Vitamin B12 Deficiency

bryanpj

Hi all. I used to have Vitamin B12 Deficiency. i used to have to go to the local HSE Nurse's office for a B12 injection once every three months. The nurse there told me it was a very common condition, and showed me a box filled with slips each representing a patient in the local community with B12 deficiency. There seemed like a great many names for the little town i live in! I moved to France in 2009, and was surprised when i went to the hospital there for my injection, and the doctor looked at me as if he had never heard giving injections for this condition. I did get my injection, but the medical staff informed me that it was not a common thing, especially for someone of my age (31 at the time). After two years living in france i got my bloods tested and discovered i was no longer B12 deficient (my irish doctor told me it would never go away). I'm just wondering is there a B12 deficiency epidemic in Ireland, and if so why? and why is it that such a close neighbour does not seem to have the same issue?

locum-motion

Principal causes of B12 deficiency:

1. Lack of B12 in the diet. Other than Vegans, virtually everybody has sufficient B12 in their diet, as you don't need very much of it, and it's present in lots of non-vegan foods. (How to fix this problem: Stop being Vegan, or take Vitamin B12 tablets)

2. Inability to absorb B12 from gut to bloodstream. The main reason for this inability is a disease called Pernicious Anaemia. If you have PA, you need B12 injections, as tablets are no use, since you can't absorb them anyway.

I once did a survey of prescribing patterns of B12 injections for the doctors local to a pharmacy I used to work in. For one of the local doctors, the rate of prescriptions for B12 injections was over 6 times greater than for the average of the other local doctors. One possible reason for this is that - by coincidence - a high proportion of PA sufferers happened to choose the same doctor. Another possible reason is that the surgery was able to charge £15 a pop to administer these 'vital' monthly injections. I know which reason I personally believe is the true one.

I leave you with this: www.quackwatch.com is a very interesting website that attempts to expose quacks in all their forms. They have an article there entitled "Quackery: How Should It Be Defined?"
It makes interesting reading. Have a look at the very first bullet point on that page, about 4 paragraphs down. Bear in mind that this is an attempt to actually define what is dodgy practice in healthcare.

bryanpj

thanks very much for the reply Locum

i did have PA, and i was a veggie at the time. I did have quite strong symptoms until i started receiving the injections, so it certainly wasn't a case of being incorrectly prescribed, Do you think that the apparently huge numbers of people being given B12 injections in Ireland might reflect a trend of poor judgement on behalf of the health professionals prescribing them?

I am just reading that article now, interesting stuff!

locum-motion

bryanpj wrote: »

thanks very much for the reply Locum

i did have PA, and i was a veggie at the time. I did have quite strong symptoms until i started receiving the injections, so it certainly wasn't a case of being incorrectly prescribed, Do you think that the apparently huge numbers of people being given B12 injections in Ireland might reflect a trend of poor judgement on behalf of the health professionals prescribing them?

I am just reading that article now, interesting stuff!

I think "a trend of poor judgement" would be a - shall we say - 'charitable' way of describing it!

mardybumbum

Autoimmune diseases (pernicious anemia, coeliac and MS) are much more common in the Celtic population and Scandanavians. I believe it had something to do with our ancient ancestors use of wheat and barley. So while France may be "geographical" neighbours I think the origins of the AI diseases go back to the Neolithic period.

I hope I am making at least some sense there.
No doubt that the factors locum motion mentioned also play a role.

ZYX

Biggest cause of B12 deficiency in Ireland is mis-diagnosis. Some hospitals actually have artificially lowered their "normal" levels. God know why.

Second big problem is doctors mis treating it. I have spoken about this here before but if you are young (31for example) and if your GP starts you on B12 injections without having fully investigated you then that GP is an idiot.

bryanpj

wow, thanks Locum....how disturbing that conclusion is.

Thanks mardybum, i was wondering if there was an element of that kind of thing at play...certainly explains a lot. The reason i was so keen to get to the bottom of this is i still remember the french doctor's face when i explained that i needed b12 injections, he didn't say it, but i got the impression he had never had to do it before!

