Imbalances in vitamins

Vitamin A helps boost learning skills and increase the brain’s plasticity. This makes it particularly good for learning, memory and focus Scott, T. and Amen, D. (May 2015). The Brain Warrior’s Way to Attacking Anxiety, Depression and Ageing. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/.

Vitamin A is also important for hormonal balance.

Vitamin A exists in two main forms

• Retinol – a bioactive form of vitamin A as found in animal foods
• Carotenoid, vitamin A as found in plant foods which still requires conversion to retinol

Several factors can prevent the body from converting plant based carotenoids to their bioactive retinol form.

• Genetics
• Alcohol use
• Certain medicines
• Poor digestion and absorption, especially of fats, which are essential for vitamin A production
• Unbalanced vegan diet

This can lead to vitamin A deficiency.

Possible mental health symptoms of vitamin A deficiency

• Mood disorders
• Thyroid dysfunction
• Hormonal imbalances

B vitamins are essential cofactors for the production of hormones and neurotransmitters including adrenaline, serotonin, dopamine, GABA, etc. Behrendt, I., Schneider, I., Schuchardt, J. P., Bitterlich, N. and Hahn, A. (2016). Effect of an herbal extract of Sideritis scardica and B-vitamins on cognitive performance under stress: a pilot study. [online] International Journal of Phytomedicine, 8 (1), pp.95-103. Available at: http://www.arjournals.org/index.php/ijpm/article/view/1736 [accessed 10 Oct. 2017].

• Vitamins B3 and B6 are both essential for balanced brain function and B5 is essential for optimal adrenal function Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p.115..
• Vitamins B6, B12 and B9 can help prevent damage from brain oxidation

B vitamins are the best available protection against elevated levels of the amino acid, homocysteine.

In excess, homocysteine:

• Increases your risk of mood disorders
• Leads to poor mental performance
• Leads to memory loss
• Can cause dementia, and Alzheimer’s disease
• Promotes inflammation, which kills brain cells and damages blood cells in the body and brain

Possible mental health symptoms of deficiency in B vitamins

• Depression and mood swings
• Cognitive issues
  • Poor concentration and attention
  • Memory issues and possibly Alzheimer’s
• Anxiety
• Irritability
• Insomnia
• Exhaustion and lethargy
• Poor sleep

Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 172., Amen, D. (2013). Unleash The Power Of The Female Brain. New York: Harmony Books, p. 79., Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 76.

Possible causes of B vitamin deficiency

• Poor digestion and absorption
• High levels of estrogen, which interferes with the metabolism of B vitamins
• Poor diet
• Alcohol
• Smoking
• Caffeine Gluck, M. and Edgson, V. (2010). It Must Be My Hormones. Camberwell, Vic.: Penguin Group (Australia), p. 116.

B1 is needed to turn glucose into energy which the brain uses as fuel.Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 61. It is responsible for converting carbohydrates into energy, it helps with the digestion of proteins and fats.

Possible mental health symptoms of B1 deficiency

• Poor concentration and attention Kaur, J., Bhatia, M. S. and Gautam, P. (2014). Role of dietary factors in Psychiatry. [online] Diet and Psychiatry, 17 (2). Available at: http://medind.nic.in/daa/t14/i2/daat14i2p452.pdf [accessed 29 Aug. 2017]., Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 68.
• Depression
  • Low levels of B1 can cause the brain to lose energy, causing depressive symptoms Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185.
• Fatigue
• Can lead to encephalopathy, where there is abnormal brain function Via, M. (2012). The malnutrition of obesity: micronutrient deficiencies that promote diabetes. [online] ISRN Endocrinology. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313629/ [accessed 29 Aug. 2017].

Possible causes of B1 deficiency

It is rare to be deficient in thiamine, but the main causes of its insufficiency are:

• Alcoholism
• Vomiting
• Kidney dialysis
• HIV
• Overconsumption of refined carbohydratesGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185.
• Gastrointestinal illnesses including Crohn’s disease, anorexia
• Poor digestion and absorption

B2 is essential for energy production and the nervous system.Talbott, S. (2007). The Cortisol Connection. Alameda, CA: Hunter House, p. 189.

