You’re pretty sure you know your body and you tell your doctor you’re just not feeling right. You’re tired, maybe a little depressed, a bit achy. Maybe your digestion is “off.” The list of foods you can’t seem to enjoy is definitely longer. Your doctor’s empathic, not at all dismissive of your symptoms, but after a physical exam and some apparently appropriate tests she can’t find anything really wrong. On the surface, this is reassuring. After all, the main reason we do go to doctors is to ascertain that nothing serious is going on. Still, could she be overlooking something? After decades of treating patients with longstanding but undiagnosed chronic symptoms, here’s the first of six overlooked diagnoses I see most frequently in our patients at WholeHealth Chicago. Low Levels of Vitamin B-12 One of the eight B vitamins, B-12 is involved in the metabolism of every cell in your body. Years ago B-12 was called “maturation factor” because cells need B-12 to mature from being young and ineffectual whippersnappers to fully functioning and mature.
B-12 deficiencies affect three major systems in your body: your blood, nervous system, and, less often, gastrointestinal tract. These three are targets because their cells either have a high turnover rate (blood and intestinal lining) or need a lot of B-12 to function smoothly (nervous system). The symptoms of low B-12 levels are related to each of these areas. The irony is that with all these there’s usually just one predominant symptom, and making a connection to low B-12 can easily be delayed until other symptoms start to appear. For example, if your only symptom is tingling in your hands, you might undergo all sorts of diagnostic tests before your doctor thinks “Maybe we should check her B-12 level.” What causes B-12 deficiency? The list of causes is lengthy, but by far the most frequent culprit is a dietary one. Vegetarians who aren’t paying attention to the B-12 in their food choices will have downward-drifting B-12 levels, and virtually all vegans not taking Vitamin B-12 supplements ultimately develop deficiencies.
Even the various vegan organizations acknowledge it’s not possible to get adequate B-12 while following a strictly vegan diet, and that’s because the richest sources are animal products. Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells. These cells produce a substance called intrinsic factor, necessary for B-12 absorption. Also, since you need stomach acid to absorb B-12, long-term use of acid-suppressing proton pump inhibitors (Nexium, etc.) can lead to B-12 deficiency, as can chronic intestinal conditions like Crohn’s disease, celiac disease, and intestinal parasites. The main danger of missing this diagnosis is that (while quite rare) the damage to your nerves and even brain can be permanent. Other serious consequences: your anemia can get so severe it causes heart failure and collapse. Or you could be misdiagnosed with a major depressive disorder or even psychosis and take unneeded psychiatric medications for months (or years) before someone notices you look yellow-ish and you’re finally diagnosed with megaloblastic anemia.
There are four reasons why this diagnosis is missed: It’s virtually impossible to take too much B-12 as any excess of this water-soluble vitamin is eliminated via urine. Nutritional guru Alan Gaby, MD, has commented that the only way too much B-12 will kill you is if you fill your bathtub with it and drown. Foods high in B-12 are animal products: meat, poultry, seafood, dairy, and eggs, with eggs having the least. Because all animals store B-12 in their livers, eating liver is an excellent (though not particularly popular) treatment for B-12 deficiency. Your grandmother or great-grandmother likely remembers a time when her doctor told someone in the family to eat more liver. And since people with low B-12 are likely to also have gastrointestinal symptoms that interfere with B-12 absorption, the best way to quickly increase (and maintain) B-12 levels are with B-12 injections, chewable tablets, or the recently released nasal sprays and skin patches. In my own practice, a deficient patient receives a series of four B-12 injections (or four B-12 containing Meyer’s Cocktails) and also starts (and maintains herself on) a daily B-12 chewable tablet.
Usually within a month her levels are back to normal. There’s more to come in the Commonly Missed Diagnoses series. Next week: overlooked diagnosis #2, vitamin D deficiencyQ. My husband takes metformin and some other medications as well as supplements. His last blood work showed high levels of Vitamin B12 (more than 2000 pg/ml), which is disconcerting. Is this harmful, and what could be causing it? A. Your husband needs a thorough workup. High levels of vitamin B12 are unusual for someone on metformin. In fact, many people who take this diabetes drug have low vitamin B12 levels. A study in the Journal of Clinical Endocrinology and Metabolism (online, Feb. 22, 2016) concluded: “Long-term use of metformin in DPPOS was associated with biochemical B12 deficiency and anemia. Routine testing of vitamin B12 levels in metformin-treated patients should be considered.” Because metformin often causes digestive tract upset, many patients are also put on a proton pump inhibitor (PPIs) such as esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec).
