The expanding understanding of the biochemical and physiologic role of micronutrients, commonly referred to as vitamins and minerals, is driving the identification of their consequences in both deficiency and toxicity. Neural tissue is quite sensitive to physiologic changes, and as such, micronutrient deficiencies can have significant and profound effects on the functioning of both the central and peripheral nervous systems. Understanding which micronutrients can affect the nervous system can aid physician identification of these neurological symptoms and signs, leading to diagnostic testing and appropriate therapy.
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Papers of particular interest, published recently, have been highlighted as: • Of importance
• Kazemi A, Frazier T, Cave M. Micronutrient-related neurologic complications following bariatric surgery. Curr Gastroenterol Rep. 2010;12:288–95. This is an excellent review of neurologic complications after bariatric surgery leading to micronutrient deficiencies.
Dalla Torre C, Lucchetta M, Cacciavillani M, et al. Reversible isolated sensory axonal neuropathy due to cobalamin deficiency. Muscle Nerve. 2012;45(3):428–30.
• Kumar N. Neurologic presentations of nutritional deficiencies. Neurol Clin. 2010;28:107–70. Excellent in-depth review of nutritional deficiencies presenting with neurologic disorders.
Shorvon SD, Carney MW, Chanarian I, et al. The neuropsychiatry of megaloblastic anemia. Br Med J. 1980;281:1036–8.
• Becker DA, Balcer LJ, Galetta SL. The neurological complications of nutritional deficiency following bariatric surgery. J Obes. 2012;2012:1–8. This article is an excellent review of the micronutrient deficiencies and subsequent clinical scenarios occurring after bariatric surgery.
Neumann CG, Swindseid ME, Jacob M, et al. Biochemical evidence of thiamin deficiency in young Ghanian children. Am J Clin Nutr. 1979;32:99–104.
Kumar N, Low PA. Myeloneuropathy and anemia due to copper malabsorption. J Neurol. 2004;251:747–9.
Baugh CM, Malone JH, Butterworth CE. Human biotin deficiency. Am J Clin Nutr. 1968;21(2):173–82.
• Stabler SP. Vitamin B12 deficiency. NEJM. 2013;368(2):149–60. This is a very recent article describing the pathophysiology and causes of vitamin B12 deficiency, as well as evaluation, testing, and treatment strategies.
Sharrief AZ, Raffel J, Zee DS. Vitamin B12 deficiency with bilateral globus pallidus abnormalities. Arch Neurol. 2012;69(6):769–72.
Svenson J. Case report: neurologic disease and vitamin B-12 deficiency. Am J Emerg Med. 2007;25:987.e3–4.
Kumar N. Copper deficiency myelopathy (human swayback). Mayo Clin Proc. 2006;81(10):1371–84.
Pineles SL, Wilson CA, Balcer LJ, et al. Combined optic neuropathy and myelopathy secondary to copper deficiency. Surv Ophthalmol. 2010;55(4):386–92.
Brigelius-Flohe R, Traber MG. Vitamin E: function and metabolism. FASEB J. 1999;13(10):1145–55.
Sokol RJ, Vitamin E. Deficiency and neurologic disease. Annu Rev Nutr. 1988;8:351–73.
Herrmann W, Obeid R. Cobalamin deficiency. Subcell Biochem. 2012;56:301–22.
Spinazzi M, Angelini C, Patrini C. Subacute sensory ataxia and optic neuropathywith thiamine deficiency. Nat Rev Neurol. 2010;6(5):288–93.
Frantz DJ. Neurologic complications of bariatric surgery: involvement of central, peripheral, and enteric nervous systems. Curr Gastroenterol Rep. 2012;14:367–72.
Jaiser SR, Winston GP. Copper deficiency myelopathy. J Neurol. 2010;257(6):869–81.
Bolamperti L, Leone MA, Stecco A, et al. Myeloneuropathy due to copper deficiency: clinical and MRI findings after copper supplementation. Neurol Sci. 2009;30(6):521–4.
