Could It Be B12?: An Epidemic of Misdiagnoses

"This book is a must read for everyone in contact with other human beings. I have dealt with the devestating effects of b12 deficiency for all of my 20's and 30's (at least) with everything getting nothing but worst in the last year. My little boy shares many of my symptoms and is being tested as we speak...now that we know how to test! My son's doctor had no idea how to test him. Two weeks into B12 therapy most of the symptoms that have been plaguing me for years are gone! The rest are slowly improving and I suspect that they will continue to improve. When I think of all the doctors and tests and appointments and medications and theories I have had over the past years, it is downright depressing. All I needed was what my body was screaming for...B12! Cheap, easy to get, effective and mandatory B12!!!!

This book lays it out well and is very well referenced. The format is very reader friendly with many great examples. If you are looking for a book that you could bring into your doctor for their education (for your own survival!), this is the one. It is an absolute horror that this illness goes unfound for so long in so many people. Protect yourself and your loved ones and have this book on hand always. This is the best gift you could give anyone. It saved me in ways I don't even want to think about. Thank you to the authors for this important piece of knowledge that is far too ignored in the medical community."
~ Written on 2008-07-13

"This book contains critical information that could change the lives of many people. Anyone with any sort of unexplained health problems, from Alzheimers to leg pain to autism, must read this. I also wish every doctor would read it and become more aware of the prevalence of B12 deficiency. After reading it at the library, I bought a copy for myself and one for my doctor."
~ Written on 2008-02-24

"If you have or suspect having a vitamin B 12 deficiency or if you need to learn about this deficiency for any reason, I recommend you read carefully the book " Could it be B 12 ? An epidemic of Misdiagnoses " by Sally M. Pacholok and Jeffrey J. Stuart. But don't let it be your only source of information about the deficiency. Because at least half of alternative reliable scientific reports about this subject strongly disagree with the major allegations of the authors of this book. You must also be aware of the alternative opinions before deciding on what to do about your vitamin B 12 deficiency. I am not a medical expert and do not say who is right or wrong. However, I am glad I researched other sources of information after I was diagnosed with B 12 deficiency and after I read this book. I couldn't find any other books on this subject but there are a lot of serious scientific reports published on the internet by credible hospitals, laboratories, medical journals etc. You don't have to be a medical expert to understand them, they are written for the general public. Some of the information on the internet is crap but a significant portion is reliable , very informative and based on sound scientific reasearch and experiments.

Search from Google under the headings of vitamin B12 deficiency, homocysteine, methyl malonic acid, intrinsic factor and pernicious anemia. A lot of articles will pop up among them by reliable hospitals such as the Mayo Clinic and some labs etc. Also search under the same headings from the websites of Wikipedia the Free Encyclopedia, American Family Doctor and Lab test on line. There are many other websites that include reliable information on Vitamin B 12 deficiency. After reading the book " Could it be B 12 ? An epidemic of Misdiagnoses " my initial reaction was an anger towards my doctor who diagnosed me with a B 12 deficiency believing that he had given me false information. I also had written a very favorable review of this book immediately after having read it two and a half months ago on January 19 2008. I have hereby replaced on April 11th 2008 my previous review of the book with this one based on my subsequent research on the internet about the topic from about ten different reliable scientific reports from different sources. My initial review was based only on the book. The present review is based on both the book and my subsequent extensive research. About half of the medical literature agrees with the authors of this book on the method of diagnosing and treatment of the vitamin B 12 deficiency. The remaining 50 % that disagree also base their views on sound scientific studies.

The authors of the book claim that most doctors in the world are ignorant about vitamin B12 deficiency. After finishing the book I initially bought this argument. However, after conducting the research on the internet I mentioned above I disagree that most doctors are ignorant about it. Surely there are a lot of doctors who are in fact ignorant about it and who misdiagnose. Even my doctor told me some things about vitamin B 12 deficiency some of which I still think are wrong. However, not all doctors who disagree with the authors are ignorant ; there are many among the disagreeing doctors who are very knowledgeable about this subject. Their methods of diagnosing and treating the deficiency maybe different than that of the authors. That does not necessarily make them ignorant. You can see this for yourself by reading their reports on the internet where they express alternative opinions about vitamin B 12 deficiency. Yet the authors of the book accuse all doctors who disagree with them with ignorance. I feel that it is unfair and unconvincing to accuse everyone who disagrees with you with ignorance. I got suspicious about that and found the alternative opinions. I am glad I did not let this book be my only source, I almost went and expressed my disatisfaction with my doctor based on this book. I regret that after reading the book and before reading alternative reports I got into an argument with a neuropsychiatrist whose acquaintance I made in a sports club who challenged the views in the book when I mentioned them to her.
Fortunately I did not go and quarrel with my own doctor based on the book ( it scares me to think I almost did ) because I had the sanity to investigate the deficiency from alternative sources.

