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Dr Benson Riddle

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Symptoms and Health Risks of B-Group Vitamins

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Dear Dr Benson,

What are the symptoms of low B-group vitamins?

Do the symptoms and health risks differ between different B-group vitamins?

The B-group vitamins are water soluble vitamins once thought to be a single vitamin.

Later it was discovered that they are in fact 8 distinctly different chemical compounds that just happen to often coexist in the same foods.

As a general rule the B-group vitamins play a role in metabolism, cellular growth, and maintaining healthy skin and neurological function.

As a general rule the B-group vitamins play a role in metabolism, cellular growth, and maintaining healthy skin and neurological function.

As the B-group vitamins are water soluble and essentially unable to be stored, they generally need to be replenished daily, with any excess excreted in the urine.

Deficiencies in people living in the developed world with sufficient access to and intake of a well balanced diet is thus rare, and the use of dietary supplementswith large amounts of B-group vitamins simply results in money literally going down the toilet!

There are 4 specific B-group vitamin deficiency states that are well recognised however…

Vitamin B1 (Thiamine) deficiency, known as Beriberi, is still occasionally seen in our society amongst those with poor diets often associated with chronic alcoholism.

It is a life threatening disease with the potential to cause heart and neurological problems.

Vitamin B3 (Niacin) deficiency, known as Pelagra, is now rarely seen in developed countries, except in those with very poor diets or people with various psychiatric conditions who refuse to eat. The classical symptoms are known as “the four D’s”: diarrhoea, dermatitis, dementia, and death.

Vitamin B12 (technically a family of chemically-related compounds) deficiency is sometimes seen in vegans not taking supplements, as the active form of this vitamin in humans can only be sourced from animal products.

It can also be seen among elderly people as absorption through the gut declines with age, and in those with the condition known as Pernicious anaemia.

Vitamin B12is important for the normal functioning of the brain and nervous system, and for the formation of blood.

As a result, deficiency can lead to serious conditions such as anaemia, weakness, nerve damage and cognitive impairment.

Deficiency most commonly results in reduced formation of red blood cells leading to anaemia, and has been implicated in the development of neural tube defects in developing babies; therefore, pregnant women are advised to take supplements prior to conception, and throughout the first trimester.

Lastly, Vitamin B9 (Folate) is also necessary for the production and maintenance of new cells, and is especially important during periods of rapid cell division and growth such as infancy and pregnancy.

Deficiency most commonly results in reduced formation of red blood cells leading to anaemia, and has been implicated in the development of neural tube defects in developing babies; therefore, pregnant women are advised to take supplements prior to conception, and throughout the first trimester. 

Deficiency is still occasionally seen in those with poor diets, often in chronic alcoholics, despite the widespread fortification of flour with Folate.

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HEALTH

What to eat if you have high cholesterol

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Do you have high cholesterol and curious about your food options? Dr Benson answers your questions.

Dr Benson,

I have recently been told my cholesterol is too high 6.2.

Are there any cakes for people like me?

If I make cakes at home should I be using a different flour. Someone suggested Almond Flour???

“Good vs Bad Cholesterol”

When you get given a cholesterol result, it is important to ensure you get both the LDL (“Bad” Cholesterol) and HDL (“Good” Cholesterol).  This is because it depends how much of the Total Cholesterol level is made up of the potentially cardiovascular-damaging LDL, compared to how much is made up of the cardiovascular-protective HDL!

In most cases you want to aim for your HDL to make up more than 25% of the total, and for the LDL to be less than 3.5 (or even less than 3.0 to be ideal).

However if we assume your result is suggestive of you having a high LDL level, what can you do about it?

Unfortunately changing the type of flour you use in your cakes really makes no difference at all.  You see our level of LDL is generally a result of 2 things: genetics and bad fats.  And it really has little to do with how much actual cholesterol we eat, which is why eating cholesterol-free or reduced products, as was popular in the late 80’s and 90’s, made little difference.

