B vitamins and their combination could reduce migraine headaches: A randomized double-blind controlled trial

Background: The B vitamins can potentially help prevent migraine. This study was designed to examine the effects of supplementation with thiamine (B1), pyridoxine (B6), cobalamin (B12), folic acid (B9), and a combination of these vitamins on women with episodic migraine (EM). Methods: This study was a double-blind, placebo-controlled, randomized, clinical trial conducted on 120 women with EM. The participants were divided into the 6 groups of B1 (n = 20), B6 (n = 20), B12 (n = 20), B9 (n = 20), vitamin B complex (n = 20), and placebo (n = 20). Subjects received 1 capsule daily for 12 weeks. As part of the baseline and post-intervention phases, paper-based headache diaries were used to record the number of abortive drugs consumed and the frequency of headache attacks, and the Migraine Disability Assessment Questionnaire (MIDAS) was used to assess migraine disability. Results: A 16-week study on women with EM revealed that the mean changes in the frequency of headache attacks decreased significantly in all vitamin groups in comparison with the placebo group (P < 0.001). In contrast to the placebo, there was also a significant improvement in the migraine disability score in each vitamin group (P < 0.001). The 12-week supplementation with vitamins B9, B1, B6, B12, and B complex also brought on a significant decrease in the use of abortive drugs compared to the placebo group (P = 0.032). Conclusion: The results of this study showed that B1, B6, B12, and B9, and a combination of these vitamins could be effective as an adjuvant in treatment and prophylaxis of EM. Further large trials with long-term follow-ups will be required to confirm our results.

Vitamin C Deficiency of Korean Homeless Patients Visiting to Emergency Department with Acute Alcohol Intoxication

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.

Dietetic habits and quality of semen in Indian subjects

Dietetic habits revealed significant effect on seminal plasma vitamin B12 levels. The mean values for seminal plasma vitamin B12 activity in lactovegetarians from normozoospermic, oligozoospermic and azoospermic groups are significantly lower than the corresponding mean values observed in the nonvegetarian subjects. The mean vitamin B12 content of seminal plasma in azoospermic group was distinctly lower than the mean values in normozoospermic and oligozoospermic groups. However, seminal plasma vitamin B12 values showed no correlation with the sperm content of the corresponding semen in both normozoospermic and oligozoospermic subjects. Studies on sperm morphology and on biochemical parameters revealed no significant effect of the type of diet on sperm count, sperm motility, percentage abnormal sperms, seminal plasma total proteins, albumin, fructose, citric acid, acid and alkaline phosphatase activity in normozoospermic group.

Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females

OBJECTIVE

The study was designed to determine the impact of currently available oral contraceptive agents (OCAs), smoking, and alcohol on biochemical indexes of folate and vitamin B-12 in adolescent females.

DESIGN

Subjects completed a 3-day weighed food record along with a detailed lifestyle questionnaire that included questions on OCA, cigarette, and alcohol use. After subjects had fasted overnight, blood samples were collected and analyzed for levels of serum and red blood cell (RBC) folate and serum B-12 and homocysteine.

SUBJECTS/SETTINGS

Two hundred twenty-nine adolescent females (aged 14 to 20 years) were recruited from southern Ontario, Canada, by advertisements in newspapers, high schools, universities, shopping malls, adolescent drop-in centers, and community groups.

STATISTICAL ANALYSES PERFORMED

Multiple regression models were used to determine the effect of lifestyle factors and covariates (e.g., dietary folate intake, supplemental folate intake, and age) on biochemical indexes.

RESULTS

OCA use, alcohol use, and smoking were not significantly associated with lower serum or RBC folate levels, after controlling for folate intake. Serum homocysteine levels were not associated with smoking or OCA use; however, we estimated a 13% higher concentration among alcohol users than nonusers. Smoking and alcohol use were not associated with serum B-12 levels, but OCA use was associated with an estimated 33% lower serum B-12 level than nonuse.