Merci ZYX, it's terrible to think of people getting regular injections (because most people don't like having them) due to a mis-diagnosis. in my case, i had fairly pronounced muscle fascinations, and my bloods showed up very low b12 levels, so it was definitely warranted.

RobFowl

bryanpj wrote: »

wow, thanks Locum....how disturbing that conclusion is.

Thanks mardybum, i was wondering if there was an element of that kind of thing at play...certainly explains a lot. The reason i was so keen to get to the bottom of this is i still remember the french doctor's face when i explained that i needed b12 injections, he didn't say it, but i got the impression he had never had to do it before!

Merci ZYX, it's terrible to think of people getting regular injections (because most people don't like having them) due to a mis-diagnosis. in my case, i had fairly pronounced muscle fascinations, and my bloods showed up very low b12 levels, so it was definitely warranted.

Have to say thats interesting about the French because French doctors are notorius for overusing B12 injections .........
They use it as a "tonic" or generic treatment for tiredness..

bryanpj

lol, ok thanks rob, maybe something was lost in translation, but i certainly gathered they thought it was highly unusual for a 31year old guy to be getting b12 injections

RobFowl

bryanpj wrote: »

lol, ok thanks rob, maybe something was lost in translation, but i certainly gathered they thought it was highly unusual for a 31year old guy to be getting b12 injections

It's certainly something which is the subject of confusion here.
One problem is that the levels the labs use is based on American averages. Yet in the USA they fortify bread/cereals with B12. Thus ours will almost always look lower.
Pernicious anaemia (which can be tricky to diagnose and is supposely 1 in 1000) probably needs long term regular injections (but not always).
Low B12 on screening in the absence of symtoms certainly does not. The grey area in between is quite large though......

newmug

What are the symptoms of low B12 if you dont mind me asking?

bryanpj

Thanks for the follow up Rob

Newmug, my only symptoms were what are known as benign fasciculations....which is where various muscles make involuntary jumps or twitches. i was slightly concerned at the time that it could be like MS or something but turned out to be just lo2 b12 levels. I believe more often people suffer from a sense of fatigue when their b12 levels are low, but i did not experience this at the time it was diagnosed, perhaps due to my age. (i still get minor fasciculations, but i believe this is a very common thing, and can happen just as a result of stress or tiredness)

opinion guy

RobFowl wrote: »

It's certainly something which is the subject of confusion here.
One problem is that the levels the labs use is based on American averages. Yet in the USA they fortify bread/cereals with B12. Thus ours will almost always look lower.
Pernicious anaemia (which can be tricky to diagnose and is supposely 1 in 1000) probably needs long term regular injections (but not always).
Low B12 on screening in the absence of symtoms certainly does not. The grey area in between is quite large though......

My understanding is that they are thinking the lower limit should be higher than currently.

Though I also heard that there is a trend to megadosing oral supplements instead of the injection

Saaron

What are good sources of B12?

locum-motion

opinion guy wrote: »

...

Though I also heard that there is a trend to megadosing oral supplements instead of the injection

IF a person is unable to absorb B12, they're unable to absorb B12. Giving a bigger dose by mouth isn't gonna help!

opinion guy

locum-motion wrote: »

IF a person is unable to absorb B12, they're unable to absorb B12. Giving a bigger dose by mouth isn't gonna help!

Dogma.

Dogma challenged:
http://www.ncbi.nlm.nih.gov/pubmed/21600388
http://www.ncbi.nlm.nih.gov/pubmed/16585128
http://www.ncbi.nlm.nih.gov/pubmed/19193702
http://www.ncbi.nlm.nih.gov/pubmed/14749150
http://www.ncbi.nlm.nih.gov/pubmed/16034940

Small studies. But it certainly cast doubt on the dogma.

RobFowl

opinion guy wrote: »

My understanding is that they are thinking the lower limit should be higher than currently.

Though I also heard that there is a trend to megadosing oral supplements instead of the injection

locum-motion wrote: »

IF a person is unable to absorb B12, they're unable to absorb B12. Giving a bigger dose by mouth isn't gonna help!