Instead most of the LDL is made by our liver in response to the amount of saturated fat (animal fat, palm and coconut oil) or trans fats (found in take away foods, snack foods and baked goods) we eat, with some influence from our genes (which we obviously can’t do anything about).

As a result it is best to limit or avoid altogether the following:

Deli meats, fatty meat cuts, sausages, take away foods, full fat dairy products, butter, cream sauces, mayonnaise, coconut and palm products, cakes, biscuits, chips, other snack foods

  • Including or increasing your intake of the good fats in your diet e.g. olive oil, oily fish (tuna, salmon, sardines, herring, ocean trout), flaxseed oil, nuts, seeds, avocados
  • Restricting your alcohol consumption to a maximum of 2 standard drinks a day, and ideally not drinking every day
  • Exercise for at least 30 mins most days of the week e.g. walk with an aim to do 10,000 steps a day
  • Try to attain the healthy weight for your height, and most importantly reduce your waist size
  • Reduce the high-GI carbohydrates in your diet by avoiding white bread, white rice (except Basmati), low-fibre breakfast cereals, excessive amounts of potato, sugar, cakes, biscuits, muffins, soft drinks, cordials, excessive amounts of fruit juice
  • Don’t smoke

Obviously these things are simply not enough in some people.  If someone has a significantly high cholesterol level, or a high risk for cardiovascular disease, then cholesterol-lowering medication is often necessary, and would need to be discussed with your doctor.

So the bad news … for now maybe it’s best to avoid any cake at all!

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HEALTH

Reducing Cellulite

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Dear Dr Benson,

I would just like to know what helps to reduce the appearance of cellulite?

The term cellulite refers to a characteristic form of dimpling seen on the hips and thighs of females.

It is a normal appearance that has been unfairly stigmatised. The pattern of dimpling is related to the attachment of the system of little fibrous bands (called septae) that contain the fat.

It is a normal appearance that has been unfairly stigmatised.

There is no effective specific treatment for cellulite in spite of the plethora of misinformation in the popular press.

Mesotherapy is one of the more commonly used techniques now and involves the injection of certain substances, via a very fine needle, underneath the dermal layer of the skin into the subcutaneous fat tissue in the area selected.

Currently however, it is unknown what happens to the broken down fat cells once they leave the targeted area and what effects the various substances injected have on the body’s organs and tissues.

There really is very little scientific and/or clinical evidence to support this technique, and is no standardisation within the practice in terms of what substances are used, quantities used and amount and frequency of injections.

 

Generally, cellulite can usually only be improved if body weight is maintained in the optimal range, and the muscles in that region are kept well toned.

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HEALTH

Chocolate Cravings

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Dear Dr Benson,

Why do I crave chocolate?

Food cravings are thought to be due to external prompts and our emotional state, rather than actual hunger.

We tend to be bored, anxious, or depressed immediately before experiencing cravings, so one way of explaining cravings is self-medication for feeling miserable.

…One way of explaining cravings is self-medication for feeling miserable.

Chocolate does contain a variety of substances, many of which can have the effect of improving our mood.

Sugar and fat are obvious, both of which stimulate the hypothalamus, inducing pleasurable sensations by increasing levels of serotonin(a brain chemical that is also increased by the use of anti-depressant medications). 

High levels of the amino acid Tryptophanis also relevant, as it can be used by the brain to make serotonin. 

The chemical known as Theobromineis also known to have a mood-elevating effect (and can be quite toxic to dogs and cats, which is why pets should never be fed chocolate). 

Chocolate has also been shown to contain N-acylethanolamines which may result in heightened sensitivity and euphoria… possibly explaining chocolate’s aphrodisiac reputation!

Chocolate… may result in heightened sensitivity and euphoria… possibly explaining chocolate’s aphrodisiac reputation!

However it is also interesting to know that such chemicals are also contained in other less appealing foods such as broccoli.