The major allegations by the authors about which there is approximately 50 % agreement and of course 50 % disagreement among medical experts throughout the whole world have to do with the method of diagnosis and treatment of vitamin B 12 deficiency.

The authors claim that a serum ( blood ) B 12 test for a deficiency is unreliable by itself and must be accompanied by urinary methyl malonic acid ( MMA ) and serum homocysteine tests. Because in some cases a vitamin B 12 deficiency may damage the nervous system many years before it shows up on blood tests. Doctors who rely on the vitamin B 12 blood test alone could miss a B 12 deficiency if it does not show up on the blood test. The authors allege very strongly that the best measure of B 12 deficiency is the urinary methyl malonic acid and creatinine ratio test done properly along with serum B 12 and serum homocysteine tests. In the medical literature I researched there is strong support for this view. But there are also equally strong arguments in favor of the alternative view, claiming that on the contrary urinary MMA test results are not a reliable indicator of vitamin B 12 deficiency and that serum B 12 tests are more reliable. This is exactly the opposite of what the authors of the book claim.The book mentions that there are doctors that claim this. And it claims that these doctors are ignorant. However, in the reports the doctors state the reasons why urinary or blood MMA tests are unreliable and explain the results of scientific studies in support of their view. They are by no means ignorant.

The other major disagreement is about the method of treatment. The authors of the book claim that Vitamin B 12 oral tablets even in high doses are very often ineffective in treatment of the deficiency and insist that pain free injections directly into the blood is indispensible as a treatment method. They claim that nobody should lose time and risk ineffective treatment with oral tablets. In some cases this maybe true for swallowed oral tablets which have to cross the digestive system. However, I came across many different reports on the internet that mention the effectiveness of sublingual ( under the tounge ) oral vitamin B 12 pills that are also absorbed directly into the bloodstream. Especially during the recent several years many independent studies throughout the world indicate that sublingual vitamin B 12 pills have been found to be as effective as injections into the blood, making the injections unnecessary in many cases. After discrediting the oral tablets and strongly promoting the injections throughout their book even the authors back off from their claims on page 153 under the heading : " A Final Word about Oral B 12 " where they admit the promising recent studies about the efficacy of oral tablets administered sublingually. After I took 1000 mg of swallowable oral tablets for four months my serum B 12 level shot through the roof rising from far below the lower limit to more than twice the upper limit ! My doctor told me to discontinue swallowing the pills.

So, read the book and read any serious other sources you can find on the internet and then decide with your doctor about how you will proceed to diagnose and treat your or your loved one(s)' vitamin B 12 deficiency. Just don't take everything the book or the reports say for granted. Make your own analysis and draw your own conclusions based on a varied rich source of reliable information about this subject. Good luck !
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~ Written on 2008-01-19

"This book has taught me so much, it is a must for everyone to read. An absolute eye opener even for someone who already suffers from the condition."
~ Written on 2007-12-26

"Could it Be B12, An Epidemic of MisDiagnoses by Sally M. Pacholok R.N. and Jeffrey J Stuart D.O.

A good friend of ours had a sudden unrelenting pain in her leg which baffled her doctors. After many months of suffering, and many failed treatments and medications, she tried inexpensive vitamin B12 injections which immediately worked, providing complete relief. Occasionally the pain returns and reminds her it's time for another B12 injection. The injections are easy with a small syringe and tiny needle, and the B12 is injected under the skin twice a week.

There are many more stories of B12 misdiagnosis in Pacholok's book. Nurse Pacholok first describes her own ordeal with pernicious anemia and B12 deficiency which motivated her to become an expert on the topic. Working within the health care system, she was appalled at the numbers of patients with obvious signs and symptoms of B12 deficiency who were misdiagnosed.

Finding the medical system apathetic and unresponsive to her advice about B12 deficiency, Pacholok wrote this book to empower medical consumers and to educate their physicians. Pacholok is on a crusade to change medical practice to routinely screen for B12 deficiency, and her book is one giant step in that direction.

Vitamin B12 deficiency is estimated to affect 10%-15% of individuals over the age of 60 years. 40% of elderly hospitalized patients have low or borderline serum B12 levels, and 50% of long term vegetarians have B12 deficiency.