Possible mental health symptoms of B2 deficiency

• Depression
• Hypomania
  • Hypomania is a mild form of mania and is characterized by a lack of inhibitions in behaviour and euphoria
• Psychopathic tendencies

Kaur, J., Bhatia, M. S. and Gautam, P. (2014). Role of dietary factors in Psychiatry. [online] Diet and Psychiatry, 17 (2). Available at: http://medind.nic.in/daa/t14/i2/daat14i2p452.pdf [accessed 29 Aug. 2017]. 

• B3 can improve memory and reduce the risk of dementia and cognitive decline
• B3 is necessary to support omega 3 and omega 6 conversion to prostaglandins
  • Some prostaglandins have an anti-inflammatory effect, but their effect on mental health can be both positive and negative
  • In Alzheimer’s disease prostaglandins can be both neurotoxic and neuroprotective depending on the particular receptor involvedFattahi, M. J. and Mirshafiey. A. (2014). Positive and negative effects of prostaglandins in Alzheimer’s disease. [online] Psychiatry and Clinical Neurosciences, 68 (1), pp. 50-60. Available at: http://onlinelibrary.wiley.com/doi/10.1111/pcn.12092/abstract [accessed 29 Aug. 2017].
  • High levels of prostaglandins are seen in depressionLuca, M., Luca, A., Celia, A. and Calandra, C. (2013). Prostaglandins pathway as a possible biological link between cancer and major depression. [online] Current Angiogenesis, 2 (2), pp. 143-8. Available at: http://www.eurekaselect.com/110213/article [accessed 29 Aug. 2017].
• In high doses (several grams), B3 has been found to be effective in treating schizophrenia and psychotic episodesHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 63, p. 67.
• B3 can help with depression and anxietyGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185., Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 172.

Possible mental health symptoms of B3 deficiency

• Depression
  • There is a link between B3 and Tryptophan and Serotonin
    • If there is a B3 deficiency, the body will use tryptophan to make B3, however this process is very expensive in tryptophan
    • The production of B3 from tryptophan will take priority over the production of serotonin from tryptophan, thereby reducing the amount of serotonin available Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185.
    • When B3 levels are sufficient, our body will have a lower requirement for tryptophanShibata, K. (2015) Nutritional Aspects of Tryptophan Metabolism. In: S. Mittal, ed., Targeting the Broadly Pathogenic Kynurenine Pathway. Springer International Publishing, pp. 31-43., Viljoen, M., Swanepoel, A. and Bipath, P. (2015). Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake. [online] Medical Hypotheses, 84 (3), pp. 178–82. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25596911 [accessed 29 Aug. 2017].

• PsychosisHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 68.
• Exhaustion and lethargy
• AnxietyLake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 172.
• Poor memory

Possible causes of B3 deficiency

• Over-consumption of refined carbohydratesGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185.
• Poor digestion and absorption
• Alcoholism

• B5 is important in regulating stress and adrenal functionTalbott, S. (2007). The Cortisol Connection. Alameda, CA: Hunter House, p. 190.
• B5 boosts acetylcholine production which aids memoryHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 63. and improves mood

Possible mental health symptoms of B5 deficiency

• Poor memory
• Difficulty in dealing with stress
• Exhaustion
• Insomnia
• Depression
• Irritability

Davison, K. M. and Kaplan, B. J. (2012). Nutrient intakes are correlated with overall psychiatric functioning in adults with mood disorders. [online] The Canadian Journal of Psychiatry, 57 (2), pp. 85–92. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22340148 [accessed 29 Aug. 2017]., Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 63, p. 68.

Possible causes of Vitamin B5 deficiency

• Poor diet
• Poor digestion and absorption
• Smoking

(2017). Vitamin B5 (Pantothenic acid). [online] University of Maryland Medical Center. Available at: http://www.umm.edu/health/medical/altmed/supplement/vitamin-b5-pantothenic-acid [accessed 30 Oct. 2017].

