Q for Jimmylegs... *Update

[Punchy]

Jimmy, you're the first person I thought to ask .

What vitamin deficiencies could cause me to see spots in my peripheral?

I'm 5 months pregnant and haven't been so good at keeping up with my prenatal vitamins. For the past week I've been seeing sparkly gold dots off and on. My blood pressure is fine and so far my MS has been pretty dormant... My OB didn't seem concerned so didn't do any extra blood tests, but it's bugging me.

I'd appreciate any advice you could give. And I promise to keep taking my prenatals.

[jimmylegs]

punchy you are shocking. please do keep your promise!!

okay this is a brutal list of questions, but i would like to know a few things to help narrow this one down:

- were you diligent with your vitamins at first?
- if so, how long before you started to slide?
- have you been on any pharmaceutical drugs over the last 5 months?
- if so, which one(s), when, and for what duration?
- when did you first notice the visual symptoms?
- are they happening more often now. than when you first noticed them?
- are there more of them visible now, than when you first saw them?
- is there any motion/postural change or activity that seems to be a trigger?
- what is the composition (with amounts) of your prenatal supplement? (i don't imagine it is an ms-specific prenatal supplement!)
- do you have a doctor who is receptive to a request for some bloodwork?

okay i'm done will check back for your replies hehehe
JL

[Sharon]

Punchy - Just a thought

Do you think they are gold spots or could they be what are called flashers?
You might try PM "eyedoc" - He would be helpful in ruling out the flashers. And, flashers to my knowledge are not caused by vitamin deficiencies.

Sharon

[Punchy]

- were you diligent with your vitamins at first?
Very. I took them for 6 months then stopped 1 month into the pregnancy - brutal morning sickness prevented pill swallowing. Now I only take one or two a week.

- have you been on any pharmaceutical drugs over the last 5 months?
No - I take Diclectin for morning sickness, which is B6 and antihistamine. I take 2 pills twice a day (4 totalt) for the past 4 months.

- when did you first notice the visual symptoms?
About two weeks ago.

- are they happening more often now. than when you first noticed them? |
Definitely. At first it was when I was tired, now it's off and on randomly.

- are there more of them visible now, than when you first saw them?
Yes

- is there any motion/postural change or activity that seems to be a trigger?
No - even when lazing on the couch.

- what is the composition (with amounts) of your prenatal supplement? (i don't imagine it is an ms-specific prenatal supplement!)

PregVit prescription multi - vit: http://www.pregvit.com/pdf/PV_Consumer_en.pdf

- do you have a doctor who is receptive to a request for some bloodwork?

The OB is too busy but my GP would be happy to check

[Punchy]

Hi Sharon - they're definitely little gold circles, like glowing dust motes.

I did go for an opthamologist check up last October and had a neuro check up at the end of March and got the all clear.

Thanks so much for taking the time. Shucks.

[Kasuku]

Hi Punchy,

I have the samething and my neurologist and ophthalmologist diagnosed "Partial Vitreous Detachment". It's a condition where the vitreous liquid (more like jellow) in the back of the eye, behind the lens is hardening as a normal aging process and as a result pulling on the retina. When it pulls on the retina, it stimulates the nerve ending and creates these sparkles of light. It is a normal aging process, however, most people don't notice it. It usually stops after few months. In any case, I would visit an ophthlamologist to make sure there is nothing serious.

K

[NHE]

Punchy - Just a thought

Do you think they are gold spots or could they be what are called flashers?
You might try PM "eyedoc" - He would be helpful in ruling out the flashers. And, flashers to my knowledge are not caused by vitamin deficiencies.

I second the suggestion to PM Eyedoc. It might also be a good idea to see an ophthalmologist.

NHE

[jimmylegs]

okay so here are the ingredients of your prenatal vittymins:

MORNING
Beta-Carotene (source of vitamin A) 2700 IU
Vitamin B1 (thiamine mononitrate) 3 mg
Vitamin B2 (riboflavin) 3.4 mg
Niacinamide 20 mg
Pantothenic Acid (calcium pantothenate) 5 mg
Vitamin B6 (pyridoxine HCl) 10 mg
Vitamin C (ascorbic acid) 120 mg
Vitamin E (dl-alpha tocopheryl acetate) 30 IU
Copper (cupric oxide) 2 mg
Iodine (potassium iodide) 0.15 mg
Iron (ferrous fumarate)* 35 mg
Magnesium (magnesium oxide) 50 mg
Zinc (zinc oxide) 15 mg
* Elemental amount

What the important nonmedicinal ingredients are:
PregVit® pink (a.m.) tablet contains:
ammonium hydroxide, N-butyl alcohol, carnauba wax, D&C Red #27, FD&C Blue #1, FD&C Blue #2, FD&C Red #40, FD&C Yellow #6, isopropyl alcohol, macrogol/PEG 3350, magnesium stearate, microcrystalline cellulose, polyvinyl alcohol, propylene glycol, shellac glaze, simethicone, sodium croscarmellose, sodium lauryl sulfate, starch (corn starch), talc, titanium dioxide.