B12 absorption depends on many cofactors, so it is possible to take adequate amounts of B12 in the diet, and still have a B12 deficiency. Absorption of B12 requires gastric acid, so anything which reduces gastric acid production such as gastric surgery, atrophic gastritis, or antacid drugs could produce B12 deficiency. The very popular antacid drug Prilosec (omeprazole) has been clearly shown to decrease B12 absorption. Other antacid pills such as Prevacid, Protonix, antac, Nexium, Aciphex, Zantec, Tagamet, Pepcid, Maalox, mylanta, reduce gastric acid, inhibit B12 absorption and may produce B12 deficiency. Drugs such as Metformin and other diabetes drugs can cause B12 deficiency. The anesthetic agent, Nitrous Oxide, or "laughing gas", used in dental or surgical procedures causes B12 deficiency

Pernicious anemia is the second most common cause of B12 deficiency. This is an autoimmune disease with loss of Intrinsic Factor, in which antibodies damage the stomach lining interrupting the B12 absorption mechanism.

Other people at risk for B12 deficiency include vegetarians, people with eating disorders such as bulemia and anorexia, inflammatory bowel disease with malabsorption (ie. crohn's).

Auto-immune diseases such as Hashimoto's thyroiditis may be associated with B12 deficiency(pernicious anemia).

Vitamin B12 deficiency can cause unusual neurological symptoms such as tremor, gait disturbance, severe pain, and can mimic MS (multiple sclerosis) or even Parkinson's Syndrome. The physical signs and symptoms can often mimic other diseases and the diagnosis is frequently missed.

B12 deficiency damages the myelin sheath around the nerve fibers, this is a soft fatty insulating material which is also damaged in demyelinating diseases such as multiple sclerosis.

B12 deficiency can cause mental changes such as irritability, apathy, sleepiness, paranoia, personality changes, depression (including post-partum depression), memory loss, dementia, cognitive dysfunction or deterioration, fuzzy thinking, psychosis, dementia, hallucinations, violent behavior, in children; autistic behavior, developmental delay.

B12 deficiency can cause neurological signs and symptoms of abnormal sensations (pain, tingling, and/or numbness of legs, arms trunk or anywhere),diminished sense of touch, pain or temperature (may mimic diabetic neuropathy Charcot foot), loss of position sense, weakness, clumsiness, tremor, any symptoms which may mimic parkinson's or multiple sclerosis, spasticity of muscles, incontinence, paralysis, vision changes, damage to optic nerve (optic neuritis).

Atherosclerotic vascular disease is increased by B12 deficiency including; Coronary artery disease, TIAs, CVA, heart attack, heart failure, claudication, all associated with elevated homocysteine levels caused by B12 deficiency.

B12 deficiency causes Megaloblastic Anemia (enlarged red blood cells with anemia). In this type of anemia, the red blood cells are fewer in number, yet they are larger in diameter (this large size is called megaloblastic and is measured on the CBC with the mean corpuscular volume, MCV). The anemia can cause fatigue, and weakness.

Cervical Dysplasia and increased risk for other dysplasias and cancers are associated with B12 deficiency. B12 supplementation is cancer prevention.

Most doctors do not test for B12, and if they do a test it is the serum B12 which may be unreliable because of the wide normal range. A more accurate test, urinary methyl malonic acid was developed by Eric Norman MD, and is inexpensive and widely available (MMA). The Methyl Malonic Acid MMA is elevated in the urine and serum in patients with B12 deficiency. Pacholok makes the case that everyone presenting for medical care should be routinely screened for B12 deficiency with the MMA, serum B12 and Homocysteine tests.

Treatment is Curative:

Treatment with inexpensive B12 injections or sublingual tablets is curative. Recent work by Kuzminski showed that daily 2 mg. oral B12 serves as well as monthly 1 mg intramuscular B12 injections. Serum Homocysteine is elevated in B12 deficiency. It is important to discover B12 deficiency early, since nerve damage can be irreversible if not discovered right away.

In conclusion, this is the definitive book on B12 deficiency, diagnosis and treatment for the lay reader and for the interested physician. As a result of reading this book, I now routinely test serum B12 and Urinary MMA on ALL patients, and have been surprised to find many symptomatic B12 deficient patients completely missed by the medical system. Needles to say, it is very gratifying to see ill patients completely recover with B12 injections.

I applaud the authors on a job well done, bringing B12 deficiency to the attention of the public, and no doubt saving many lives in the process. This book will make a positive impact on the nations's health, and change medical practice for the better. The only thing I would change about the book is to give Sally a name that is easier to pronounce.

Jeffrey Dach MD
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~ Written on 2007-12-23