… After 3 months, the patient's neuropathy complaints were repaired and the vocal fold were evaluated as normal.” In this case, the man had been taking insulin, valsartan and

metformin for five years. Metformin, a diabetes drug, has previ- ously been linked to vitamin B12 deficiency. In one study, aver- age vitamin B12 levels were lower among those taking metformin, and 4% were deficient compared to 2% in the placebo group. Further, nearly 20% of those taking metformin had borderline

low vitamin B12 levels compared to 10% of those taking a pla- cebo. More people in the metformin group were also anemic, which is associated with vitamin B12 deficiency. The case-study researchers noted, “Physicians should be kept

in mind that long term use of metformin could result vitamin B12 deficiency when assessing the etiology of vocal fold paralysis.” The Journal of Laryngology & Otology researchers also noted

that it’s important for clinicians to consider vitamin B12 defi- ciency in the case of vocal fold palsy, stating, “It is important to consider vitamin B12 deficiency as a cause, as speedy identifica- tion and treatment can help prevent permanent neurological damage.”

Some Vitamin B12 Deficiency Symptoms May Be Missed The symptoms of vitamin B12 deficiency can be subtle or

mirror other conditions, putting them at risk of being overlooked or misdiagnosed by clinicians. One of the effects of deficiency is a blood condition called megaloblastic anemia. It causes the bone marrow to release immature blood cells, which are unable to deliver adequate amounts of oxygen to the body. The result is fatigue and pale skin. Those with megaloblastic anemia may also develop jaundice,

a slight yellowing of the skin or eyes. Some with vitamin B12 deficiency also report experiencing eye twitching or eyelid spasms. In the featured study, a 74-year-old woman with B12 deficiency also experienced blurred vision, along with gait dis- turbances and problems with balance. Mental health problems can also be a sign of not enough

B12, and it’s been observed that up to 30% of patients hospital- ized for depression may be B12 deficient, while among the el- derly with depressive disorders, those with B12 deficiency may

be 70% more likely to experience depression. Those researchers went so far as to say that vitamin B12 may be causally related to depression.

Vitamin B12 May Be Useful for COVID-19 B vitamins also play an important role in cell functioning,

energy metabolism and immune function, leading one group of researchers to suggest that they could be useful for treating CO- VID-19, and vitamin B status should be assessed in COVID-19 patients. “Vitamin B assists in proper activation of both the innate and

adaptive immune responses, reduces proinflammatory cytokine levels, improves respiratory function, maintains endothelial in- tegrity, prevents hypercoagulability and can reduce the length of stay in hospital,” researchers wrote in the journal Maturitas. In terms of vitamin B12, specifically, it modulates gut micro-

biota, and low levels may lead to increased inflammation and oxidative stress. A study also suggested that vitamin B12 supple- ments may reduce COVID-19-related organ damage and symp- toms. Researchers with the Singapore General Hospital and Duke-

NUS Medical School also set out to determine if a combination of vitamin D, magnesium and vitamin B12 would improve out- comes among COVID-19 patients aged 50 and older. Seventeen patients received oral vitamin D3 (1,000 IU),

magnesium (150 milligrams (mg)) and vitamin B12 (500 mcg) — together known as DMB — upon admission for a median of five days while 26 patients who did not receive DMB served as the control group. Significant benefits were seen among the DMB group, with

only 17.6% requiring initiation of oxygen therapy during their hospitalization, compared to 61.5% of those in the control group. The requirement for oxygen is associated with an increased risk of needing intensive care, and the DMB group also benefited in this area.

Among those in the DMB group who required supplemental

oxygen (three out of the 17 patients), two required ICU admission while one did not. Among the control group, all of those who needed supplemental oxygen required further ICU support. Nine

Robinhood Integrative Health Bruce Lantelme, MD

Weston “Wiggy” Saunders, MD Elizabeth Bozeman, MD

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