Hemmer B, Glocker FX, Schumacher M, et al. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J Neurol Neurosurg Psychiatry. 1998;65:822–7.
Russel J, Batten FE, Collier J. Subacute combined degeneration of the spinal cord. Brain. 1900;10:849–50.
Healton EB, Savage DG, Brust JC, et al. Neurologic aspects of cobalamin deficiency. Medicine (Baltimore). 1991;70:229–45.
Buchman N, Mendelsson E, Lerner V, et al. Delirium associated with vitamin B12 deficiency after pneumonia. Clin Neuropharmacol. 1999;22:356–8.
Harrington AL, Dixon TM, Ho CH. Vitamin B-12 deficiency as a cause of delirium in a patient with spinal cord injury. Arch Phys Med Rehabil. 2011;92:1917–20.
Koffman BM, Greenfield LJ, Ali II, et al. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33(2):166–76.
Lough ME. Wernicke’s encephalopathy: expanding the diagnostic toolbox. Neuropsychol Rev. 2012;22:181–94.
`Kopelman MD, Thompson AD, Guerrini I, et al. The Korsakoff syndrome: clinical aspects, psychology, and treatment. Alcohol Alcohol. 2009;44(2):148–54.
Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s encephalopathy and Korsakoff’s psychosis. Alcohol Alcohol. 2006;41(2):151–8.
Zahr NM, Kaufman KL, Harper CG. Clinical and pathologic features of alcohol-related brain damage. Nat Rev Neurol. 2011;7(5):284–94.
Barnard K, Colon-Emeric C. Extraskeletal effects of vitamin D in older adults: cardiovascular disease, mortality, mood, and cognition. Am J Geriatr Pharmacother. 2010;8(1):4–33.
Ii Y, Kuzuhara S. Dementia associated with vitamin B12 deficiency. Nippon Rinsho. 2004;62(suppl):365–7.
Goebels N, Sokya M. Dementia associated with vitamin B12 deficiency: presentation of two cases and review of the literature. J Neuropsychiatry Clin Neurosci. 2000;12:389–94.
Annweiler C, Schott AM, Berrut G, et al. Vitamin D and ageing: neurological issues. Neuropsychobiology. 2010;62:139–50.
Annweiler C, Allali G, Allain P, et al. Vitamin D and cognitive performance in adults: a systematic review. Eur J Neurol. 2009;16:1083–9.
Grant W. Does vitamin D reduce the risk of dementia? J Alzheimers Dis. 2009;17:151–9.
Etgen T, Sander D, Bickel H, et al. Vitamin D deficiency, cognitive impairment and dementia: a systematic review and meta-analysis. Dement Geriatr Cogn Disord. 2012;33:297–305.
Akbaraly NT, Hininger-Favier I, Carriere I, et al. Plasma selenium over time and cognitive decline in the elderly. Epidemiology. 2007;18:52–8.
Gao S, Jin Y, Hall KS, et al. Selenium level and cognitive function in rural elderly Chinese. Am J Epidemiol. 2007;165:955–65.
Yavuz BB, Cankurtaran M, Haznedaroglu IC, et al. Iron deficiency can cause cognitive impairment in geriatric patients. J Nutr Health Aging. 2012;16(3):220–4.
Penland JG. The importance of boron nutrition for brain and psychological function. Biol Trace Elem Res. 1998;66:299–317.
Malouf R, Grimley Evans J. The effect of vitamin B6 on cognition. Cochrane Database Syst Rev. 2003;4, CD004393.
Prasad AS. Clinical, immunological, anti-inflammatory, and antioxidant roles of zinc. Exp Gerontol. 2008;43:370–7.
Aggett P. Severe zinc deficiency. In: Mills C, editor. Zinc in human biology. London: Springer; 1989. p. 259–80.
Rayman MP. The importance of selenium to human health. Lancet. 2000;356:233–41.
Reilly C. The nutritional trace metals. Oxford: Blackwell Publishing; 2004.
Sethi NK, Robilo8 E, Sadan Y. Neurological Manifestations of Vitamin B12 Deficiency. Int J Nutr Wellness. 2005; 2(1).