Vitamin B6 is involved in processing amino acids, converting nutrients into energy, and is necessary for the synthesis of neurotransmitters serotonin, GABA and dopamine Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185., Peters, L., Fernstrand, A. M., Garssen, J. and Verster, J. C. (2015). The effect of dietary intake of vitamin B6 on sleep quality and insomnia. European Neuropsychopharmacology, 25(S2), pp. 654–5. Available at: https://dspace.library.uu.nl/handle/1874/330126 [accessed 29 Aug. 2017].:

• B6 is necessary for the production of serotonin and dopamine, and therefore can help boost mood and motivation
• B6 is necessary for the production of GABA, and also helps to modulate elevated cortisol, thereby making it effective in decreasing anxiety, especially when combined with magnesiumTalbott, S. (2007). The Cortisol Connection. Alameda, CA: Hunter House, p. 191.
• B6 helps with focus and mental energyScott, T. and Amen, D. (May 2015). The Brain Warrior’s Way to Attacking Anxiety, Depression and Ageing. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/.
• B6, combined with vitamin C and magnesium, has been shown to significantly reduce the symptoms of children with autismHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 64.
• B6 and zinc have been shown to be low in people with autism, ADHD and depressionHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 64.
• B6 supports the conversion of omega 3 and omega 6 into prostaglandinsHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 47.
  • Prostaglandins have an anti-inflammatory effect, but their effect on mental health can be both positive and negative
  • In Alzheimer’s disease prostaglandins can be both neurotoxic and neuroprotective depending on the particular receptor involvedFattahi, M. J. and Mirshafiey. A. (2014). Positive and negative effects of prostaglandins in Alzheimer’s disease. [online] Psychiatry and Clinical Neurosciences, 68 (1), pp. 50-60. Available at: http://onlinelibrary.wiley.com/doi/10.1111/pcn.12092/abstract [accessed 29 Aug. 2017].
• High levels of prostaglandins are seen in depressionLuca, M., Luca, A., Celia, A. and Calandra, C. (2013). Prostaglandins pathway as a possible biological link between cancer and major depression. [online] Current Angiogenesis, 2 (2), pp. 143-8. Available at: http://www.eurekaselect.com/110213/article [accessed 29 Aug. 2017].

Possible mental health symptoms of B6 deficiency

• Depression
• Confusion
• Memory problems, specifically short-term memory loss
• Attention and concentration difficulties
• Obsessive compulsive behaviour
• Anxiety and difficulty in dealing with stress
• Nervousness
• Irritability
• Insomnia

Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 172., Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 68., Schellack, G., Harirari, P. and Schellack, N. (2015). B-complex vitamin deficiency and supplementation. [online] SA Pharmaceutical Journal, 82 (4), pp. 28–32. Available at: https://www.researchgate.net/publication/283556727_B-complex_vitamin_deficiency_and_supplementation [accessed 29 Aug. 2017].

Possible causes of B6 deficiency

• Over-consumption of refined carbohydrates and the under-consumption of proteins
• Alcoholism
• Smoking
• Certain medications
• Stress
• Poor digestion and absorption 

Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185., Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 64.

Diagnosing B6 deficiency

• The gold standard is transaminase stimulation blood test
• A cheaper alternative is to take a urine test to detect the compound pyrroles, since most people with B-6 deficiency have elevated pyrroles (pyroluria)

Walsh, W. (2004). Nutrient Power. New York, NY: Skyhorse Pub., p. 74., Ehrlich, S. D. (2015). Vitamin B6 (Pyridoxine). [online] University of Maryland Medical Center. Available at: http://umm.edu/health/medical/altmed/supplement/vitamin-b6-pyridoxine [accessed 31 Aug. 2017].

• B8 aids in creating healthy cell membranes and maintaining electrical energy and nutrient transfer between cells
• B8 helps to regulate serotonin

Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 185., Schellack, G., Harirari, P. and Schellack, N. (2015). B-complex vitamin deficiency and supplementation. [online] SA Pharmaceutical Journal, 82 (4), pp. 28–32. Available at: https://www.researchgate.net/publication/283556727_B-complex_vitamin_deficiency_and_supplementation [accessed 29 Aug. 2017].

Possible mental health symptoms of B8 deficiency

• Mental confusion
• Depression
• Exhaustion and lethargy

Possible causes of B8 deficiency

• Vitamin B8 deficiency is rarely caused by a poor diet as it is found in many food types and only a small amount is needed by the body to avoid the symptoms listed above
• The major cause of deficiency is the inability of the body to absorb the nutrient properly, often due to:
  • Alcoholism
  • The use of various antibiotics, particularly sulfur-based antibiotic
  • Poor digestion and absorption

Sedesse, P. (2011). Symptoms and Causes of Vitamin B8 Deficiency. [online] Explain Health. Available at: http://www.explain-health.com/symptoms-causes-vitamin-b8-deficiency.html [accessed 27 Oct. 2017].

