B12 Deficiency and Miscarriage Far More Common than Doctors Think

A recurring theme in the medical literature is that B12 deficiency is a fairly rare cause of miscarriage or stillbirth. The evidence, however, suggests otherwise. One recent study, for instance, compared thirty-six women who'd suffered recurrent fetal loss to forty women who'd carried healthy babies to term. The researchers found that 31 percent of the women who'd lost several babies had high homocysteine levels. (Elevated homocysteine, as we noted in Chapter 5, is caused by low levels of folic...

Infertility treatment first things first

Americans spend millions of dollars each year on fertility drugs, artificial insemination, and in vitro fertilization. There is a place for these drugs and interventions, but only when simple, safe, inexpensive measures are exhausted. High on the list of such measures is getting tested for B12 status. This testing must include a serum B12 level, a urinary MMA test, and a homocysteine test (see chapters 1, 10, and 11). These simple tests, if provided routinely to infertile couples, might spare...

Speculation Does true MS involve a B12

MS and B12 deficiency are two different diseases, and doctors diagnose the great majority of cases of MS correctly. Yet intriguing (although highly speculative) clues are now leading scientists to explore the possibility that even classic multiple sclerosis may involve a defect in B12 metabolism. Interestingly, there are many similarities between MS and pernicious anemia, the autoimmune form of B12 deficiency we described in Chapter 1. The two diseases strike both young adults* and middle-aged...

The oral versus injected issue

There are studies noting that high-dose oral cyanocobalamin (1,0002,000 mcg daily) is equivalent to cyanocobalamin injections. A recent U.S. study, for example, demonstrated that daily high-dose oral B12 (2,000 We recommend hydroxocobalamin over cyanocobalamin for the treatment of B 2 deficiency. mcg) was as effective in producing hematologic and neurologic responses as a standard injectable regimen in patients with B12 deficiency. This study strongly supports the view that oral B12 at doses of...

Current deficits in diagnosis of pediatric b12 deficiency

For more than a century, the medical literature has clearly defined the effects of B12 deficiency on the brain and nervous system. These effects include cerebral atrophy, demyelination, degeneration of cortical neurons, and decreased production of neurotransmitters. B12 deficiency causes an array of neuropsychiatric manifestations including depression, apathy, paranoia, hallucinations, psychosis, self-injury, paresthesias, balance and gait problems, tremor, neuropathy, visual problems, taste,...

When did doctors discover the link between B12 and mental illness

The answer to this question is over a century ago which makes it all the more surprising that most doctors fail to routinely consider B12 deficiency as a cause of psychiatric patients' symptoms. Physicians Melvin Hector and John Burton note in a journal article that in the early 1900s, doctors discovered that pernicious anemia (one form of B12 deficiency) caused symptoms including apathy, decreased ability to do mental work, loss of memory, restlessness, irritability, indifference, emotional...

Childhood and adolescence B 12 deficiency and learning problems

Every year, several million parents put their children on vegetarian, vegan, or macrobiotic diets. At the same time, millions of adolescents choose, either for health reasons or for philosophical reasons, to forgo meat and animal products. Again, this is a valid decision if these children and teens obtain the right amounts of supplemental B12 (as well as adequate levels of iron and other nutrients), and if they have no medical problems that prevent them from absorbing B12 properly. Research...

Gene Mutations May Cause B12 Deficiency in Some Patients

In addition to the many common causes of B12 deficiency, some patients may have mutations in genes encoding important proteins of the B12 metabolic pathway. These defects can be complete, causing death in infancy, or partial, with a delayed onset. N. Dali-Youcef and Emmanuel Andres wrote in the Quarterly Journal of Medicine 2009, Mutations in genes encoding the intrinsic factor (GIF), cubilin, amnionless, transcobalamin II or its receptor provoke defects in cobalamin absorption and or cellular...

