Vitamin B12 Deficiency by Jeffrey Dach MD

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Vitamin B12 Deficiency, the Epidemic of Misdiagnosis

A good friend of ours, otherwise healthy, had the sudden onset of severe leg pain which baffled her doctors who could not explain it. After many months of suffering and no relief from many different medications and treatments, she tried inexpensive vitamin B12 injections, which gave her complete relief. Occasionally the pain returns and reminds her that it is time for another B12 injection. The injections are simple to do, with a syringe and tiny needle, the B12 is injected under the skin twice a week.

I found this B12 story interesting, and there are many more B12 stories of misdiagnosis in this book, "Could it Be B12, An Epidemic of MisDiagnoses?" by Sally M. Pacholok R.N. and Jeffrey J Stuart D.O. (1).

How Common is B12 Deficiency?

Vitamin B12 deficiency is estimated to affect 10%-15% of individuals over the age of 60 (2). A recent study in Israel of elderly hospitalized patients found 40% had low or borderline serum B12 levels. (3). Vegetarians are another group with inadequate dietary B12 intake since much of our B12 comes from meat consumption. A recent study showed 50% of long term vegetarians have B12 deficiency, with decreased serum B12 levels and elevated homocysteine levels. (4) (5)

What Causes B12 Deficiency?

B12 is a huge molecule and absorption depends on many cofactors, so that it is quite 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. (6) (7). Other antacid pills such as Prevacid, Protonix, Zantac, 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 (8).

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 (crohn's). Auto-immune diseases such as hashimoto's thyroiditis may also be associated with pernicious anemia.

In addition, Miller has identified genetic defects in which transport proteins are absent or deficient causing B12 deficiency (9).

Symptoms Which Might Indicate a B12 Deficiency

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. An excellent book on the topic is: Could it Be B12? An Epidemic of Misdiagnosis by Sally M. Pacholok, R.N. and Jeffrey J Stuart, D.O. (10)

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.

Mental Changes:

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.

Neurological Signs and Symptoms:

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).

Vascular Problems:

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.

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 corpscular volume, MCV). The anemia can cause fatigue, and weakess.

Increased Cancer Risk from B12 Deficiency

Cervical Dysplasia and increased risk for other dysplasias and cancers is associated with B12 deficiency. B12 supplementation is part of our cancer prevention program.

Testing for the Diagnosis of B12 Deficiency

The standard serum B12 test which is commonly used may be unreliable (11). Therefore, a more accurate test called the methyl malonate test has been devised. (12). The substance, Methyl Malonate is elevated in the urine and serum in patients with B12 deficiency. We have added this test to our standard panel, so everyone will be routinely screened with the most advanced and accurate test for B12 deficiency. Should the B12 level be low in spite of oral or sublingual B12 supplements, then inexpensive B12 injections can be taken at home. Recent work by Kuzminski showed that daily 2 mg. oral B12 serves as well as monthly 1 mg intramuscular B12 injections. (13).

Serum Homocysteine is elevated in B12 deficiency, and of course the standard serum B12 test is aso included in our panel.

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Regards,

Jeffrey Dach, M.D.
4700 Sheridan, Suite T.
Hollywood Florida, 33021
954 983 1443

References

(100) The Norman Clinical Laboratory,an excellent web site devoted to B12 and Methyl Malonic Acid testing with many references. Dr. Norman is the medical pioneer credited with doing all the original methyl malonate work.

(100) Letter to the Editor By Dr. Norman discussing value of MMA testing for B12 deficiency.

(101) B12 Page at the Linus Pauling Institute, an excellent page on B12 with a excellent list of references with links.

(102) B12 Article by Mary Enig at Weston Price Institute

(103) Sally Pacholok, R.N. Health Forum Message Board where you can read her messages and post your own message.

(104) Could it Be B12? An Epidemic of Misdiagnosis by Sally M. Pacholok, R.N. and Jeffrey J Stuart, D.O.

(105) B12 deficiency article in Postgraduate Medicine

(106) EDITORIAL: Assessing the association between vitamin B-12 status and cognitive function in older adults by Joshua W Miller, American Journal of Clinical Nutrition, Vol. 84, No. 6, 1259-1260, December 2006

(107) Persistence of neurological damage induced by dietary vitamin B-12 deficiency in infancy. Ursula von Schenck, Christine Bender-Götze, Berthold Koletzko. Arch Dis Child 1997;77:137-139 ( August )

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A Medical Article that I Published in 1980:

(7) Dach J, Patel N, Patel S, Petasnick J. Peritoneal mesothelioma: CT, sonography, and gallium-67 scan. AJR Am J Roentgenol. 1980 Sep;135(3):614

Jeffrey Dach, M.D.
Member of the Board of the American Academy of Anti-Aging Medicine
Board Certified by the American Board of Radiology

4700 Sheridan, Suite T
Hollywood Fl 33021
office phone 954-983-1443

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Jeffrey Dach, M.D.
4700 Sheridan Suite T.
Hollywood, Fl 33021
954-983-1443

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Dr. Dach is Board Certified by the American Board of Radiology and a member of the Board of the American Academy of Anti-Aging Medicine. He has 25 years experience in the Memorial Hospital System as an interventional radiologist. His current practice focuses on Bio-identical hormone supplementation for men and women, menopause, andropause, HGH, testosterone, natural thyroid and the use of natural substances rather than drugs in the appropriate setting.

Conflict of Interest Disclaimer: We receive no money from the pharmaceutical industry or from the NIH. We do not sell any products to the public at large. We do however, make available selected nutritional supplements to our office clients at a small markup to cover our costs.

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Jeffrey Dach MD 4700 Sheridan Suite T, Hollywood, Fl 33021 phone: 954-983-1443

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