Folate is a general term for a group of water soluble vitamins known as B9, naturally found in foods. Folic acid refers to the oxidized synthetic compound used in dietary supplements and food fortification

Having too little vitamin B9 in our blood can cause folic acid deficiency anemia (a decrease in the amount of red blood cells or hemoglobin in the blood).

• Folate is essential for healthy methylation of DNA
  • DNA methylation causes alterations in the function of genes throughout the lifetime of an individual which can predispose to certain mental illnessIrwin, R. E., Pentieva, K., Cassidy, T., Lees-Murdock, D. J., McLaughlin, M., Prasad, G., McNulty, H. and Walsh, C. P. (2016). The interplay between DNA methylation, folate and neurocognitive development. [online] Epigenomics, 8 (6), pp. 863–79. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27319574 [accessed 29 Aug. 2017].
  • B9 is essential for normal cell development, and DNA synthesisGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 173-193.
    • This is especially relevant in early pregnancy when growth of the foetus is most rapid and folate is needed for cell division
• Folate levels have an impact on the synthesis of serotonin, dopamine and norepinephrineWalsh, W. (2004). Nutrient Power. New York, NY: Skyhorse Pub., p. 78., Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 103, p. 159.
• Folic acid and related substances folinic acid (leucovorin) and 5-methyltetrahydrofolate (5-MTHF) can exert an antidepressant effect by increasing the synthesis of monoamine neurotransmitters norepinephrine, serotonin and dopamine, neurotransmitters which are believed to be deficient in depressed individualsRechenberg, K. and Humphries, D. (2013). Nutritional Interventions in Depression and Perinatal Depression. [online] Yale Journal of Biology and Medicine, 86 (2), pp. 127-37. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670433/ [accessed 30 Aug. 2017]., Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 103, p. 159.
• Low folate levels have been associated with depression, folate-deficiency related depression, manic depression, and schizophreniaHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 64, p. 247., Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p.156.
• Low dietary folate can increase the risk of severe depression by as much as 3 timesGreger, M. and Stone, G. (2015). How Not to Die. London: Macmillan, p. 209.
• A sign of having folate-deficiency related depression is if you have experienced adverse reactions to SSRIs Walsh, W. (2004). Nutrient Power. New York, NY: Skyhorse Pub., p. 77.
• Antidepressant treatments do not work as well on people with a folate deficiency
  • Depressed people with lower rates of folate are more likely to relapseGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 173-193.
• B9 can help with cognitive function and moodsScott, T. and Amen, D. (May 2015). The Brain Warrior’s Way to Attacking Anxiety, Depression and Ageing. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/.

Possible mental health symptoms of B9 deficiency

• Depression, especially in folate-deficiency related depression
  • A sign of having folate-deficiency related depression is if you have experienced adverse reactions to SSRIsWalsh, W. (2004). Nutrient Power. New York, NY: Skyhorse Pub., p. 77.
• HypomaniaSharpley, A. L., Hockney, R., McPeake, L., Geddes, J. R. and Cowen, P. J. (2014). Folic acid supplementation for prevention of mood disorders in young people at familial risk: a randomised, double blind, placebo controlled trial. [online] Journal of Affective Disorders, 167, pp. 306–311. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25010374 [accessed 29 Aug. 2017].
• Anxiety
• PsychosisHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 64, p. 68.
  • Abnormally low serum folate levels correlate with chronic psychosisLake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., pp. 218-9.
• Poor attention and concentration
  • However high folate levels in association with normal vitamin B12 levels are associated with worse cognitive functionMoore, E. M., Ames, D., Mander, A. G., Carne, R. P., Brodaty, H., Woodward, M. C., Boundy, K., Ellis K. A., Bush, A. I., Faux, N. G., Martins, R. N., Masters, C. L., Rowe, C.C., Szoeke, C. and Watters, D. A. (2014). Among vitamin B12 deficient older people, high folate levels are associated with worse cognitive function: combined data from three cohorts. [online] Journal of Alzheimer’s Disease, 39 (3), pp. 661–8. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24246419 [accessed 29 Aug. 2017].
• Poor memory
• Exhaustion and lethargy