EVENING
Each oval shaped, blue (p.m.), film coated, immediate release tablet contains:
Folic Acid 1.1 mg
Vitamin B12 (cyanocobalamin) 12 μg
Vitamin D3 (cholecalciferol) 250 IU
Calcium (calcium carbonate)* 300 mg
* Elemental amount

PregVit® blue (p.m.) tablet contains:
ammonium hydroxide, N-butyl alcohol, carnauba wax, D&C Red #27, FD&C Blue #2, FD&C Red #40, FD&C Yellow #6, isopropyl alcohol, macrogol/PEG 3350, magnesium stearate, polyvinyl alcohol, propylene glycol, shellac glaze, simethicone, sodium croscarmellose, sodium lauryl sulfate, talc, titanium dioxide.

***

that's great that they are staging the intake through the day, and interesting to note that they separate the mag and D3.

the amounts seem very small though - much lower than is recommended for MS patients, let alone pregnant ones. i'm a little concerned about the copper being in there too... especially when ms-ers are low in zinc. the copper zinc ratio is a pretty important one...

and, those non-medicinal ingredients go on forever!! some of them are pretty scary...

BUT, it's good to hear that you don't have to worry about pharma nutrient depletion.

you DO need to worry about nutrient depletion courtesy of little junior, however!

there are a few nutrients that are particularly important for the eye... vitamins A, C, E, selenium, zinc, and fatty acids.

and here are the issues with these same nutrients in MS patients:

...The levels of four antioxidant vitamins [JL note: ascorbic acid, betacarotene, retinol and alpha tocopherol - basically A, C, and E] were significantly lower in MS patients compared to controls (p < 0.05).
...Vitamin A promotes healthy surface linings of the eyes

the link to zinc:
the importance of zinc to MS for all kinds of things like supporting the blood brain barrier, fixing intestinal permeability, supporting your liver to produce adequate uric acid etc etc is clear

...Breast-milk beta-carotene concentrations were higher in all women supplemented with beta-carotene, but breast-milk retinol concentrations were higher only in women who received beta-carotene + zinc.
...Zinc supplementation during pregnancy improved the vitamin A status of mothers and infants postpartum, which indicates a specific role of zinc in vitamin A metabolism
...Zinc is required to make retinol binding protein (RBP) which transports vitamin A. Therefore, a deficiency in zinc limits the body's ability to move vitamin A stores from the liver to body tissues [1].

...The Se content of whole blood was low (52.6 +/- 11.3 ng/ml) in MS patients from this high-risk area [JL note: that would be low soil selenium] compared to the controls (68.8 +/- 11.0).

thyroid connection:
... Selenium: Selenium is used in the synthesis of T3 from T4. If the blood test reveals that your T3 levels are lagged behind your T4 levels, you should try for the supplement that contains the selenium. However, one should take this supplement after consulting the doctor...

i think it's pretty well established that we ms-ers need more omega 3 fatty acids..

***

punchy i suggest that pregvit is suited for essentially healthy mothers. we ms-ers have greater need of various nutrients. and baby will get what he or she needs first, while you get the scraps. pregnancy is particularly draining wrt zinc, too.

here's what you could do to augment the pregvit:

-in the morning, consider also taking a b50 complex, such as genestra liquid b-complex. if you're not familiar with genestra, it is only sold in stores that have a nutritionist on staff. it has low folic acid in the daily teaspoon so since your prescription has plenty, you shouldn't be overdoing it. if you start to feel 'phantom itch', your folic acid has probably gone too high.

[an aside related to the thyroid...
...B vitamins: The group of vitamin B is extremely helpful to the body’s synthesis of T4. A standard vitamin B complex supplement will ensure that you are getting enough nourishment for your thyroid gland.]

-try and find an A-C-E antioxidant blend to get your daily vitamin E intake up to 400IU, with the A and C balanced to match - you can take A up to 10,000 IU daily and C you can take grams of it all day.

-this is more for the ms side of things, not so much the pregnancy or the vision issues, but consider bumping up your daily magnesium intake, you can get powdered magnesium citrate in 250mg capsules, and i'd suggest taking one with the morning pregvit pill, and another with the pm one.