Masalha R, Chudakov B, Muhamad M, et al. Cobalamin-responsive psychosis as the sole manifestation of vitamin B12 deficiency. Isr Med Assoc J. 2001;3:701–3.
Nuttall J, Oteiza PI. Zinc and the ERK kinases in the developing brain. Neurotox Res. 2012;21:128–41.
Levensen CW. Zinc: the new antidepressant? Nutr Rev. 2006;64(1):39–42.
Sawada T, Yokoi K. Effect of zinc supplementation on mood states in young women: a pilot study. Eur J Clin Nutr. 2010;64(3):331–3.
Moorthy D, Peter I, Scott TM, et al. Status of vitamins B-12 and B-6 but not folate, homocysteine, and the methylenetetrahydrofolate reductase C677T polymorphism Are associated with impaired cognition and depression in adults. J Nutr. 2012;142(8):1554–60.
Rao NP, Kumar NC, Raman BR, et al. Role of vitamin B12 in depressive disorder – a case report. Gen Hosp Psychiatry. 2008;30:185–6.
Penninx BW, Guralnik JM, Ferrucci L, et al. Vitamin B12 deficiency and depression in physically disabled older women: epidemiologic evidence from the women’s health and aging study. Am J Psychiatry. 2000;157(5):715–21.
Zhang G, Ding H, Chen H, et al. Thiamine nutritional status and depressive symptoms are inversely associated among older Chinese adults. J Nutr. 2013;143(1):53–8.
Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 2005;19(1):59–65.
Gilbody S, Lewis S, Lightfoot T. Methylenetetrahydrofolate reductase (MTHFR) genetic polymorphisms and psychiatric disorders: a HuGE review. Am J Epidemiol. 2007;165(1):1–13.
Miller AL. The methylation, neurotransmitter, and antioxidant connections between folate and depression. Altern Med Rev. 2008;13(3):216–26.
Gaweesh S, Ewies AA. Folic acid supplementation cures hot flashes in postmenopausal women. Med Hypotheses. 2010;74(2):286–8.
Karakula H, Opolska A, Kowal A, et al. Does diet affect our mood? The significance of folic acid and homocysteine. Pol Merkur Lekarski. 2009;26(152):136–41.
Cleary MJ, Cleary JP. Anorexia nervosa: a form of subclinical pellagra. Int Clin Nutr Rev. 1989;9:137–43.
Carr RE, Ripps H, Siegel IM, et al. Rhodopsin and the electrical activity of the retina in congenital night blindness. Invest Ophthalmol Vis Sci. 1966;5(5):497–507.
Dowling JE, Wald G. Vitamin deficiency and night blindness. Proc Natl Acad Sci. 1958;44:648–61.
Naismith RT, Shepherd JB, Weihl CC, et al. Acute and bilateral blindness due to optic neuropathy associated with copper deficiency. Arch Neurol. 2009;66(8):1025–7.
Spinazzi M, De Lazzari F, Tavolato B, Angelini C, Manara R, Armani M. Myelo-optico-neuropathyin copper deficiency occurring after partial gastrectomy. Do small bowel bacterial overgrowth syndrome and occult zinc ingestion tip the balance? J Neurol. 2007;254:1012–7.
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Conflict of Interest
Pinckney J. Maxwell IV declares that he has no conflict of interest.
Stephanie C. Montgomery declares that she has no conflict of interest.
Rodrigo Cavallazzi declares that he has no conflict of interest.
Robert G. Martindale declares that he has no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Nutrition and Obesity
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Maxwell, P.J., Montgomery, S.C., Cavallazzi, R. et al. What Micronutrient Deficiencies Should Be Considered in Distinct Neurological Disorders?. Curr Gastroenterol Rep 15, 331 (2013). https://doi.org/10.1007/s11894-013-0331-7
- Micronutrient deficiency
- Trace mineral deficiency
- Vitamin deficiency
- Nutritional deficiency
- Neurological disorder
- Peripheral neuropathy
- Optic neuropathy
- Night blindness