Possible causes of B9 deficiency

• Poor diet, especially with a lack of citrus fruits, leafy green vegetables and whole grains
• Poor digestion and absorption
• Alcoholism
• Severe kidney disease that requires dialysis
• Certain medicines, such as some used for cancer,rheumatoid arthritis, and seizures
• Smoking
• Some people have a greater need for folic acid
  • During pregnancy
  • People who have genetic variants, for instance, MTHFR is a genetic variant resulting in reduced folate levelsSontag, J. M., Wasek, B., Taleski, G., Smith, J., Arning, E., Sontag, E. and Bottiglieri, T. (2014). Altered protein phosphatase 2A methylation and Tau phosphorylation in the young and aged brain of methylenetetrahydrofolate reductase (MTHFR) deficient mice. [online] Frontiers in Aging Neuroscience, 6, p. 214. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25202269 [accessed 29 Aug. 2017].
  • Illness such as sickle cell disease

An essential nutrient for the nervous system and the brain, as well as in energy metabolismGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 159-173., Zhang, Y., Hodgson, N. W., Trivedi, M. S., Abdolmaleky, H. M., Fournier, M., Cuenod, M., Do, K. Q. and Deth, R. C. (2016). Decreased brain levels of vitamin B12 in aging, autism and schizophrenia. [online] PloS One, 11 (1), e0146797. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26799654 [accessed 29 Aug. 2017].:

• B12 deficiency has been picked up in many patients with dementiaHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 65.
• B12 plays a vital role in energy metabolism and its deficiency can lead to fatigue and depressionGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 159-173. 
• B12 deficiency can cause damage to the nerves, stripping them of the protective myelin sheath, which disrupts communication throughout the nervous systemPacholok, S. M. and Stuart, J. J. (2005). Could It Be B12? Sanger, CA: Quill Driver Books/Word Dancer Press, p. 59.
• B12 is important for proper methylation and homocysteine recyclingBrogan, Kelly. (2016) A Mind Of Your Own. HarperCollins, p. 125

Possible mental health symptoms of B12 deficiency

• DepressionLake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 156.
  • “Studies have shown that up to 30 percent of those hospitalised for depression are deficient in vitamin B12”Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 180.
• Anxiety
  • The most common side effect of B12 deficiency beyond fatigue is anxietyScott, T. and Osborne, P. (May 2015). Grainflammation – How Grain Consumption Contributes to Anxiety and Mood Disorders. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/., Greenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 180.
• Exhaustion and apathy
• Confusion and poor memoryIssac, T. G., Soundarya, S., Christopher, R. and Chandra, S. R. (2015). Vitamin B12 deficiency: An important reversible co-morbidity in neuropsychiatric manifestations. [online] Indian Journal of Psychological Medicine, 37 (1), pp. 26-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25722508 [accessed 29 Aug. 2017].
  • Alzheimer’s-like symptomsPacholok, S. M. and Stuart, J. J. (2005). Could It Be B12? Sanger, CA: Quill Driver Books/Word Dancer Press, p. 69.
• Irritability
• Aggressive behaviour
• PsychosisTufan, A. E., Bilici, R., Usta, G. and Erdoğan, A. (2012). Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report. [online] Child and Adolescent Psychiatry and Mental Health, 6 (1), p. 25. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22726236 [accessed 29 Aug. 2017]., Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 68.
• Poor sleep

Possible causes of B12 deficiency

Although most people consume enough B12 from food, they may be deficient due to:

• Gut issues
  • Conditions affecting the small intestine, such as Crohn’s disease, celiac disease, bacterial growth, or a parasite
  • Poor digestion and absorption, leaky gut, gut dysbiosis
• Gluten intolerance
  • Gluten is notorious for damaging the two areas of the gastrointestinal tract where B12 is absorbed, which can cause B12 deficiencyScott, T. and Osborne, P. (May 2015). Grainflammation – How Grain Consumption Contributes to Anxiety and Mood Disorders. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/.
• Vegan or vegetarian diet
  • B12 is especially abundant in meat, eggs and dairy products
  • Spirulina and tempeh contain an analogue from of B12 that blocks the absorption of the form of B12 the body needs
  • Intake of these analogues can cause as false positive for blood serum testing of B12Pacholok, S. M. and Stuart, J. J. (2005). Could It Be B12? Sanger, CA: Quill Driver Books/Word Dancer Press, p. 162.
• Certain medications
  • Psychiatric medicationsPacholok, S. M. and Stuart, J. J. (2005). Could It Be B12? Sanger, CA: Quill Driver Books/Word Dancer Press, p. 5.
  • Long-term use of acid-reducing drugs
    • Stomach acids help break down animal proteins that have vitamin B12English, J. (2013). Gastric Balance: Heartburn Not Always Caused by Excess Acid. [online] Nutrition Review. Available at: https://nutritionreview.org/2013/04/gastric-balance-heartburn-caused-excess-acid/ [accessed 29 Aug. 2017].
• Alcoholism
• Smoking
• Immune system disorders, such as Graves’ disease or lupus