So it may be the combination of chocolate’s sensory characteristics — sweetness, texture and aroma — that largely explain chocolate cravings…

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HEALTH

Are you dizzy or nauseous when exercising?

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Hydration is the key to beating feelings of dizziness and nausea while exercising.

Dear Dr. Benson,

I work out three to four times per 5 day week and keep fairly active on weekends. Of late, I’ve been experiencing some light-headedness while doing weights, and a few times following workouts have been experiencing nausea or vomiting.

A deciding factor in the nausea episodes seems to be where I work out, as the upstairs area of the gym has lots of air conditioners and the downstairs area has a low roof and feels quite hot, and although I do different exercises in both locations, there are some cross-overs during which I find I have less trouble in the better ventilated area. Dizziness has been experienced at both. There are occasionally times it has been experienced during the working day, although this normally follows periods of high stress or poor sleep, so I have not really been highly concerned with it. I’m also experiencing lethargy far earlier in my workouts that I was a few months ago.

I’m not sure if it’s a dietary thing or if it’s something I should see a GP about. It’s certainly the case that if my food consumption is slightly increased, I experience dizziness less frequently, although if I increase it significantly, then vomiting and nausea increases during workouts (this, I assume, is more related to undigested food in the stomach as blood is diverted to the muscles than to anything else).

I take protein supplements post-workout and occasionally pre-workout if I lack the time at work for a mid-morning snack. My first meal is usually around 8am and the post-workout consumption is about 1pm, sometimes 2pm. Consistency of mid-morning meals is erratic at best- maybe one day out of five, as usually I get swamped with work.

Is this likely to be a simple case of needing a greater energy intake? Could it be related to blood sugar? Or should I consider seeing a GP just in case?

Kind regards, 

Reuben

Dear Reuben,

Obviously it would be important for you to see your GP for a basic check up and blood tests to rule out any significant problem.  If these episodes of dizziness, nausea and vomiting are also associated with headaches for example, your GP should do a thorough neurological examination to ensure that there is no intracranial pathology.

However it is possible that your symptoms are related to either the environment, as you have identified with it being more likely to happen in hotter, less ventilated areas; or occasionally these symptoms can be due to hyperventilation that occurs in some people when they work out and lift heavy weights, so ensure your breathing is slow and controlled.

More possible though I feel that it may actually be the result of low blood sugar and/ or some dehydration during your workouts, which leads us to a good discussion on exercise hydration and nutrition advice…

The fluid and energy you consume before, during, and after an exercise session are all equally important, not only to optimise your performance (and hence the effectiveness of your work-out), but also to maintain comfort and hence make the experience more enjoyable.

 

Before exercise it is important to drink at least 500mls of water in the 2 hrs leading up, including 200mls of water  in the 15 minutes before starting;

You also need to eat an easily digested carbohydrate 1-4 hours leading up e.g. fruit such as banana, pasta, potato, rice, breakfast cereal, etc.

Protein is too heavy pre-exercise, and won’t provide a source of quick acting energy.

During exercise you should aim to drink at least 200mls of water or sports drink every 20 minutes.

If you don’t use a sports drink, make sure you have some form of quickly digested carbohydrate at least once an hour e.g. fruit, sports bars etc.

 

After exercise you should drink at least 500-1000mls of water in the 2 hours following

(until your urine is clear!), and eat a source of carbohydrate and protein e.g. fruit smoothie, nutritional supplement drink, yoghurt, etc.

If you are trying to gain muscle, adding protein powders is useful here.

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HEALTH

Acid reflux, what’s causing it? Dr Ben explains

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Dear Dr Benson,

 

Is it possible to suffer from reflux, indigestion and discomfort in the chest and just under the ribs from eating diary?

 

I recently had a tube put down my throat to see why the reflux was so bad but nothing came of it.

I have stayed off dairy for a while and feel better for it, but yesterday had some mini quiche and forgot that they have cheese etc in them and I have now been suffering all night and day.

