Tuesday, May 28, 2013

Diagnosing and Treating Vitamin B12 Deficiency video

Just briefly: People know I don't have the sort of life which leads to watching YouTube videos. This is a long one. I watched it all when I should have been at comments on the blog or answering emails (oops).

Diagnosing and Treating Vitamin B12 Deficiency

I have a (severely coeliac) friend who has recently, and rather belatedly, been diagnosed with catastrophic neurological B12 deficiency. The biggest problem with getting a diagnosis in most cases is folic acid supplementation. Folate eliminates the anaemia associated with the term "pernicious anaemia". Your haematology is normal. Your myelin falls to pieces. Your doctor diagnoses all sorts of things except the one which might avoid neurological melt down.

As a vet I use serum low B12/folate as surrogate markers for GI malabsorption problems and, in these days of crapinabag, we do a lot of testing. In my patients B12 deficiency is very, very common and we probably miss a fair number of "atypical" B12 deficiencies. We treat the ones we see. It's a good idea.


BTW I've never seen a low folate in a cat or dog. They do happen, but B12 is the very common one.

EDIT WTF, Paula had a low folate, normal B12 result from a dog today. Upper GI signs and vomiting. Well, there you go! Bed time now. END EDIT

BTW two, myelin failure as a loss of insulation is self explanatory. But the schwann cells also supply the lactate for normal neurological energy generation. Loss of lactate is a metabolic catastrophe for nerve cells.


merrymayhem said...

I have B12 deficiency and based on a couple symptoms that went away after supplementing, I've probably been deficient since high school (so 20 or so years). Fortunately I don't think I have any serious problems from it and have 3 healthy children. My deficiency was not found until after they were born.

Recently I came across a youtube video of a mostly raw vegan family. The father had his family's blood tested to ensure everyone was doing well on the diet and it seemed pretty clear to me that his children are B12 deficient even though they were within the normal range. Their WBC counts were all on the lower end of normal and neutrophils off the chart low. His children have not been to a doctor in years, probably since adopting the diet. I commented to let him know what I thought. I'm sure the green smoothies are helping raise their folate level and masking the other blood abnormalities.

I'm glad my doctor knew that the lab range was too low. When I slack on supplementing for too long, the first symptom to return is my hair shedding excessively. My hands and feet used to always be freezing cold, that went away about 2 days after my first B12 injection and has not come back

ItsTheWooo said...

Peter, she shared her story with me too; totally amazing. I was like this:


On the other hand its good to know that America actually isn't the land of crap doctors. If pt is confirmed celiac malabsorption is expected.

ItsTheWooo said...

I have no idea why raw veganism is not child abuse. This is frankly neglect, and a durianrider-esque b12 deficient nervous system break down case is in no position to make any medical decisions for helpless children.

The government only intervenes when the malnutrition of veganism reaches a point where children almost or actually die. It might offend our dogmatic religious myths that animal foods are obesigenic + evil + gluttonous, and an ethical diet free of animal products is spiritually purifying and ideally healthy too.

Until of course your kids *die* and then the government has no choice but to admit you are starving/abusing them.

Toxic said...

Ha. Ha. I lived. Again. Despite my doctors. Favourite symptom - hearing a whole garden fete in my back yard, complete with announcements to "make your way to the jam judging". (It proved to be the dawn chorus). Least favourite symptom, everything else. The psychosis was pretty impressive. I had no idea sanity rested on adequate levels of B12. I went normal with the first shots. Peter, thank you for this post. I appreciate it. Pernicious, formerly known as Toxic ;)

Puddleg said...

One possible cause of B12 deficiency is nitrous oxide overuse. Used to be popular among the youth here and probably still is. B12 is used up quenching peroxynitrite; creatine also does this. So when you eat meat, the creatine is protecting the B12.

Brilliant video, Peter.

Galina L. said...