Diagnosing B12 deficiency

Serum vitamin B12 test measures the amount of B12 in blood serum:

• This test can be unreliable, however, so it is better to take in conjunction with MMA (Methyl Malonic Acid) test to measure levels of MMA in urine or blood
• MMA detection in urine is more accurate than in blood
• Elevated MMA indicates a B12 deficiencyPacholok, S. M. and Stuart, J. J. (2005). Could It Be B12? Sanger, CA: Quill Driver Books/Word Dancer Press, p. 10.

Choline is a member of the B complex family.Elsawy, G., Abdelrahman, O. and Hamza, A. (2014). Effect of Choline Supplementation on Rapid Weight Loss and Biochemical Variables Among Female Taekwondo and Judo Athletes. [online] Journal of Human Kinetics, 40, pp. 77-82. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096089/ [accessed 29 Aug. 2017].

Supplementing with choline can help with anxiety and depression.Holland, J. (2015). Moody Bitches. New York: Penguin, p.174.

• People with mental illness have a greater need for Vitamin CHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 65.
• Vitamin C supports the conversion of tryptophan to serotonin, as it’s a cofactor in the production of tryptophan-5-hydroxylase, which is needed to convert 5-htp into serotonin
• Vitamin C can help calm nervousness and anxietyTalbott, S. (2007). The Cortisol Connection. Alameda, CA: Hunter House, p. 149.
• Vitamin C can help protect against cognitive declineScott, T. and Amen, D. (May 2015). The Brain Warrior’s Way to Attacking Anxiety, Depression and Ageing. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/
• Vitamin C is required for the production of progesterone, which is essential for hormonal balance and also for the production of the calming neurotransmitter GABA
• Low levels of vitamin C adversely influence embryonic brain developmentMeredith, M. E. and May, J. M. (2013). Regulation of embryonic neurotransmitter and tyrosine hydroxylase protein levels by ascorbic acid. [online] Brain Research 1539, pp. 7-14. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24095796 [accessed 30 Aug. 2017].
• Vitamin C has been shown to reduce the symptoms of depression and schizophreniaHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 65.
• Vitamin C supports the conversion of omega 3 and omega 6 into prostaglandinsHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 37.
  • Prostaglandins have an anti-inflammatory effect, but their effect on mental health can be both positive and negative
    • In Alzheimer’s disease prostaglandins can be both neurotoxic and neuroprotective depending on the particular receptor involvedFattahi, M. J. and Mirshafiey. A. (2014). Positive and negative effects of prostaglandins in Alzheimer’s disease. [online] Psychiatry and Clinical Neurosciences, 68 (1), pp. 50-60. Available at: http://onlinelibrary.wiley.com/doi/10.1111/pcn.12092/abstract [accessed 29 Aug. 2017].
  • High levels of prostaglandins are seen in depressionLuca, M., Luca, A., Celia, A. and Calandra, C. (2013). Prostaglandins pathway as a possible biological link between cancer and major depression. [online] Current Angiogenesis, 2 (2), pp. 143-8. Available at: http://www.eurekaselect.com/110213/article [accessed 29 Aug. 2017].
• Vitamin C is an essential antioxidant and anti-inflammatory, and supports our immune system

Possible mental health symptoms of C deficiency

• Anxiety and lower stress resilienceTalbott, S. (2007). The Cortisol Connection. Alameda, CA: Hunter House, p. 149., Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 65, p. 68., Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 172.
• DepressionAmr, M., El-Mogy, A., Shams, T., Vieira, K. and Lakhan, S. E. (2013). Efficacy of vitamin C as an adjunct to fluoxetine therapy in pediatric major depressive disorder: a randomized, double-blind, placebo-controlled pilot study. [online] Nutrition Journal, 12 (1), p. 31. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23510529 [accessed 29 Aug. 2017].
• PsychosisHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 65, p. 68.