Newer treatment protocol

Today, maintenance therapy should be titrated based on a patient's response to treatment. It is important to remember that 80 percent of the injected cyanocobalamin dose is excreted within the first twenty-four hours. G. Richard Lee, M.D., notes in Wintrobe's Clinical Hematology that a single injection, even of massive amounts of B12, is not sufficient to replenish body stores. This is because the body's ability to retain the injected B12 is limited. Thus, he writes, If greater than 1 mg of B12...

Developmental disorders the B 12 link

Not all cases of B12 deficiency in infancy stem from an inadequate diet. A number of children suffer, instead, from genetic flaws that impair some aspect of the complex process of B12 metabolism. In fact, there are ten different inherited defects that are known to impair the pathways of B12 metabolism and transport in humans. Seven alter cellular utilization and coenzyme production, and the other three affect absorption and transport. All of these disorders can severely damage a child...

Why the Thirty Year Wait

Cardiovascular disease is the nation's leading killer and a major cause of disability. In 2009, approximately 785,000 Americans had a new heart attack, and approximately 470,000 had a recurrent attack. The Centers for Disease Control and Prevention (CDC) notes, About every 25 seconds, an American will have a coronary event, and about one every minute will die from one.19 Thus, it's amazing that the discovery of the homocysteine cardiovascular disease link, more than four decades ago, didn't...

Notes

Steve, and McLean, William T. Neurologic disorders of B12 deficiency. American Family Physician, 1982, 25 111-115. 2. Heath, Thomas. Pernicious anemia One man's journey through the baffling world of medical diagnosis. Washington Post, February 22, 2000, p. Z-12. 3. Schilling, R. F., and Williams, W. J. Vitamin B12 deficiency Underdiagnosed, overtreated Hospital Practice, July 15, 1995, 47-54. 4. Wilhelm, H., Grodd, W., Schiefer, U., and Zrenner, E. Uncommon chiasmal lesions...

Homocysteine and kidney disease

One group of people who nearly always develop dangerously high homocysteine levels are individuals in end-stage renal disease (ESRD). These people's kidneys no longer function, and they are significantly debilitated, but with dialysis treatment they can live relatively normal lives for years. Their high homocysteine, however, puts them at vastly increased risk for strokes, heart attacks, and other vascular problems. For the most part, doctors trying to lower the homocysteine levels of patients...

Gastric bypass

In 2010, gastric bypass surgery (GBS) cost on average between 20,000 and 36,000. In 2008, it was estimated that about 220,000 people in the U.S. had weight loss surgery. Insurance providers, including Medicare and in some states Medicaid, are paying all or part of the cost. Physicians often recommend GBS for obese patients because they believe it will prevent death or disability. Often, however, it does the opposite. Why Because clinicians fail to understand the role vitamin B12 plays in GBS...

B12 Deficiency and Vision Problems

Research is desperately needed to document the incidence of B12 deficiency in patients with visual defects. Visual field loss is often the initial manifestation of disorders involving the optic chiasm. There are multiple etiologies of chiasmal lesions (traumatic, congenital, iatrogenic, intrinsic, and extrinsic), but cases have been published in medical journals documenting B12 deficiency as the cause of some of these chiasmal visual field defects (bitemporal hemianopsia or junction scotoma).23...

B12 deficiency a cause of frequent falls AND fallrelated TRAuMA

Dementia is the saddest consequence of undiagnosed B12 deficiency, but it's far from the only one. Another is frequent falling, which strips many seniors of their independence and can cause fatal injuries. In fact, falling is the most common cause of fatal injuries among people over sixty-five, with nearly ten thousand seniors dying of fall-related injuries each year. Hospitals treat a third of a million hip fractures every year, most of them in elderly patients, and half of these elderly...

Cant Conceive How B12 Deficiency Contributes to Male and Female Infertility

Vitamin B deficiency is associated with infertility Pregnancy may occur in the presence of B deficiency, but may be associated with recurrent early fetal loss. hematologist Michael Bennett, M.D.1 A deficiency of B leads to reduced sperm counts and sperm motility. Joseph Pizzorno, M.D., and Michael Murray, M.D.2 Millions of couples each year are thrilled to learn that their dream of starting a family is becoming a reality. But for one in eight couples who want children, the dream becomes a...