Just recently an elementary school in NY became vegetairian http://thinkprogress.org/health/2013/05/02/1955821/new-york-city-vegetarian-school/?mobile=nc
, and it is considered to be a progress

“It’s been a really great response from the kids, but they also understand it’s about what is the healthiest option for them,” principal Bob Groff told ABCNews.com. “Because we teach them throughout our curriculum to make healthy choices, they understand what is happening and believe in what we’re doing too.”

Toxic said...

Don't want to dominate Peter's comments, so if anyone would like to know more about symptoms, please see:

Lori Miller said...

This is what "Sybil" suffered from, and the whole mental illness of multiple personality disorder (now debunked) was built up around it. (Sybil belonged to the Seventh-Day Adventist Church, which practices veganism.)

Toxic said...

Compared to that, my experience is very dull!

Anonymous said...

Thanks, Galina. Any remaining optimism I had about the evolvement of human intelligence has just been shattered by that story.

I almost teared-up.

brighteye said...

Peter: Thanks for all the information you provide on the blog, highly appreciated. Glad you can find time to post. I really liked your "what I eat" post.
I have a friend who is vegan. It's like he is in a sect. No rational argument works. Sometimes I would love to hit him on the head, it's really frustrating.

Bris said...

Just take a high dose multi B complex each day. It costs a few cents and the only "downside" is bright yellow urine.

Puddleg said...

Toxic's experience suggests B complex may not be effective enough, and the folate may mask symptoms.
I recommend sublingual methylcobalamin 1-3mg daily if you want to know if B12 will make a difference, and can't easily get injections. This is potent enough, cheap, well-absorbed, and already methylated.

Toxic said...

George is right.

I was supplementing orally by 17,000% the RDV, and had ZERO B12 available to my tissue.

It depends on what is causing the deficiency as to how best to correct it. Sometimes shots are the only way.

Ordinary bloods don't really help. The film explains which tests other than B12 and folate might get you to an accurate diagnosis. The Uk Pernicious Anaemia Society has some interesting videos, too, but they are a bit ponderous and long. But as someone with a particular interest, I found them very helpful.

Galina L. said...

It is really easy to learn how to give yourself an injection in a butt in front of a mirror.I did. Needles and syringes are available for sale in a veterinary supply shop.

Anonymous said...

Wow, this video is awesome. I wasn't aware of how common the B12 deficiency is.


ThisisBetty said...

Enjoyed the vid. : > People don't realize at all how poorly informed about nutrition most doctors are. It never ceases to amaze that people are diagnosed with mental illness before even considering diet. Several examples from my friends and family are coming to mind. My best friend feels like an idiot for not realizing (for ten years!) on her own that her health problems were caused by soy, which has a "health halo" .. she had been to many doctors over the years and they finally just came up with this: "You need to see a shrink."

Puddleg said...

@ Toxic,
this new paper on incidence of esinophilic esophagitis and celiac disease is pretty striking and might help improve the early diagnosis of CD;

This study confirms the association between EoE and CD. However, this association may be limited to pediatrics where the risk of each condition is increased 50 to 75-fold in patients diagnosed with the alternative condition. The concomitant diagnosis of these conditions should be considered in pediatric patients with upper gastrointestinal symptoms.

50-75 fold - those are some odds.
Diagnosing CD in a pediatric patient with esophagitis ought to be as easy as diagnosing lung cancer in a chain smoker.

Galina L. said...

My mom's partner most likely has low B12. He is 82,looks skinny, but his weist keeps getting wider, he believes that living on grains is healthy and very appropriate for his age. It is impossable to convince him to go to a blood test, however he found himself in a hospital in March with a mild stroke, which didn't improve his mental and physical state, but he is still quite capable of doing home chores, buying groseries without a car and walking everywhere.
What is the a reasonable dose of B12 to inject for him?

ItsTheWooo said...

Watching the video it really highlights the behavior of raw vegans. It seems apparently many of them have this explaining their bizarre behavior that almost looks like drug addiction or mental illness.

ItsTheWooo said...

So many people with gastric bypass clearly have this.