Possible causes of vitamin C deficiency

• Poor diet
• Inflammatory disorders
• Smoking
• Stress
• Alcoholism

Vitamin D, which comes mainly from the sun, but also from food, is necessary for the production of important neurotransmitters for mental health and for hormonal balance. It is needed for the activation of calcium and phosphorous and for the development of bones and teeth, and is also essential for mental health.

• Vitamin D is vital for brain functionGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 182.
• In the body Vitamin D turns to an active form that is necessary for production of neurotransmitters dopamine, epinephrine and norepinephrine Holick, M. F. (2010). The Vitamin D Solution. New York: Hudson Street Press, p. 129.
• Vitamin D is necessary to convert the amino acid tryptophan to serotoninWalker, M., Green, J., Ferrie, R. and Cook-Mills, J. (2017). Serotonin Receptor Regulation of Eosinophil Transendothelial Migration. [online] The FASEB Journal, 31 (1), 55.7. Available at: http://www.fasebj.org/content/31/1_Supplement/55.7.abstract?sid=3d50bd4d-647a-480b-a80a-a6e9c1330ad6 [accessed 30 Aug. 2017].
• Vitamin D is helpful against depression and anxietyScott, T. and Keith, L. (May 2015). Anxiety, Depression and the Vegetarian Diet. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/.
• Vitamin D is essential for hormonal balance, itself important for mental health
• Vitamin D deficiency in early life is associated with autistic spectrum disorder, and schizophrenia
• Vitamin D deficiency is associated with Alzheimer’sGezen-Ak, D., Yılmazer, S. and Dursun, E. (2014). Why vitamin D in Alzheimer’s disease? The hypothesis. [online] Journal of Alzheimer’s Disease, 40 (2), pp. 257-269. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24413618 [accessed 29 Aug. 17]. 

Possible mental health symptoms of D deficiency

• DepressionGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, pp. 180-5.
• Seasonal affective disorder (SAD)
  • SAD occurs during dark times of the year, showing a direct link between vitamin D and depressionGreenblatt, J. (2011). The Breakthrough Depression Solution. North Branch, MN: Sunrise River Press, p. 182., Milaneschi, Y., Hoogendijk, W., Lips, P., Heijboer, A. C., Schoevers, R., Van Hemert, A. M., Beekman, A. T., Smit, J. H. and Penninx, B. W. (2014). The association between low vitamin D and depressive disorders. [online] Molecular Psychiatry, 19 (4), pp. 444-51. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23568194 [accessed 29 Aug. 2017].
• Chronic fatigue
• Cognitive impairmentAmen, D. (2013). Unleash The Power Of The Female Brain. New York: Harmony Books, p. 77., Eyles, D. W., Burne, T. H. and McGrath, J. J. (2013). Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. [online] Frontiers in Neuroendocrinology, 34 (1), pp. 47–64. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22796576 [accessed 29 Aug. 2017].
• PsychosisAmen, D. (2013). Unleash The Power Of The Female Brain. New York: Harmony Books, p. 77.
• Hormonal issues such as PMSHolick, M. F. (2010). The Vitamin D Solution. New York: Hudson Street Press, p. 129.
• Anxiety
• DementiaHolick, M. F. (2010). The Vitamin D Solution. New York: Hudson Street Press, p. 140., Forsyth, C. Fact Sheets. Available at: http://www.dr-forsyth.com/Dr_Charles_Forsyth/Dr_Charles_Forsyth_-_Homeopathy,_Nutrition,_Allergy,_Ecological_Medicine_-_Reigate,_Croydon,_Surrey_%26_Biolab,_Central_London_2.html.