Such drugs also deplete the body of vitamin B12. The combination of a PPI and metformin would absolutely require regular laboratory tests for vitamin B12. We do not want to scare you, but one sign of liver problems could be high vitamin B12 levels. That is why your husband needs to see his physician promptly for a complete examination and another vitamin B12 test. Make sure he takes all his pill bottles (including vitamins and minerals) along just in case he is getting too much vitamin B12 from the supplements he is taking. Please let us know how he makes out.The requested URL /forums/showthread.php?169-B12-overdose-megadose was not found on this server. Additionally, a 404 Not Found error was encountered while trying to use an ErrorDocument to handle the request.Not every one has the same symptoms of vitamin B12 deficiency. You and your best friend may both be low in vitamin B12, but have very different symptoms. Because the symptoms of low vitamin B12 vary so greatly the medical community has often concentrated on one symptom and ignored others.
The result is that many people with severe symptoms of low B12 get no treatment because they don’t have the symptom popular on a given day, the “symptom d’jour” you might say. Today when there is more knowledge about vitamin B12 and its symptoms, with compelling research, there remains a tendency among healthcare providers to go with the familiar past. That might not be good for you if you have different symptoms than your healthcare provider has long associated with vitamin B12 deficiency. For example, after I was diagnosed with “profound vitamin B12 deficiency” another doctor, one not at the hospital where I was diagnosed, said I could not have vitamin B12 deficiency because I wasn’t vegetarian. For that doctor, the first and most important thing she looked for, to see if there might be vitamin B12 deficiency, was a vegetarian diet. Anyone coming to her who wasn’t vegetarian would not have their low vitamin B12 level considered as a possible cause of ill health.
Another example has to do with the fact that there are two categories of vitamin B12 deficiency symptoms: those that are related to nerves, and those related to blood. While it appears that a low vitamin B12 level experienced over a long time will inevitably lead to blood disorders ~ to blood cells being too large ~ not everyone who initially has serious B12 problems will have the large blood cells associated with advanced deficiency or the disease of pernicious anemia. Because of the wide range and confusing variety of low vitamin B12 symptoms, it is useful to look at your fingernails and see whether they have ridges or are losing their moons. These simple signs show low B12. For a better understanding read Areas of Cognition Jarrow Methyl B12 5000 mcg People who use medicine affecting B12: Patients with Autoimmune diseases to include: What is a healthy vitamin B12 level? Treatment ~ You can safely treat low B12 symptoms using Methylcobalamin
As an aside, when you buy through a link on my site you help support my site. Initial symptoms of B12 deficiency are easily overlooked. Plus, early symptoms of anemia may be masked by folic acid, or by an iron deficiency. A variety of neuropsychiatric symptoms may be the earliest and easily seen and felt symptoms. The most common neurological symptoms in low vitamin B12 are paraesthesia (numbness) of the hands and feet, diminished perceptionof vibration and position, absence of reflexes, and unsteady gait and balance — the range of symptoms is broad. Psychiatric symptoms seen in vitamin B12 deficiency are varied and fall into several different categories: Confusion and memory disturbances are the most common. Depression, with or without psychotic components, and cognitive decline are frequent. Swings in mood and personality changes from low B12, if untreated, may become a psychiatric disease. Such vague symptoms of vitamin B12 deficiency are easily overlooked, especially as the serum concentration of vitamin B12 often lies within the reference range.
(In the United States the low for the reference range is hundreds of points lower than the more realistic low in Japan and Europe.) Disorders in the gastrointestinal tract can give rise to a deficiency of vitamin B12, with symptoms being more or less pronounced. Poor mucosal function may also be a cause and may show up with glossitis (a swollen tongue). The elderly are at great risk of vitamin B12 deficiency. Age-related, often asymptomatic atrophic gastritis is common and may be enough to cause a patient to slide slowly into a negative vitamin B12 balance with depleted stores of the vitamin giving rise to dementia. (Because the low in the United States is so low, this slide may go unnoticed for considerable periods of time.) Infants of vegetarian/vegan mothers are in danger of vitamin B12 deficiency, even though their mothers may not have B12 malabsorption illness and may not show any deficiency symptoms. This is because of the relatively high need for B12 in a rapidly growing child.
Finally, if your fingernails have ridges or you are beginning to lose your moons, please try Methylcobalamin. Keep notes so you can review after you begin to feel better with a reduction in the symptoms you may have found worrying and/or baffling. If you aren’t going to go to your health food store soon, order Methylcobalamin on line. In 1997 the lines/ridges on my fingernails were the worst. I was unable to think; I tried to kill myself, and I had such horrible bone pain that it didn’t seem like it would make any difference if I immolated myself because of abuse by IRS. B12 changed all that! Vitamin B12 and Brain DamageI have found that stress coincides with lower B12 and the accompanying symptoms. Stress can break you ~ Read more.If you like the scientific side of things, then from the scientific perspective what happens to you when you are under stress is that your telomerase, which is essential for longer telomeres, is decreased. The end result is that stress shortens your telomeres and short telomeres are related to illness and earlier death.