I can't count the number of gastric bypass patients who 1 or 2 years out begin developing 'strange" neurological symptoms like significant neuropathy, fatigue, and/or significant depression and personality changes. I will never forget reading a blog of a woman who had gastric bypass and gradually became crippled by neuropathy. She blamed "trapped nerves" from surgery. Even in my early 20s I knew it was b12 deficiency, but she was totally not receptive.

It is OBVIOUS that almost all the mood/behavioral/neuropathic changes from gastric bypass are caused by b12, and really quite expected when you disable the small intestine...but no one cares; the symptoms are often dismissed as the fat person missing their food addiction and developing personality/behavioral problems from not using food drugs.

This is why I had the emotional eating myth so much... this is one of many examples of how seriously it can hurt people. No one takes the nervous system related problems of post gastric bypass patients seriously, it is always dismissed as an addictive weak immoral person "regressing".

tess said...

watching this, i strongly suspect i was getting very low a couple of years ago. since then i've begun taking the high-potency sublingual of methylcobalamin ... and i rarely trip over my own feet anymore. ;-)

does anyone but me notice that the symptom list coincides with some of those belonging to hypothyroidism? since we are notoriously poor at absorbing nutrients in general, sounds like one of the big hazards is becoming b12 deficient TOO.

Galina L. said...

I see a lot of similarities between low-thyroid symptoms and the symptoms of B12 deficiency, I don't think it is some strate interconnection, besides the fact that when a body doesn't work properly on a wrong food(and a wrong lifestyle in general) there are usually several things going out of order at the same time.

Exceptionally Brash said...

My cat eats more veggies than you do, but he also wolfs down chorella like it is crack. Is this a sign of a b12 deficiency?

Gabriella Kadar said...
This comment has been removed by the author.
Gabriella Kadar said...

Speaking of cats,

one of mine had bad teeth, dental work done and I brush all of my 6 cats teeth three times per day. But despite the surgery and cleaning, I was having a difficult time with her gingivitis.

Then by chance I bought T bone steaks one day and she jumped up on the counter showing great interest. I fed her 3 ounces of chopped steak twice on that week-end and have done so for the past 6 weeks. Her gingivitis is gone. Even if I don't brush her teeth for 3 or 4 days there is no bleeding. She started to immediately regain the weight she'd lost and hadn't regained for the past year and her fur quality is improved. She was occasionally for the previous month vomiting liquid once or twice per week but that has also stopped. She's 11 years old and is positive for
FIP, all bloodwork was normal.

Peter, what's in the beef? My other cats are all fine, healthy gums etc. I don't feed them crapinabag.

None of the other cats is interested in the beef. Sometimes some of them eat a bit of raw chicken or cooked shrimp but the beef is only attractive to her.

Gabriella Kadar said...

oops typo: I brush the cats teeth 3 times per week. They wouldn't be too thrilled if I upped it to 3 times a day..sheesh.

Bris said...


Many cats will happily chew away at a bird or mammal they have killed for an hour or more eating almost everything including bones, fur and entrails. This gives their teeth a good clean, produces plenty of saliva and gives the jaw muscles a good workout.

Processed cat foods are very soft and require very little chewing. This means the mouth produces very little saliva. This means food particles may get trapped between the teeth and under the gums encouraging bacterial overgrowth.

Jane said...

Peter, many doctors are realising that what they thought was B12 deficiency is actually copper deficiency. The enzyme activated by B12, methionine synthase, also requires copper.

Anonymous said...

Hi, The statistics link from the video brought me here and I thought maybe this interactive symptom checker that was designed by a GP in the UK would be nice for you to play with...

Anonymous said...

Hey there, Im a long time reader, first time poster, theres a great article in Chatelaine this month about the benefits of Vitamin D and your health , worth the read , male OR female


Peter said...

I see there is an intervention trial which shows some benefit on insulin sensitivity, 6m at 4000iu. That's a first, as far as I am aware... The change is not huge but it's in the right direction.