a silent epidemic: b-12 deficiency.

OK, so a vitamin deficiency hardly sounds like a big deal, right?  Something more serious like Multiple Sclerosis (MS) or Alzheimer’s or cancer or heart disease sounds much more ominous, doesn’t it?  But what if I told you that a B-12 deficiency can lead or contribute to the onset of any one of those more serious diagnoses?  Or that often a B-12 deficiency is misdiagnosed and treated as one of these life-altering and life-threatening diseases when an individual could be treated simply and relatively inexpensively with proper B-12 supplementation?

I know this sounds crazy, but before you stop reading because something so seemingly simple as a vitamin couldn’t possibly be the answer for so many problems, allow me to explain the function of B-12 in the body.  Vitamins are substances necessary for life that our bodies do not make by themselves, so they must be supplied by our diet (or synthesized in the skin from sun exposure, in the case of vitamin D).  According to the National Institute of Health, Vitamin B-12 “[keeps] the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells.”  In the absence of B-12, every system in the body is at risk of damage.  Any time the body is not getting the nutrients it needs for one reason or another, genetic or lifestyle induced system weaknesses have the potential to result in disease.  The only foods that naturally contain B-12 are animal products.  However, even if you eat animal products, absorption of B-12 is very complicated, and statistically speaking the odds are very high that your body is not absorbing or using it correctly even if you are consuming a sufficient amount of it.

So who is at risk for B-12 deficiency?  The following is a high level list taken from Could It Be B12? by Sally M. Pacholok, R.N., B.S.N. and Jeffrey J. Stuart, D.O. (formatting is mine, just so you can see easily at a glance).

People with Elevated Risk of B-12 Deficiency

  • Vegetarians, vegans, and people eating macrobiotic diets
  • People aged sixty and over
  • People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (gastric bypass)
  • People who regularly use proton-pump inhibitors, H2 blockers, antacids, metformin and related diabetes drugs, or other medications that can interfere with B-12 absorption
  • People who undergo surgeries or dental procedures involving nitrous oxide, or who abuse this drug recreationally
  • People with a history of eating disorders (anorexia or bulimia)
  • People with a history of alcoholism
  • People with a family history of pernicious anemia
  • People diagnosed with anemia (including iron deficiency anemia, sickle cell anemia, and thalassemia)
  • People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that causes malabsorption of nutrients
  • People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Graves’ disease), type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders
  • Women with a history of infertility or multiple miscarriages
  • Infants born to and/or breast fed by women who are symptomatic or are at risk for B-12 deficiency

I want to be clear that I am not suggesting that every case of MS, Alzheimer’s, cancer, heart disease, etc. is caused by a B-12 deficiency.  There are MANY causes for disease.  One of those causes is genetics – our bodies each have a genetic predisposition toward certain diseases.  What is important to remember though is that a genetic predisposition does not equal an inevitable diagnosis.  Environmental triggers bring about the onset of symptoms and progression of disease.  So leading a lifestyle that keeps the body in top condition significantly lessens the likelihood of the disease ever taking hold in the body.  Whatever the cause of a disease, checking into B-12 deficiency as a contributing factor if not the cause is easy and inexpensive.  Even in the absence of disease, making sure there is no B-12 deficiency as a preventative measure is simple.  The following is another list from Could It Be B12? of signs and symptoms that could indicate a B-12 deficiency; ruling out B-12 as the culprit in these cases would be wise.

