers in your life. Common triggers include stress, viral or bacterial infections, and mold or toxin exposure.

Dry Eyes

One of the first things to occur in Sjögren’s is the glands that produce tears, the lacrimal glands, are attacked by the immune system. You might think that we only produce tears when we cry, but our lacrimal glands are actually always working to keep our eyes moistened.

Have you ever wondered why we blink? Our eyelids keep moisture trapped beneath, so when the part of our eye that is exposed to air starts to dry out, blinking spreads a new film of moisture over them. This method only works, however, when our lacrimal glands are producing moisture.

Dry eyes can lead to burning, itching, a feeling like sand is in the eyes, blurred vision, and difficulty tolerating bright lights. Think back to the last time you were challenged to a “blinking contest”. After some time of forcing your eyes to remain open, your vision starts to become affected and you start to feel a burning sensation. This is what chronic dry eyes associated with Sjögren’s syndrome can feel like.

Dry Mouth

One of the 2 most prominent symptoms, dry mouth is uncomfortable and can lead to dental problems. Along with the lacrimal glands, the salivary glands are the first to be affected. Salivary glands produce saliva, which keeps our mouths and gums moist and also helps with digesting food.

People with Sjögren’s are more likely to develop cavities and gum disease due to lack of moisture, so recommendations include stimulating saliva production with sugar-free (xylitol or maltitol if sugar alcohols are tolerated) lozenges and brushing teeth after every meal. These types of recommendations are only good for managing symptoms without actually addressing the root cause.

What Can You Do?

At Dr. Autoimmune, we are experts at getting to the root cause of your condition and working with you to develop a personalized plan to reach your health goals. Most of our clients notice huge changes within only 30 days. Fill out the form below to get started on your health journey!