Anemia

In the emergency department, we commonly see anemic patients. Anemia can stem from blood loss due to GI bleeding, nutritional deficiency (iron, B12, and folic acid), chronic disease (renal failure), cancer (chemotherapy agents), or a combination of these. When we diagnose B12 deficiency and go back and review patients' charts, we commonly see these patients being worked up for iron deficiency anemia or GI bleeding. What we fail to see are physicians ruling out B12 deficiency as the cause of...

Which form of cobalamin is best

Current evidence indicates that hydroxocobalamin is superior to cya-nocobalamin, and methylcobalamin may be superior to hydroxocobalamin for neurologic disease. Lee notes in Wintrobe's Clinical Hematology, The initial retention of hydroxocobalamin is better than that of cyano-cobalamin twenty-eight days after injection, retention still is nearly three times greater. In addition, hydroxocobalamin is more available to cells and is processed more efficiently by them.38 Methylcobalamin (available...

B12 deficiency and autoimmune disorders

It seems strange that B12 deficiency is involved in both under-activation and over-activation of the immune system. However, it's true, because one cause of vitamin B12 deficiency is pernicious anemia, an autoimmune disorder in which the body attacks its own cells. Most physicians incorrectly use the term pernicious anemia. This diagnosis is properly reserved for the autoimmune phenomenon that results in disease and dysfunction of the stomach (gastric atrophy, poor stomach acid production,...

Primer on Peripheral Neuropathy

Peripheral neuropathy is very common, and there are numerous types and causes of this disorder. Peripheral neuropathy affects around 20 million people in the United States, and nearly 60 percent of diabetics suffer from the condition. Symptoms of neuropathy depend on which type of nerve is affected. The three main types of nerves are sensory (those that carry sensations), motor (those that control muscles), and autonomic (those that carry information to organs and glands). Neuropathy can affect...

Speculation Is there an autismB connection

Children with autism, a once-rare developmental disorder that is now becoming alarmingly common, exhibit severe speech and language problems, aloofness or abnormal social interaction, repetitive and ritualistic behavior (such as obsessively lining up toys), and in many cases self-injurious or aggressive behavior. Some cases of autism have known causes for instance, prenatal rubella infection, meningitis during early development, or specific genetic disorders. In general, however, autism is...

Tests that Could Save a Mothers Sanityand a Childs Life

More research is needed to determine the incidence of B12 deficiency in women with postpartum depression or postpartum psychosis. In the meantime, we believe that all women diagnosed with postpartum mental illness should undergo screening, including serum B12 and urinary MMA tests. Pregnancy can dramatically worsen a pre-existing B12 deficiency, because B12 is transferred to the growing fetus throughout pregnancy, and prenatal vitamins contain only sixteen micrograms of this nutrient (compared...

What Is the End Result of Untreated Vitamin B12 Deficiency or Late Diagnosis

Subacute combined degeneration (SCD) is the term doctors use to describe the damage to the spinal cord caused by chronic vitamin B12 deficiency. It typically involves the posterior and lateral columns of the spinal cord (hence the name combined system disease). In medical terminology, this is also abbreviated as SCDSC subacute combined degeneration of the spinal cord. The term SCD is customarily reserved specifically for the spinal cord lesion caused by vitamin B12 deficiency. In addition to...

Preface to the Second Edition

More than half a decade has passed since we published the original version of our book. The response from the public has been overwhelming. We've touched more lives than we ever expected, and in this new edition, we relate the stories of people young and old whose B12 deficiency diagnoses saved their health and even their lives. We will also update you on the latest research, new case studies in the medical literature, and the best tests and treatments. Sadly, the response from many in the...

Lennons story

Lennon, a beautiful baby boy, began to fall behind developmentally at nine months of age. His head stopped growing, and his weight and growth flat-lined. When Lennon was eleven months old, his pediatrician diagnosed anemia and started him on iron. As the months passed, Lennon continued to exhibit developmental delay. His language, speech, socialization, mobility, and eating were all abnormal. Lennon's parents, Melinda and Greg, were extremely concerned and took Lennon to their pediatrician...