APPLICATIONS

Our findings provide no evidence to suggest that currently available OCAs have a negative impact on the folate status of adolescent females; thus, dietary advice designed to specifically encourage an increase in folate intake among adolescents who use OCAs is not supported. In contrast, serum B-12 levels were lower among OCA users than nonusers, which suggests that an interaction between OCA and some vitamins may persist. The suboptimal biochemical folate indexes of smokers may have more to do with the dietary quality of smokers than previously appreciated. Thus, efforts to improve dietary folate intakes of adolescents who smoke may be an important strategy for improving the folate status of young women.

Vitamin B-12 deficiency is very prevalent in lactating Guatemalan women and their infants at three months postpartum

Vitamin B-12 status was evaluated in 113 Guatemalan women and their infants at 3 mo of lactation. Plasma vitamin B-12 was deficient or low in 46.7% of the mothers, and holotranscobalamin II (holo TC II) concentrations were low in 32.3%, which may indicate vitamin B-12 malabsorption. Only 9% had deficient or low plasma folate. Breast milk vitamin B-12 was low in 31%, and negatively correlated with infant urinary methylmalonic acid (UMMA, r = -0.22, P < 0.05, n = 88); UMMA was elevated in 12.2% of the infants, indicating vitamin B-12 deficiency. Mothers of the infants with elevated UMMA had significantly lower concentrations of vitamin B-12 in their breast milk compared with mothers of infants with normal UMMA concentrations (410.7 +/- 247.7 vs. 705.3 +/- 487.5 pmol/L, P = 0.05, n = 87). Mean maternal dietary intake of vitamin B-12 was significantly correlated with plasma vitamin B-12 (r = 0.20, P = 0. 05, n = 94) and was the main determinant of plasma vitamin B-12 in a linear regression model. Determinants of maternal holo TC II concentrations included dietary intake of vitamin B-12 and Giardia lamblia infection. There were no statistically significant determinants of infant UMMA concentrations. We conclude that vitamin B-12 deficiency is highly prevalent in these lactating women and is associated with depletion of the vitamin in their infants. The cause of the maternal deficiency is unknown, but malabsorption exacerbated by low dietary intake of the vitamin is a possibility.

Vitamin B12 metabolism and status during pregnancy, lactation and infancy

This overview of vitamin B12 metabolism and requirements during the continuum of pregnancy and lactation has identified several gaps in our knowledge. More information is needed concerning the roles of the different transcobalamins during pregnancy and lactation, including their impact on placental and mammary transfer of cobalamin and their effect on intestinal absorption in the infant. Knowledge is needed about the relative importance of maternal stores and current dietary intake on fetal storage of the vitamin, and on its concentration in breast milk. Because there is some evidence that infant's urinary methylmalonic acid excretion is reduced by intakes slightly higher than the current RDA, the adequacy of the current RDA for vitamin B12 during infancy should be verified. Finally, it is possible that vitamin B12 deficiency is more common in pregnant and lactating women and their young children in developing countries than has been recognized previously, due primarily to malabsorption. It is important to confirm whether or not this is the case, in view of its potential impact on infant neurobehavioral development and the relative ease with which supplements of the vitamin could be provided.

An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi

Between February and October 1990, 18,276 cases of pellagra dermatitis (due to niacin deficiency) were reported among 285,942 Mozambican refugees in Malawi. Overall, 6.3% of the refugee population developed pellagra and the attack rate was 7.8 times higher among women than men. This outbreak followed a 5-month cessation of groundnut distribution (the major source of niacin) to refugees. A matched-pair case-control study confirmed the protective role of the daily consumption of groundnuts (Odds Ratio [OR] = 0.08), as well as the independent role of garden ownership (OR = 0.34), and home maize milling (OR = 0.3). Recommended corrective action included early case finding and treatment, distribution of niacin tablets, prompt identification of groundnut supply on the world market, fortification with niacin of the food ration and diversification of the food basket through access to local markets.