Mental Changes

  • Irritability
  • Apathy
  • Sleepiness
  • Suspiciousness (paranoia)
  • Personality changes
  • Depression (including postpartum depression)
  • Memory loss
  • Dementia, intellectual deterioration
  • Hallucinations
  • Violent behavior
  • In children, developmental delay and/or autistic behavior

Neurological Signs & Symptoms

  • Abnormal sensations (pain, tingling and/or numbness of legs, arms, trunk, or other area)
  • Diminished sense of touch, pain, and/or temperature
  • Loss of position sense (awareness of body position)
  • Weakness (legs, arms, trunk, or other area)
  • Clumsiness (stiff or awkward movements)
  • Tremor
  • Symptoms mimicking Parkinson’s disease or multiple sclerosis
  • Spasticity of muscles
  • Incontinence (urine and/or stool)
  • Paralysis
  • Vision changes (decreased vision or loss of vision)
  • Damage to the optic nerve (optic neuritis, inflammation, or atrophy of the optic nerve)

Vascular Problems

  • Transient ischemic attacks (TIAs, or “mini-strokes”)
  • Cerebral vascular accident (CVA or “stroke”)
  • Coronary artery disease
  • Myocardial infarction (“heart attack”)
  • Congestive heart failure
  • Palpitations
  • Orthostatic hypotension (low blood pressure when standing, which can cause fainting and falls)
  • Deep vein thrombosis (blood clot to the leg or arm)
  • Pulmonary embolism (blood clot to the lung)

Additional Signs & Symptoms

  • Shortness of breath
  • Generalized weakness
  • Chronic fatigue or tiredness
  • Loss of appetite/weight loss or anorexia
  • Epigastric pain (poor digestion, full or bloated feeling after eating small or normal sized meals)
  • Gastrointestinal problems (diarrhea, constipation)
  • Osteoporosis
  • Increased susceptibility to infection
  • In newborns and infants, failure to thrive
  • Tinnitus (ringing or roaring in the ears)
  • Vitiligo (white patches of skin) or, conversely, hyperpigmentation of skin
  • Prematurely gray hair

The list certainly goes on.  The stories of devastating damage done due to misdiagnosis and successes from proper treatment are widely varied and each unique.  For more information, check out Could It Be B12? by Sally M. Pacholok, R.N., B.S.N. and Jeffrey J. Stuart, D.O.  Pacholok and Stuart have dedicated their careers to promoting the awareness of B-12 deficiencies as they have seen first-hand the statistically significant prevalence of overlooking B-12 deficiency and the resulting damage as well as the amazing recovery of patients who have been so blessed as to be properly diagnosed and treated.  They also have a helpful website, www.b12awareness.org, that provides more information about testing, proper interpretation of test results (they recommend revising the Serum B-12 Test to a low of 450 pg/ml vs. the 200 pg/ml commonly accepted as the low normal by the majority of medical professionals), and B-12 stories from patients and their loved ones.

My B-12 story is still developing.  Aside from a few years in childhood when I wasn’t given the choice, I have been a vegetarian my entire life.  I didn’t know until I began seeking out and studying information about health and wellness that B-12 was a vitamin that I could not get (at least not sufficiently) from plant sources.  Being a vegetarian does not come with a how to manual, so unless someone or something brings it to your attention, who’s to know?  I have faithfully visited my doctor every year for annual checkups and have seen other care providers for various ailments.  At least two of those visits showed possible  indicators of a B-12 deficiency – early anemia and gluten intolerance.  Every time you visit a care provider, you fill out paperwork about your health history and lifestyle.  Most, if not all, of the care providers I visited knew that I was a vegetarian, which in itself is a risk factor for B-12 deficiency.  Yet, not once was B-12 considered or tested as a possible cause for complaints.  Not once was it suggested that I supplement with B-12, even if it wasn’t the cause of my complaints, just because I am at a high-risk due to my diet.  I have been fortunate enough to not have experienced any noticeable damage despite the likely low level of B-12 in my body, but I don’t intend to see what condition might develop in its absence.  Currently, I am using Jarrow Formulas Methyl B12 5000mcg lozenges to supplement.  As vitamin B-12 is water-soluble, it is not stored in the body; it is either absorbed for usage or flushed out, so there is no indication that high doses pose any risks.  Still, based on my research, I’m not confident that simply supplementing, even with such a high dose, is effective if a deficiency already exists or in cases of malabsorption.  I plan to be tested at my next doctor visit and will add an update if anything new and interesting comes of it.

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