-you should be able to safely add another 25mg per day of zinc, and 200mcg per day of selenium (you can get that 200mcg from 3 brazil nuts)

-think about adding 900mg calcium and 3000IU vitamin d3 at bedtime.

-and finally for the eyes and ms, find a nice fish oil supplement, try to check the vitamin A content if you can, to ensure you don't go over 10,000 IU daily.

here's a link to diet for eye nutrition:
http://www.allaboutvision.com/nutrition ... ummary.htm

now to bloodwork - if you can get levels of b12, 25(OH)2D3, zinc, uric acid, copper, vit E, calcium, magnesium, and essential fatty acids that would be a very useful set of information. also, selenium would be good to know but that's not covered by OHIP - maybe you have other coverage that will pay for selenium testing.

HTH,
JL

[Punchy]

Thank you so, so much!

I will put a call in to my GP for some blood tests and I'll ask her if she thinks I need to pay a visit to the opthamologist as well.

I am going to print out this email and bring it along too.

[jimmylegs]

good stuff punchy, once the results come in maybe ask your doc's office to fax you the results.. don't let them just tell you everything's normal!

for all those nutrients, try to aim for OPTIMAL levels, for instance, "normal" uric acid = 140-360, average ms uric acid = 194, and healthy controls more like 290-300. when i started to supplement zinc, my uric acid which had sat at 188-194 for years, rocketed up to 255 (and i'd only got the zinc up to 11.6!)

likely in my regimen thread i'll have posted what i've come up with for optimal target ranges, based on comparing findings in 'healthy controls' from various studies of most of the nutrients i've mentioned here.

if you do get to the eye doctor, please report back if they find anything specific because that will REALLY help narrow things down.

HTH!!
JL

[jimmylegs]

i noticed i put down for bloodwork most of the usual MS suspects but did not include the vitamin A and C that would be relevant to the eyes so maybe throw those into the mix! as antioxidants, they are also relevant to MS and worth knowing about. i personally have not got them into my standard testing regimen yet though!

[Punchy]

So i saw an ophthamologist this morning, and there's no evidence of MS activity.

He said it's just common floaters caused by vitreous separation, which is normal with age. Apparently people with astigmatism are more prone early on.

Thank goodness. I am to go back in 6 weeks for a follow-up just in case, but I think I can breathe easy now.

[jimmylegs]

when my stepdad's retina spontaneously detached the doctors said it was age related, never mind the huge dose of chemotherapy he had just started

here's some more info:

http://www.retinavitreouscenter.com/faqs.html
The Age Related Eye Disease Study (AREDS) has now shown that vitamin supplementation is important in slowing the progression of macular degeneration in patients with moderate dry macular degeneration or patients with more advanced disease in one eye only. The most benefit was derived from a combination of antioxidants and zinc, in the following daily doses:

Beta Carotene 15 mg
Vitamin C 500 mg
Vitamin E 400 IU
Zinc 80 mg (as zinc oxide)
Copper 2 mg (as cupric oxide)

Consult with your physician, however, before taking such supplements. There is evidence that beta carotene supplementation actually increases the risk of lung cancer in smokers, so current or recent smokers (within the past 5 years, or with a history of heavy smoking) should probably avoid beta carotene. Vitamin E supplementation may also have a negative impact on the effect of cholesterol-lowering drugs known as statins. A limitation of the AREDS study is that carotenoids, such as lutein, were not studied. Lutein is a dietary carotenoid found in highest amounts in dark green leafy vegetables, such as spinach, kale, and collard greens. It seems that lutein may benefit patients with macular degeneration based on various pieces of evidence, but no trial has been performed to assess the safety or efficacy of lutein supplementation. Even with vitamin supplementation, a good healthy diet, low in fat, and rich in fruits and vegetables, is likely to play an important part in macular degeneration prevention. Regular exercise and avoidance of smoking are other ways to improve overall health and prevent various eye diseases.

There is also evidence that patients with retinitis pigmentosa (RP) benefit from vitamin A supplementation. 15,000 IU of Vitamin A palmitate daily has been shown to slow the loss of retinal function in typical RP. High dose vitamin A supplementation may be associated with liver damage and birth defects, though, so your physician should be involved in such a treatment, and regular blood testing is recommended during treatment.

[Punchy]

Thanks! I have to be very careful with Vit A, as it can be dangerous to the fetus, though it is safer in beta-carotene form.

[jimmylegs]

just wanted to comment that many of the studies with negative findings in beta carotene and vitamin e supplementation, use synthetic or incomplete vitamin forms