Vascular manifestations in homocystinuria

Homocystinuria was discovered in a 21-year-old woman when she presented with lower limb ischemia and pulmonary embolism. This patient had a partial deficit in cystathionine-synthetase and took strongly dosed oral contraceptive medication. This report underscores: (1) the value of searching for this type of pathology even in the adult; (2) the possibility of disclosure by another condition, and particularly, drug-induced; (3) the importance of searching for other involved members of the same family; and (4) the possibility of treatment in vitamin sensitive patients.

Effects of sub-50 oral contraceptives on homocysteine metabolism: a preliminary study

The influence of a monophasic sub-50 oral contraceptive (OC), Marvelon, on fasting total homocysteine levels was investigated in OC users and controls. Homocysteine levels in serum of OC users were significantly higher (P less than .01) than in controls during the low-hormonal phase of the cycles and comparable with levels determined in heterozygotes for homocystinuria. Blood levels of pyridoxal phosphate (PLP) were significantly lower (P less than .05) in OC users both in the low and high hormonal phase. However, there were no significant differences in the levels of homocysteine nor in folate and vitamin B12 between both groups in the high-hormonal phase. In contrast to the control group, the homocysteine levels in OC users in the high-hormonal phase of the cycle were significantly decreased compared with those on a low-hormonal day (P less than .05). These data suggest that cyclically recurrent periods of hyperhomocysteinemia do occur during sub-50 OC use in normal women and might be considered a predisposition to the occurrence of vascular complications.

Enzymatic evaluation of riboflavin status of infants

Riboflavin status of solely breast-fed (SBF) infants aged 1-6 months (study 1) and solely or partially breast-fed (PBF) and weaned infants aged 6-24 months (study 2) was examined by the erythrocyte glutathione reductase activation test. Maternal riboflavin status and milk riboflavin content were also measured in study 1. Riboflavin status of the infants was significantly superior to that of their mothers. However, 35 per cent of SBF infants examined suffered from biochemical riboflavin deficiency as judged by the glutathione reductase test. Supplementary feeding of 6-8-month-old infants and weaning of older infants had positive effect on riboflavin status. There was no obvious relationship between riboflavin status and anthropometric status. Milk riboflavin concentration was comparable or only slightly lower than values reported for Western women, despite marked deficiency in the mothers.

Contraceptive steroid effects on nonreproductive organ systems

Oral contraceptives affect many organ systems in addition to the reproductive tract. In some cases the alteration is just a clinical laboratory test result value; in others it represents a true alteration in metabolism, with the induction of increased enzyme activity. Even with the markedly reduced steroid content of today's oral contraceptives, the practitioner must continue to be aware of these potential and real effects on nonreproductive organ systems.

Oral contraceptives and the cobalamin (vitamin B12) metabolism

The mean concentrations of serum (S)-cobalamin (vitamin B12) and S-unsaturated B12 binding capacity (UBBC) were significantly decreased in 101 women (mean age: 30.4 years) taking oral contraceptives (OC) of the combination type, compared to 113 controls. OC users more frequently showed decreased concentrations of S-cobalamin (less than 200 pmol/l) than did their controls. However, the incidence of particularly low concentrations (less than 150 pmol/l) in OC users was not increased. To study a possible dose-dependent effect, 27 women (mean age: 50.5 years) given high-dose estrogen preparations (1-4 mg estrogen) were compared with 31 controls. The two groups showed no difference with regard to S-cobalamin, but the mean S- and plasma-UBBC levels were significantly decreased in the high-dose estrogen group. 12 OC users with decreased S-cobalamin (less than 200 pmol/l), 9 OC users with normal S-cobalamin and 10 controls were studied more intensively. The mean hemoglobin concentration was significantly decreased in those OC users having decreased S-cobalamin. On the contrary, the absorption and excretion of radiolabeled cobalamin and the concentrations of erythrocyte-folate, S-iron and -transferrin did not show any difference between the groups, and all results were normal, by and large. No characteristic changes in plasma volume were found. It is concluded that routine measurement of S-cobalamin in women taking OC is not justified.

