Vitamin B

Next in our quick series of Vitamin FAQ’s we look at vitamin B (if you missed Vitamin A – you can read it here).

There are actually lots of different types of vitamin B, but for our bodies the main ones are:

  • B1 – thiamin
  • B2 – riboflavin
  • B3 – niacin
  • B5 – pantothenic acid
  • B6 – pyridoxine
  • B7 – biotin
  • Folate (folic acid)
  • B12

 

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In general, they all aid the process of breaking down key aspects of our food, releasing much needed energy into our system, as well as helping keep our eyes, skin and nervous system healthy.

Vitamin B6 has a specific role in using and storing the protein and carbohydrates we take in as part of our diet and helping our body to produce haemoglobin. Haemoglobin is what makes our blood look red and critically carries oxygen around the body.

Folic acid – most well known as the supplement that is needed in pregnancy – is crucial for reducing the risk of developmental defects of the central neural tube of unborn babies. The neural tube is the early form of our central nervous system. Developmental problems at this crucial stage of a baby’s growth can lead to problems such as spina bifida. However it’s not just pregnant women – it also helps all of us to make healthy red blood cells.

Perhaps the most well known is vitamin B12. This actually helps us to use folic acid. It also is vital in keeping the nervous system healthy and plays a key role in making red blood cells.

With so many types of B vitamins, the ways we can get this into our diet are varied. Importantly, some of these vitamins cannot be stored in the body – so we need a daily supply in our diet. Thiamin cannot be stored – and it’s recommended that men need around 1mg/day and women around 0.8mg/day. Similarly we need daily riboflavin at around 1.3mg for men and 1.1mg for women. Niacin also cannot be stored and men should aim for around 16.5mg and women around 13mg.

A word of caution about niacin – too much for a long time can lead to liver problems and cause skin flushes. Similarly B6 in excessive amounts  (e.g. more than 200mg) can lead to a problem called peripheral neuropathy. This is a problem of the nervous system where we can develop loss of sensation in our limbs (peripheries). Men should aim for around 1.4mg/day of B6 and women around 1.2mg.

Many foods are rich in a number of B vitamins including: eggs, fresh/dried fruit,  leafy green vegetables, broccoli, wholegrain bread, fortified cereals, milk (cow’s), nuts,

Some specific diets e.g. vegetarians and vegans can sometimes struggle with B vitamins, and B12 in particular. B vitamins are in abundance in animal products – meats, fish, eggs, cows milk etc. However with careful planning, it is possible to get all the recommended amounts in your diet without additional supplementation. However, a multivitamin can be a helpful addition to more restrictive diets and might be worth discussing with your doctor.

Folic Acid

As we have already learned, folic acid (or folate) is pivotal in a baby’s development and throughout our life by helping us produce red blood cells. The average adult needs 200micrograms of folic acid/day and it cannot be stored meaning you need a daily amount. An additional supplement is provided to pregnant women – either 400mcg of 5mg depending on their medical history. Caution is required with additional supplementation – too much can possibly cover up an existing B12 deficiency.

This is found in vegetables such as asparagus, peas, sprouts and broccoli. It is also prevalent in liver but this should be avoided in pregnancy.

B12

The most well known of all B vitamins is B12. A deficiency of B12 is something that has been in the media more of late. This is the vitamin that those who avoid animal products in their most struggle with – as it is only found naturally in animal products – meats, milks, eggs.  It is some fortified cereals however.

We need around 1.5micrograms/day and this is something we can store in the body.

Deficiency in B12 causes wide ranging symptoms including low mood, changes in mental state, altered or abnormal sensation, fatigue, irritability, anaemia and reduced fertility. Whilst some changes can be reversed with treatment, if left unchecked and untreated, some of the damage can be permanent.

Why am I so tired all the time?

“Doctor, I’m just exhausted. All the time. I’m so tired, there must be something wrong with me”

Pretty much every GP or family doctor will hear this several times a day. Tiredness is ubiquitous with our fast paced modern lives, but at what point is it more than just our lifestyle and an indicator that something is medically wrong?

Feeling tired all the time, that feeling that even after a long sleep you don’t feel rested. It’s feeling like you could nap at pretty much any time of day. It’s draining for patients and can have a real knock on impact on their quality of life.

 

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There many medical explanations for tiredness such as hypothyroidism, anaemia and depression but it’s important to also examine your own habits and patterns to work out if it’s anything you might be able to change.

 

In my clinic I tend to try approach both the biological and the behavioural aspects of tiredness simultaneously. Lets get you looked at, examined and tested if relevant, but lets take pause to look at you as a whole – how are your stress levels, are you worried about anything, whats happening with your weight and your appetite, when do you go to bed – to get a sense of anything else we might be able to improve upon.