What are the common causes (could it be dairy?) and what can I do about it?

From Burning Chest

 

 

Dear Burning Chest,

“Reflux” occurs when stomach acid rises up into your oesophagus (food pipe) and causes discomfort. The delicate lining of the oesophagus is unable to withstand the acid like the lining of the stomach can.

Over a long period of time this can lead to some very serious problems, such as strictures (narrowings) and even oesophageal cancer, so it should always be dealt with!

This is the reason people often have an endoscopy, to look for any complications of constant reflux, not to look for the cause.

Unfortunately the cause is most likely that sufferers simply have a weak sphincter (muscle) at the bottom of the oesophagus, and are probably just born with this.

Occasionally sufferers may also have a Hiatus Hernia (protrusion of the upper part of the stomach into the chest cavity through a tear or weakness in the diaphragm), but this rarely requires any change in treatment.

However, certain things are thought to make reflux worse such as being overweight, eating large meals, eating within 3 hours of bed, eating quickly, alcohol (especially spirits), smoking, tight clothing, and even stress.

A number of foods are also commonly implicated – and vary for each individual person – but may include chocolate, fatty and fried foods, chilli, spices, peppermint, spearmint, onions, garlic, capsicum, citrus, tomato products, fizzy drinks and caffeine.

Dairy is not one of those, and in fact milk used to be used as a treatment for reflux and ulcer disease many years ago before we had more effective medications.

The lactose in dairy products can sometimes cause digestive problems in people who are lactose intolerant, but these symptoms generally include abdominal pain, bloating, distension, flatulence and diarrhoea.

It is possible, but I think very unlikely therefore to have anything to do with dairy products, so instead look to see if it could have been any of those other foods mentioned.

As for treatment of reflux, it sounds like you should definitely be on some anti-acid medications to improve your symptoms.

Most effective are the proton-pump inhibitors, examples of which include Nexium, Pariet and Somac, so ask your doctor, but remember some work better than others in particular people.

In the meantime the use of antacids (e.g. Mylanta Double Strength Suspension) should provide temporary relief…

Dr Ben

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HEALTH

Do gallstones equal gallbladder removal? Dr Ben explains

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Dear Doc, 

I have a gallstone that is 2 cm which isn’t causing me any problems.

My family has a strong history of gallstone problems and my mother and younger sister have both had their gallbladder removed. 

Why is the gallbladder removed and not just the stone?

 

 

 

 

 

 

 

 

 

My sister’s gallbladder problems only began when she was pregnant, and my doctor has advised me to have my gallbladder removed before trying to conceive.

Is there any alternatives? What should I do? 

Confused

 

 

Dear Confused,

There’s two parts to this question.

First, when gall stones are causing problems why is the entire gallbladder removed rather than just the stone? This is because the gallbladder would almost always form more stones that would again cause more problems, since it has already done so once.

Given that the gallbladder has only a minor function anyway, and its absence is hardly of any significance, it makes sense that it be removed in order to reduce any future episodes.

Second, when is removal of the gallbladder indicated? Simply the presence of stones in the gallbladder is not an indication for its removal. This is because a significant proportion of the population have gallstones without ever causing any problems, so a lot of gallbladder surgery would end up taking place unnecessarily.

The only reason to have the gallbladder surgically removed (called a cholecystectomy) is if gallstones proven on ultrasound are causing symptoms.

Such symptoms include intermittent episodes of pain (biliary colic), acute inflammation/infection of the gallbladder (cholecystitis), or the even more serious possibility of stones blocking the pancreas resulting in pancreatitis.

So given that your gallstones aren’t causing you any problems (that is they are asymptomatic), it would be advisable for you to do nothing – especially not surgery – and you would have great difficulty in finding any good surgeon who would be prepared to remove it in your case anyway!

They could cause your problems one day, but then again statistics would say they will more likely not … so why go through surgery unless you actually need to?

Dr Ben

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