Nutrition and the pill

Apart from their gynecologic influence as birth control agents, oral contraceptives (OCs) have been shown to affect a number of metabolic and nutritional processes, some insignificantly and others beneficially. The use of contraceptive pills has been shown to decrease the physiologic levels of six nutrients--riboflavin, pyridoxine, folacin, vitamin B12, ascorbic acid and zinc--and to increase the levels of four others--vitamin C, iron, copper and vitamin A. Women who take OCs and have adequate diets need little or no supplemental vitamins. Vitamin and mineral increases caused by OCs do not require treatment.

A trial of daily vitamin supplementation as a means of reducing oral contraceptive side effects and discontinuation in Sri Lanka

A 4-cell randomized, blind clinical trial was conducted at three sites in Sri Lanka to evaluate the impact of daily vitamin supplements in preventing oral contraceptive side effects and in improving continuation. No significant effects were found.

Factors affecting riboflavin requirements of oral contraceptive users and nonusers

Riboflavin depletion has been identified in women on oral contraceptives (OC) but change in riboflavin nutriture has not been consistently demonstrated in all OC user groups studied. Discrepant findings in reports have been attributed to differences of pill formulation or riboflavin intake. Aims of this study were to compare the riboflavin requirements of healthy OC users and nonusers on diets prepared in a metabolic unit. A single daily menu and meal pattern was used. The basic diet providing riboflavin at a level of 0.6 mg/1000 kcal was used in the period of acclimation and period 1. In periods 2 and 3, the riboflavin content of the diet was increased to 0.8 and 1.0 mg/1000 kcal, respectively. The riboflavin status of subjects was monitored by erythrocyte glutathione reductase assay and urinary riboflavin excretion. Eight women on OC and 10 nonusers participated. Erythrocyte glutathione reductase assay values and urinary riboflavin excretion showed intersubject and interperiod differences but no significant group differences (OC versus non-OC) in erythrocyte glutathione reductase values or in urinary riboflavin per g creatinine. It was concluded that when dietary intake is controlled, OC do not significantly influence riboflavin status. Riboflavin needs were related to energy requirements of the subjects.

Oral contraceptives: effect of folate and vitamin B12 metabolism

Women who use oral contraceptives have impaired folate metabolism as shown by slightly but significantly lower levels of folate in the serum and the erythrocytes and an increased urinary excretion of formiminoglutamic acid. The vitamin B12 level in their serum is also significantly lower than that of control groups. However, there is no evidence of tissue depletion of vitamin B12 associated with the use of oral contraceptives. The causes and clinical significance of the impairment of folate and vitamin B12 metabolism in these women is discussed in this review of the literature. Clinicians are advised to ensure that women who shop taking "the pill" because they wish to conceive have adequate folate stores before becoming pregnant.

Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives

Forty-seven young women with mild or moderate dysplasia of the uterine cervix (cervical intraepithelial neoplasia) diagnosed by cervical smears, received oral supplements of folic acid, 10 mg, or a placebo (ascorbic acid, 10 mg) daily for 3 months under double-blind conditions. All had used a combination-type oral contraceptive agent for at least 6 months and continued it while returning monthly for follow-up examinations. All smears and a biopsy obtained at the end of the trial period were classified by a single observer without knowledge of treatment status using an arbitrary scoring system (1 normal, 2 mild, 3 moderate, 4 severe, 5 carcinoma in situe). Mean biopsy scores from folate supplemented subjects were significantly better than in folate-unsupplemented subjects (2.28 versus 2.92, respectively; p less than 0.05). Final versus initial cytology scores were also significantly better in supplemented subjects (1.95 versus 2.32, respectively; p less than 0.05), unchanged in patients receiving the placebo (2.27 versus 2.30, respectively). Before treatment the mean red cell folate concentration was lower among oral contraceptive agent users than nonusers (189 versus 269 ng/ml, respectively; p less than 0.01) and even lower among users with dysplasia (161 versus 269 ng/ml, respectively; p less than 0.001). Morphological features of megaloblastosis were associated with dysplasia and also improved in folate supplemented subjects. These studies indicate that either a reversible, localized derangement in folate metabolism may sometimes be misdiagnosed as cervical dysplasia, or else such a derangement is an integral component of the dysplastic process that may be arrested or in some cases reversed by oral folic acid supplementation.