Possible causes of vitamin D deficiency

• Poor diet
• Limited exposure to sunlight
  • Because vitamin D is made when your skin is exposed to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings or have an occupation that prevents sun exposure
• Having darker skin
  • The pigment melanin reduces the skin’s ability to make vitamin D in response to sunlight exposure
  • Some studies show that older adults with darker skin are at high risk of vitamin D deficiency

Diagnosing D deficiency

To diagnose deficiency, get a 25-hydroxyvitamin D test, also called a 25(OH) D test:

• This tests for the inactive form of vitamin D
• Testing for the activated form of vitamin D does not accurately reflect vitamin D deficiency, even if levels comes up as normal or elevatedHolick, M. F. (2010). The Vitamin D Solution. New York: Hudson Street Press, p. 147.
• Deficiency of 25(OH) D is
  • < 20 nanograms per millilitre (ng/ml)
  • Insufficiency 21 – 29 ng/ml
  • Sufficiency > 30 ng/mlHolick, M. F. (2010). The Vitamin D Solution. New York: Hudson Street Press, p. 147.
• Optimal levels of 25-hydroxy vitamin D
  • Between 75 and 250 nmol/L (nanograms per litre) at minimum
  • Ideally between 125 and 250 nmol/LAmen, D. (2013). Unleash The Power Of The Female Brain. New York: Harmony Books, p. 78.

• Protects essential brain fats from oxidation caused by trans fats, stress, pollution, smoking, etc.Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 79, p. 81.
• Can help with poor attention and memoryMangialasche, F., Solomon, A., Kåreholt, I., Hooshmand, B., Cecchetti, R., Fratiglioni, L., Soininen, H., Laatikainen, T., Mecocci, P. and Kivipelto, M. (2013). Serum levels of vitamin E forms and risk of cognitive impairment in a Finnish cohort of older adults. [online] Experimental Gerontology, 48 (12), pp. 1428–35. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24113154 [accessed 29 Aug. 2017].
• Has been shown to prevent and slow the progression of Alzheimer’sHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 82.
• Can help protect against anxietyLake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 172.

Possible mental health symptoms of E deficiency

• AnxietyLake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., p. 172.
• Cognitive decline such as poor attention and memoryMangialasche, F., Solomon, A., Kåreholt, I., Hooshmand, B., Cecchetti, R., Fratiglioni, L., Soininen, H., Laatikainen, T., Mecocci, P. and Kivipelto, M. (2013). Serum levels of vitamin E forms and risk of cognitive impairment in a Finnish cohort of older adults. [online] Experimental Gerontology, 48 (12), pp. 1428–35. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24113154 [accessed 29 Aug. 2017].

Co-enzyme Q10 is a vitamin-like substance present in the mitochondria of cells. It is a natural antioxidant made by every cell in the body, and is very important for the brain, helping with energy, cognition and memory.

• CoQ10 is one of the few antioxidants that is fat soluble, which means that it can access the brain and protect it against free radical attack
• CoQ10 is important in generating energy for cells, and participates in 95% of energy production
• Organs in the body with high energy requirements, have high levels of CQ10
• CoQ10 has a vital role in reducing oxidative damage to cells

It strengthens the immune system, and aids energy production at a cellular level.Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 81.

Possible mental health symptoms of CoQ10 deficiency

• Schizophrenic patients have been shown to have lower levels of co-q10 than the rest of the populationHolford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p. 81.
• Depression
• Poor memory
• Poor attention and concentration
• Irritability
• Chronic fatigue syndrome
• Exhaustion
• Parkinson’s disease
• Dementia
• Slower response time

Kinoshita, T., Maruyama, K. and Tanigawa, T. (2016). The Effects of Long-Term Ubiquinol Intake on Improving the Quality of Life of Community Residents. [online] Functional Foods in Health and Disease, 6 (1), pp. 16–32. Available at: https://ffhdj.com/index.php/ffhd/article/view/225 [accessed 29 Aug. 2017].

Possible causes of CoQ10 deficiency

• Age
  • As we age, our body’s natural ability to produce CoQ10 declinesWada, H., Goto, H., Hagiwara, S. and Yamamoto, Y. (2007). Redox status of coenzyme Q10 is associated with chronological age. [online] Journal of the American Geriatrics Society, 55 (7), pp. 1141-2. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17608895 [accessed 29 Aug. 2017].
• Statins
  • Can have a negative effect on CoQ10 levelsRundek, T., Naini, A., Sacco, R., Coates, K. and DiMauro, S. (2004). Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. [online] Archives of Neurology, 61 (6), pp. 889-92. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15210526 [accessed 29 Aug. 2017].
• Poor digestion and absorption