A quiz for physicians Did you know these facts About Vitamin B12 deficiency

Vitamin B12 deficiency and or pernicious anemia may be present without anemia or macrocytosis. 2. Vitamin B12 deficiency and or pernicious anemia may be present in patients with a normal CBC or a microcytic anemia. 3. Patients with B12 deficiency have been misdiagnosed as having anemia of chronic disease and internal bleeding. After extensive testing proves no bleeding has occurred, patients are given the diagnosis of unexplained anemia. 4. In the past, by the time anemia was symptomatic, more...

Problem 1 Failure to recognize the neurological and psychiatric symptoms of B12 deficiency

The number one reason for the high rate of missed diagnoses is that physicians fail to recognize the neuropsychiatric signs and symptoms of B12 deficiency. It is well known and has been well documented that B12 deficiency damages the brain, spinal cord, peripheral nerves, and the nerves of the eye, often well before blood abnormalities appear. Thus, doctors who think of B12 deficiency only in the context of anemia will miss the majority of cases that pass through their offices and hospitals....

Doctors Story

Even physicians have been misdiagnosed with other neurological disorders when the real diagnosis was vitamin B12 deficiency. In 2004, David Carr, M.D., a local pediatrician in Orlando, Florida, began having paresthesias and balance problems which he himself thought may be MS. In 2005, he became very ill. Carr was misdiagnosed with olivopontocerebellar atrophy (OPCA) or multisystem atrophy at age fifty-five. He lost fifty pounds, lost his vision, and gradually deteriorated to the point where he...

Am I Losing My Mind When B12 Deficiency Causes Mental Illness

Deficiency of essential nutrients like folic acid and vitamin B is an obvious risk factor for both disorders with cognitive impairment and depression. Current research suggests that low levels of vitamin B are associated with dementia and depression Vitamin B2 deficiency has also been associated with psychosis, bipolar disorder, and catatonia. Psychiatrist Glenn Catalano, M.D., and colleagues2 I have gained a distinct sense that we physicians, neurologists, and psychiatrists have been miserly...

When B 12 deficiency causes false cancer scares

In addition to increasing your risk of cancer, B12 deficiency can increase the odds that you'll receive an incorrect diagnosis of precancerous lesions, particularly if you're a woman. That's because B12 deficiency causes the cells lining the cervix to become deformed. These cell changes can cause Pap smears to appear abnormal, often leading to additional tests or even to unnecessary surgeries. Thus, the presence of what appear to be pre-malignant cells in a Pap smear should always lead doctors...

Appendices

Appendix A Causes of Vitamin B12 Deficiency gastric bypass surgery (weight loss) H2-blockers (Zantac, Tagamet, Pepcid) Appendix B Systems Affected by B12 Deficiency demyelination of CNS posterior column disease, lateral column disease, spinothalamic tract, brain atrophy paresthesia, ataxia, extremity weakness, paralysis, confusion dementia, depression, psychosis, incontinence, visual disturbances bone marrow hypercellular, megaloblastosis, hemolysis, large metamyelocytes, pancytopenia fatigue,...

Bladder problems and male sexuality

Are you always worrying about whether you'll make it to the bathroom on time Or are you a man taking Viagra or Cialis If so, you need to be screened for vitamin B12 deficiency. Why Because B12 deficiency strikes one part of the nervous system called the autonomic nervous system. If untreated, the damage that low B12 does to this system can result in impotence in men, hyperactive bladder in men or women, and urinary or fecal incontinence in both sexes. The nerves in the autonomic nervous system...

Male infertility and b12 deficiency

In about 40 percent of cases, a couple's inability to conceive is due to male infertility. Here again, vitamin B12 plays a significant role and, again, that role is generally overlooked by doctors. The link between male infertility and insufficient B12 levels first became commonly known in the 1980s, when researchers reported a study in which 27 percent of men with sperm counts less than 20 million were able to increase these counts to more than 100 million after receiving 1,000 mcg per day of...