The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women

In this double-blind study, the effects of ascorbic acid, vitamin B6, vitamin B12, and folate supplementation on the maternal nutritional status and vitamin content of breast milk in 16 low socioeconomic lactating women were studied. Nine subjects were administered a commercial multivitamin-multimineral supplement and seven were given placebos. Milk samples were collected four times per day at 4-h intervals from 5 to 7 and 43 to 45 days postpartum. Fasting blood samples were taken from all mothers at the end of each milk collection period. Dietary records of all foods consumed were kept from 4 to 7 and 42 to 45 days postpartum. There were no significant differences in milk or plasma levels of ascorbic acid between the unsupplemented and supplemented groups. Both the EGPT index and milk concentration of vitamin B6 were significantly different (p less than 0.01) between the unsupplemented and supplemented groups. The milk concentrations of vitamin B12 increased significantly (p less than 0.05) in the supplemented group, as did the milk concentrations of folate (p less than 0.01). Because of consistently low levels of dietary vitamin B6 and folic acid in this group of low socioeconomic lactating women, either dietary changes or supplements could be necessary to maintain recommended levels of these vitamins in the womens' breast milk.

Nutritional effects of oral contraceptive use: a review

Oral contraceptives agents (OCA) have been in use for more than two decades, and at the present time, 150 to 200 million women are using the preparations. Apart from their gynecologic influence, the hormones have been shown to affect a number of metabolic and nutritional processes, some advantageously and others disadvantageously. Concern over the nutritional status of females consuming OCA prompted this review. Eight vitamins and three minerals were investigated. Contraceptive steroid ingestion was shown to depress the physiologic levels of six nutrients (riboflavin, pyridoxine, folacin, vitamin B12, ascorbic acid and zinc), elevate the levels of three others (vitamin K, iron and copper) and provide little or no change in one (alpha tocopherol) and questionable increases in another (vitamin A). It was concluded that females consuming OCA should pay particular attention to vitamin and mineral intake and, if warranted, consume physiologic supplements of needed nutrients.

Effect of oral contraceptive agents on vitamin and mineral requirements

Oral contraceptive agents alter the metabolism of some nutrients, which could affect nutritional requirements. The effects of oral contraceptives on pyridoxine, folacin, thiamin, riboflavin, vitamin A, ascorbic acid, zinc, and copper as determined by studies done in the last five years are reviewed. Evidence for actual nutritional deficiencies due to the use of oral contraceptives is still insufficient, and more research is needed. Supplements are advised only for those women in whom other factors, such as disease, impair nutritional adequacy.

Effect of natural oestrogens on tryptophan metabolism: evidence for interference of oestrogens with kynureninase

Urinary excretion of metabolites of the tryptophan-nicotinic acid ribonucleotide pathway, urinary excretion of 4-pyridoxic acid and blood concentrations of oestradiol and pyridoxal phosphate were studied in groups of post-menopausal women before or during treatment with natural oestrogens, i.e. oestradiol and oestriol, before and after loading doses of 9800 mumol L-tryptophan or 700 mumol L-kynurenine sulphate. Natural oestrogens induced abnormalities of tryptophan metabolism similar to those induced by synthetic oestrogens, and there was a dose related increase in urinary excretion of metabolites of the tryptophan-nicotinic acid ribonucleotide pathway before the kynureninase step. The increase in urinary excretion of these metabolites also after a loading dose of 700 mumol L-kynurenine indicates an inhibitory effect of oestrogens on kynureninase in vivo. Evidence is presented that this inhibition is an effect mediated through decreased availability of vitamin B6, the coenzyme of kynureninase, although the possibility of a direct effect of oestrogens on kynureninase can not be excluded.

