Chronic Cough and Vitamin B12
I can only imagine what people go through when they suffer from a long-term, chronic cough. Knock on wood, the only time I tend to cough is immediately after a cold, when the old bronchial tubes are not quite settled but trying to be. When this happens I never have just single coughs. Not even a couple at a time. My coughing becomes throat-tickle oriented and is basically uncontrollable and incessant. It interrupts life (and sleep!) Forget social interaction. I can’t carry on conversations without having anxiety that the cough will sneak up on me and force me to hack my way to the nearest source of drinking water! Going to “silent” places is most definitely off limits during the coughing stage of a cold. Church? No way. Library? I envision disapproving glances in my direction. As the tail-end to colds, my coughs are frustrating to say the least. But to live with a condition like this all the time? I’d be miserable. As I said, I can only imagine how disruptive this can be to someone’s life. So why do certain people suffer with a chronic cough that seemingly has no obvious cause? Well, the key word here is “obvious”.
There are many different causes of coughing, as evidenced by a quick internet search on the subject. But although the list of search results is very well-populated, there are a couple of potential issues that are significant, yet well-hidden in the literature. Vitamin B12 deficiency is one of these difficult-to-find, anything-but-obvious potential origins of chronic cough. Two things that readily lead to this deficiency are certain prescription medications and stress. You see, B12 needs stomach acid in order to be absorbed by the body (more on that below). So antacids, proton-pump inhibitors like Prilosec, some diabetes medications like Metformin, and aspirin will lend themselves to B12 malabsorption and subsequent deficiency due to their direct affect on the stomach and acid production. Still other medications may list “unexplained chronic cough” low on the list of potential side effects in the “rare” section. This is something that you may not notice at first, due to its seeming insignificance. Remember though that our bodies don’t all respond the same way because we’re biochemically unique. The same medication that causes one person to cough incessantly may not even bother another. Or an individual could respond to a drug in a way that has never even been documented before! In addition to medication-based depletions and side-effects, high stress levels further diminish levels of B vitamins.
Some questions and answers regarding chronic cough and Vitamin B12:
What are a few of the most important functions of Vitamin B12? This vitamin is essential for the manufacture of red blood cells. It’s needed to support the normal function of nerve cells, and to manufacture myelin, the insulating material that surrounds some of our nerve cells and speeds neural transmission. Lastly, Vitamin B12 is required for the replication of DNA, meaning new, healthy cells cannot be generated without it. This mimics all of the effects of aging.
Why might you be deficient? Lack of stomach acid (a condition termed hypochlorhydria) interferes with B12 absorption. Why? Most of the B12 in food is attached to proteins, and stomach acid is necessary to release the B12 from these proteins. Also, to get into the bloodstream, B12 must be escorted by a protein called intrinsic factor, produced by cells of the stomach. Many disorders of the stomach, such as gastritis, can interfere with the production of intrinsic factor and result in a condition is called pernicious anemia. Medications that affect the stomach – such as aspirin, antacids and proton-pump inhibitors – can also interfere with intrinsic factor production and result in B12 deficiency. The commonly used diabetes medication, Metformin, can do so as well.
What can happen if you are deficient? Anemia that results from severe B12 deficiency can be identified by a simple blood test however it’s important to note that even if your blood test comes back “normal”, subclinical B12 deficiency causes a myriad of symptoms, many of which are very uncomfortable and scary. These may include muscle weakness, fatigue, shakiness, unsteady gait, incontinence, low blood pressure, depression and other mood disorders, and cognitive problems like poor memory. In addition, Vitamin B-12 deficiency is a known cause of central and peripheral nervous system damage. It has been implicated in sensory neuropathy and autonomic nervous system dysfunction which can have a role in chronic, unexplained coughs. A recent study showed that patients with vitamin B-12 deficiency had a higher prevalence of laryngeal hyperresponsiveness. After being given B-12 supplements, their symptoms and laryngeal, bronchial, and cough thresholds significantly improved.
Who should have their B12 blood levels checked?
- Individuals over 50 years of age, as the ability to absorb B12 from food declines with age
- Anyone taking a proton-pump inhibitor or H2 inhibitor to block stomach acid
- Anyone taking Metformin (a diabetes drug)
- Strict vegetarians
- Those who have had weight-loss surgery or have a condition that interferes with the absorption of food
How do you correct a deficiency? First, you should strive to obtain more Vitamin B12 from dietary sources. In its natural form, B12 is present in significant amounts in animal foods, most prominently in liver. Other good food sources include red meats, turkey, fish and shellfish. Lesser amounts of the vitamin are present in dairy products, eggs and chicken.
Secondly, you can can take supplemental Vitamin B12 in the easily absorbed form of methylcobalamin. To bypass stomach acid and intrinsic factor deficiency issues, it is best to take a sublingual form (dissolved under the tongue) of this supplement. I have used Biospec Methyl B12 2000 with Folic Acid with much success. Keep in mind that when you supplement with nutrients you are “balancing” your system. What has likely taken years to become imbalanced will take longer than overnight to re-balance. And with any luck, that re-balancing will allow that chronic cough to become a distant memory!
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