Rethinking Fortified Cereals

The United States and Canada fortify many foods with folic acid, and Great Britain may be working on implementing a similar plan. British researchers recently conducted a study in which fifty-three healthy adults received increasing doses of folic acid over a six-month period. At the beginning of the study, the subjects' levels of homocysteine dropped in response to this nutrient. But as the folic acid dosage increased, homocysteine levels dropped less in response to this vitamin and more in...

Autism vs B12 Deficiency Acquired Brain Injury BABI

Centers for Disease Control and Prevention reports that one in 110 children have autism. As we discussed in Chapter 12, B12 deficiency in infants and children can easily be mistaken for autism. It is unknown how many children labeled as autistic have B12 Deficiency Acquired Brain Injury (BABI), but our guess is that the number is high. Identifying such children before they suffer brain injury would prevent many tragedies, and it would do so while creating a huge savings in healthcare...

Lost Children When B12 Deficiency Causes Developmental Disabilities or Learning Problems

The result was irreversible brain damage in my breast-fed child. If you're a parent, protecting your child from danger is your biggest concern. But no matter how cautious you are, there's one danger that you may not recognize the risk that your child may suffer, both physically and mentally, from a B12 deficiency. Low B12 levels severely damage the brains of hundreds of children each year, and new research shows that subclinical mental deficits may occur in...

Why is B 12 deficiency epidemic

Given the dangers of B12 deficiency, it would be natural to assume that doctors put the disorder high on their list of suspects when they see patients with weakness, dizziness, nerve pain or numbness, mental illness, falls, dementia, multiple sclerosis-like symptoms, chronic fatigue, infertility, or other medical problems that can stem from B12 deficiency. You'd probably guess, too, that they automatically screen children with developmental delays or failure to thrive to determine if B12...

Terminal or Treatable

George Isajiw, M.D., reports the case of a 92-year-old with pernicious anemia and Alzheimer's dementia who received an inappropriate hospice referral because the patient's doctors did not take the time to uncover her reversible B12 deficiency. Isajiw comments, This case demonstrates the need to evaluate each patient on a rational, individual, clinical basis as opposed to blindly applying so-called 'evidence-based medicine' in an extremely diverse population of patients labeled with the...

Sensitive adjunctive tests that aid in diagnosis

As we noted earlier, the standard serum B12 test may fail to identify some patients with low cobalamin levels. For example, patients with underlying liver disease, alcoholism, myeloproliferative disorders, lymphoma, or intestinal bacterial overgrowth often have falsely elevated serum B12 levels. Also, as we've discussed, the lower limit for this test currently is far too low. There are adjunctive tests that can aid in the diagnosis of B12 deficiency. These include tests for urine and serum...

Common Drugs that Can Be Misprescribed for the Signs and Symptoms of B12 Deficiency

Doctors who prescribe the following drugs to treat Bi2-deficient patients' symptoms, without uncovering the cause of those symptoms, can allow undetected B12 deficiency to progress to incurable or even life-threatening stages Celexa, Effexor, Elavil, Nardil, Pa-melor, Paxil, Prozac, Serzone, Sine-quon, Tofranil, Wellbutrin, Zoloft Ativan, Klonopin, Librium, Paxil, Serax, Tranxene, Valium, Xanax Aricept, Cognex, Namenda, Exelon, Reminyl Compazine, Geodon, Haldol, Na-vane, Risperdal, Stelazine,...

If You Suffer from these Symptoms Could It Be B12 Deficiency

The neurological symptoms of B12 deficiency that occur in young and middle-aged people are very similar to those in older people. They include the following Numbness, tingling, or burning sensations of the hands, feet, extremities, or truncal area, often misdiagnosed as diabetic neuropathy or chronic inflammatory demyelinating polyneuropathy CIDP Tremor, often misdiagnosed as essential tremor or pre-Parkinson's disease Muscle weakness, paresthesias, and paralysis, sometimes attributed to...