Stress, anxiety and depression can all impact upon our sleep. Often it might be one of the first signs that you might be suffering one of these conditions. Whether it be that your mind is racing over the days events when you try and go to bed, or thinking about the events of tomorrow or the future. Some patients with anxiety report increased palpitations (a sense of the heart racing in the chest) in the evening/night time which enhances their difficulty sleeping. Patients with depression might experience ‘early morning wakening’ when they are unable to stay asleep and wake in the early hours.

Sleep hygiene is often overlooked in the 21st century, we’re more connected than ever with a myriad of devices and with the increasing advent of flexible working we’re checking work emails in the evening and working later and later at home. There is also some misunderstanding about how much sleep we actually need.

Our sleep pattern is regulated by something called a circadian rhythm, an evolutionary clock that tells us to be up when its light and sleep when it’s dark. In the days of our ancestors, this helped us to be productive in the hours when there was light and to rest to in the dark when light sources would have been limited.

Stimulants such as caffeine, alcohol and nicotine as well alarm clocks and devices plus the addition of later working and shopping hours can all interfere with our natural sleep/wake cycle.

How much sleep do we need?  How do you stack up to the numbers below?

  • Newborns (0-3 months ): 14-17 hours each day
  • Infants (4-11 months): 12-15 hours
  • Toddlers (1-2 years): 11-14 hours
  • Preschoolers (3-5): 10-13 hours
  • School age children (6-13): 9-11 hours
  • (14-17): 8-10 hours
  • Younger adults (18-25):  7-9 hours
  • Adults (26-64): 7-9 hours
  • Older adults (65+): 7-8 hours

Sleep is a priority, we need that time to allow our brains to hit the reset button.  Simple but effective techniques for a better night include: sticking to a schedule – set yourself a bed time and try and stick to it, if you are someone who runs through to-do lists for the next day, make a list before you go to bed and put it to one side, getting exercise daily will help to naturally tire you out, make your bedroom as restful as possible – limit those electronic devices and televisions in the room and turn off your phone
Techniques such as deep breathing or meditation can help to quieten your mind to prepare your body for sleep. Try inhaling for three seconds and exhaling for six. Repeat this five times. Then try to tense your toes as tight as possible, then relax, work up your body – tense and relaxing groups of muscles in turn. This helps to give the body a sense of relaxation.

When is tiredness caused by more than a few late nights? We’ve looked at a few of the more common reasons we see in clinic:

Iron deficiency anaemia.

This is the most common nutritional deficiency in the world and is common in women having regular, heavy periods. Blood loss causes us to lose iron, and if we are not able to get enough iron back in through our diet, we can build up a deficit. Besides tiredness, symptoms can include skin that appears more pale, feeling cold,  feeling dizzy or lightheaded, hair loss and brittle nails. Picked up on a blood test, your doctor can advice on a cause of replacement and may recommend further testing to discover the cause.

Hypothyroidism.

The thyroid, a small gland in the neck, is responsible for producing hormones required in many different bodily functions. Symptoms include an inability to tolerate the cold, weight gain, constipation, low mood and of course, tiredness. Again, picked up on a blood test and treatment involves replacing the deficient hormone – usually as a daily tablet.

Chronic fatigue syndrome

Something that has divided medics for years. A condition that causes long-term fatigue, it’s cause is not known. It is thought that it starts with a flu-like illness and there have been suggestions is can have links with mononucleosis, lyme disease and chlamydia. There are no definitive tests to confirm this, so often the process will start by looking for other conditions that might cause tiredness.

Coeliac Disease.

A gluten intolerance that can cause weight loss, bloating, bowel habit changes as well as tiredness. Gluten is found in foods such as breads, cakes and cereals. It’s thought around 1 in 100 people in the UK have coeliac disease, but 90% of those affected do not know they have. Diagnosis involved blood tests and biopsies and is most often managed by avoiding gluten in the diet.

Sleep apnoea.

More common in people with a higher body mass index, where the breathing tube is compromised when patients are lying down, but can also be linked to alcohol intake and smoking.  In sleep apnoea patients will have periods of interruption in their breathing when asleep. Partners might report snoring – or evening being able to hear the moments when breathing is interrupted. Testing involves sleep studies and oxygen monitoring during sleep. Patients with confirmed sleep apnoea will be given advice about how to reduce their risk factors and in more extreme cases a machine (CPAP – continuous positive airway pressure) to wear overnight which helps to move air into the lungs and keep the airways open.

 

We could all do with taking stock of our sleeping habits and taking steps to improve our sleep hygiene. But if you think that there might be something underlying the tiredness, you should always discuss this with your own doctor.