Could It Be B12?: An Epidemic of Misdiagnoses

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 si

I am an MD, a nutritional physician, and a psychiatrist (Canadian-board-certified) who has been studying vitamin B12 extensively since 1976, and applying that knowledge in my private nutritional, metabolic and psychiatric practice in Tucson AZ since 1994 (and Portsmouth VA before that). This book is an outstanding compilation of anecdotes, references and experiences on the "underground devastator" of our society. The reason why this is not common knowledge in the medical profession in the US is because the laboratory "normal range" is way too low. In Japan the range is 2.5 times higher at its low end - and Japan has very little "Alzheimer's Dementia", and less depression and bipolar disorders, than we do in the US. In the 26 years that I have been investigating B12, memory disorders and depressive/ bipolar illnesses, NO patient who came to me with a memory problem (early Alzheimer's) has gone on to Alzheimer's dementia, and I have a near-perfect track record in helping people overcome depression and bipolar disorders. These outcomes are largely due to my permanent optimization of every patient's serum B12 level. Congratulations to Ms Sally Pacholok RN on an outstanding recording of most of the important facts and treatments for this serious condition. I believe it to be the best book out there for a combination of both medical and lay readers on this condition. [To anyone reading this review: Please do not simply go and buy B12 tablets or lozenges and start taking them, before getting an accurate serum level measured.] John V Dommisse MD, MBChB, FRCP(C) Tucson, AZ, USA

Before the availability of the internet for easier research, I never found a good explanation of the workings of B12 in the body (for non-medically-trained people to understand). Most of the physicians I encountered had no good working knowledge of Pernicious Anemia. This book is an excellent reference for how B12 works, why it is essential that it be absorbed properly, and a long list of other considerations, including possible serious wrong diagnoses, in which B12 mal-absorption should be examined. Other reviewers have pointed out the readability, devotion to accuracy, and the helpful tone of this useful book. If you or a loved one has any condition related to B12, I think you will be glad to read this book. For some of us, this knowledge will make the difference between a healthy life and a miserable one.

As a primary care physician I read Ms. Pacholok's book "Could It Be B12?" with great interest. In the early 1950's a vitamin B12 shot was a sign-off gesture by many primary care doctors at the close of a Pt's visit. It seemed as though everyone got a B12 shot for no apparent documented reason. You must understand that laboratory testing in those days was awkward, expensive, and impractical. My own mother went monthly to our family GP for her routine B12 shot. She swore by it. As progress in medicine was made it became apparent that either the United States was the world's capital of pernicious anemia or perhaps B12 shots were a doctor's way to make a fast buck. With this type of prevailing sentiment anyone who wanted to be taken seriously as an ethical physician shunned the practice of "routine" Vitamin B12 shots. I do believe this stigma prevails to this day. Just mention B12 deficiency as a possible cause for any disorder and you're likely to see a smirk come across the doctor's face as those mental neurons flash back in recollection of those charlatans of an earlier era. But now unlike then we have an easily obtainable and accurate test for Vitamin B12 deficiency. I do believe medicine's nihilistic attitude toward B12 based on the past makes for a mental block on behalf of a lot of doctors to even consider B12 deficiency on their list of differential diagnoses. This is unfortunate. My only advice to the public is as Ms. Pacholok advocates: 1. Avoid shot gun B12 therapy; 2. Insist that you and your loved ones with signs and symptoms get tested. It's the right thing to do. I enjoyed the book and give it a 5 star rating. Dr. Anonymous

Recently I was diagnosed with B12 deficiency, after struggling with anemia, exhaustion, and a decreased immune system for much of my 20's. I can hardly believe what a difference B12 shots have made in my life. I'm half Scandinavian, and at least one of my Norwegian cousins has this deficiency, too, which can run in families. I have been researching everything I could find on B12 deficiency. Sally Pacholok, RN, and her husband, Jeffery Stuart, DO, have written a well-researched book on the symptoms, diagnostic tests, and treatment for B12. I wish the book dealt a little more with some of the recovery process, but the book is very thorough and well-researched. The 13 chapters are as follows: 1. An Invisible Epidemic 2. Is It Aging--or Is It B12 Deficiency? 3. Deadly Mimic: When B12 Deficiency Masquerades as Multiple Sclerosis or Other Neurological Disorders 4. Am I Losing My Mind? When B12 Deficiency Causes Mental Illness 5. Stroke, Heart Disease, and Other Vascular Problems: The B12-Homocysteine Connection 6. Lost Children: When B12 Deficiency Causes Developmental Disabilities or Learning Problems 7. Vitamin B12 and Cancer, Impaired Immune Function, and Autoimmune Disease 8. Under the Knife: Why Low B12 Levels Make Surgery Dangerous 9. Can't Conceive? How B12 Deficiency Contributes to Male and Female Infertility 10. Protecting Yourself: Are You at Risk for Vitamin B12 Deficiency? 11. Information for Physicians 12. Speculation: The Possible Role of Vitamin B12 in Autism 13. A Call for a United Effort This book is well-written, interspersing case studies/stories with research, and is a fairly easy read. If you have B12 deficiency, or have family or patients with B12 deficiency, this book is highly recommended.