Nutritional concerns during adolescence

Adolescent food habits often run counter to the special nutritional needs of this age group. Suggestions for nutrient supplements are offered, with particular emphasis on fulfilling the unique needs of the obese, athletic, or pregnant teenager.

Does use of oral contraceptives enhance the toxicity of carbon disulfide through interactions with pyridoxine and tryptophan metabolism?

It is proposed that oral contraceptive (OC) users are at increased risk to experiencing adverse psychological disorders (e.g. irritability, depression) from exposures to elevated levels of carbon disulfide (CS2). This theory is based on studies indicating that both OCs and CS2 induce either a vitamin B6 deficiency and/or enhance its requirement. Since disruptions of B6 metabolism are thought to explain, at least in part, the adverse psychological effects of OCs and CS2, it is speculated that joint exposure to these substances may result in an exaggerated disruption of B6 metabolism with the development of CS2 induced adverse psychological effects occurring at exposure levels below those normally associated with adverse effects.

Vitamin B6 nutriture during pregnancy and lactation. II. The effect of long-term use of oral contraceptives

Vitamin B6 nutriture was assessed during pregnancy and lactation to determine whether previous use of oral contraceptive agents (OCA) resulted in reduced reserves of the vitamin. Vitamin B6 levels were measured in maternal serum and urine at 5 and 7 months gestation and at delivery, in cord serum and in milk at 3 and 14 days postpartum. Long-term use of OCA (greater than 30 months) resulted in low levels of vitamin B6 in maternal serum at 5 months gestation and at delivery and in milk compared with values for short-term (1 to 30 months) and nonusers of OCA. Levels of vitamin B6 were also lower in the cord serum of long-term users of OCA as compared to nonusers.

[Metabolic studies under administration of oral contraceptives. A review]

The use of oral contraceptives can produce changes in the metabolism of carbohydrates, lipids, proteins, vitamins, and minerals. Responsible for the alterations seems to be the used oestrogen- and gestagen derivative and not so much the type of the contraceptive. The most frequent findings are raised serum-glucose-, insulin-, and triglyceride levels; disturbances in protein-metabolism increase the risk of developing thrombosis and hypertonia. Little is known about the significance of oral contraceptives on the vitamin- and mineral metabolism--yet extreme deficiencies have not been observed so far. Oral contraceptives can become an extra risk factor when given to women with metabolic disturbances.

Lactation and pregnancy in Iran. II. Diet and nutritional status

Dietary intake in the third month postpartum and nutritional status during pregnancy close to term were assessed in Iranian urban uomen of low and middle socioeconomic status as part of a study investigating nutrition, hormonal status, and lactation in a population where lactation failure is a serious problem. Dietary intake was assessed by the 24-hr-recall method. The greatest differential in food groups consumed was in animal products, fruit, and vegetables. Intake of nutrients equal to or less than 80% of recommendations in both socioeconomic groups were energy, vitamin B6, folacin, calcium, iron, and zinc. In the low socio-economic group, only average intakes of vitamin C, thiamin and protein met the standards. Significant differences were found between the socioeconomic groups in hemoglobin, hematocrit, serum total protein, and protein fractions, but not in weight and height. The only parameters of nutritional status significantly correlated with adequacy of lactation were postpartum weight and percent of standard weight for height in the low socioeconomic group, and hematocrit values in the middle socioeconomic group. Differences between pregnant and postpartum individual values of the blood parameters were in general greater in the middle socioeconomic group than the low socioeconomic group.

Evaluation of emotional reactions to oral contraceptive use

A review of available clinical studies indicates that 10 to 40 per cent of oral contraceptive users may suffer mild to moderate depression syndromes. Clinical and animal data indicate that a variety of mechanisms may be involved, including alterations in folate, pyridoxine, and vitamine B12 metabolism, as well as related effects on biogenic amine metabolism. Interactive effects may result, such as impairment of usual coping mechnisms and psychological defenses by altered central nervous system function.