I've read some of the research (will try to pull it out) and discussed this with gastroenterology at Beaumont and mega dosing with oral supplements does work.
Even in fullblown pernicious anaemia some b12 is absorbed and this (admittedly small proportion) stays contant so very high does orally will lead to some being absorbed.

bryanpj

Saaron....much as i hate putting down the vegetarian lifestyle, i have read so many articles which suggest what's said below, ie that vitamin b12 is only obtained from eating animal products....well, i don't know, but i know plenty of healthy veggies....it just didn't work long-term for me!

"B12 is the only vitamin that contains a trace element (cobalt), which is why it’s called cobalamin. Cobalamin is produced in the gut of animals. It’s the only vitamin we can’t obtain from plants or sunlight. Plants don’t need B12 so they don’t store it.

A common myth amongst vegetarians and vegans is that it’s possible to get B12 from plant sources like seaweed, fermented soy, spirulina and brewers yeast. But plant foods said to contain B12 actually contain B12 analogs called cobamides that block intake of and increase the need for true B12.

This explains why studies consistently demonstrate that up to 50% of long-term vegetarians and 80% of vegans are deficient in B12"

Saaron

bryanpj wrote: »

Saaron....much as i hate putting down the vegetarian lifestyle, i have read so many articles which suggest what's said below, ie that vitamin b12 is only obtained from eating animal products....well, i don't know, but i know plenty of healthy veggies....it just didn't work long-term for me!

"B12 is the only vitamin that contains a trace element (cobalt), which is why it’s called cobalamin. Cobalamin is produced in the gut of animals. It’s the only vitamin we can’t obtain from plants or sunlight. Plants don’t need B12 so they don’t store it.

A common myth amongst vegetarians and vegans is that it’s possible to get B12 from plant sources like seaweed, fermented soy, spirulina and brewers yeast. But plant foods said to contain B12 actually contain B12 analogs called cobamides that block intake of and increase the need for true B12.


This explains why studies consistently demonstrate that up to 50% of long-term vegetarians and 80% of vegans are deficient in B12"

Thank you, that's great information! I'm actually a vegetarian myself and although I try to get a lot the right vitamins etc and eat healthily I've never even thought about B12.

opinion guy

RobFowl wrote: »

I've read some of the research (will try to pull it out) and discussed this with gastroenterology at Beaumont and mega dosing with oral supplements does work.
Even in fullblown pernicious anaemia some b12 is absorbed and this (admittedly small proportion) stays contant so very high does orally will lead to some being absorbed.

Maybe you should organise an Irish GP based study!:)

locum-motion

RobFowl wrote: »

I've read some of the research (will try to pull it out) and discussed this with gastroenterology at Beaumont and mega dosing with oral supplements does work.
Even in fullblown pernicious anaemia some b12 is absorbed and this (admittedly small proportion) stays contant so very high does orally will lead to some being absorbed.

I stand corrected.

Traumadoc

Was it an occupational risk for dentists?
I think they got a version of tabes dorsalis. or was that sailors?;)

Mistymaud

I've not been on these boards in a long time, but here's my twopenneth:

If you've been diagnosed with PA then you are on lifetime injections.

Vitamin b12 deficiency tagged with the title Pernicious Anaemia is very misleading. In fact it's a red herring.

PA is only called PA because that's its historical title. People who were sick had not only anaemia but also neurological degeneration - as Traumadoc rightly pointed out the Tabes link.
Tabes is the neuro presentation of syphilis.
The reason the anaemia was significant was that, at the time, the neuro presentation was being confused with other conditions, including that of tabes. The only time an alternative diagnosis of PA could be made was when the patient also had anaemia. So at the time it was thought that the anaemia caused the neuro damage.

A few decades later they discovered that the anaemia, if indeed it did ever present, was actually as a result of DNA dysfunction which affects all cells including that of the blood.
Except, as can clearly be seen, the message didn't quite get through to contemporary clinicians.

So, what happens is, there is a malabsorption problem (yes, even those on a restricted diet can malabsorb. A b12 deficiency doesn't always mean it's down to diet) and, because b12 acts as a co-enzyme in several metabolic pathways, those pathways 'malfunction.' Then DNA changes start to take place which damages cells. Since we are made up of cells you can understand the damage can affect more or less anything. Sometimes these changes occur in the blood resulting in haematological indicators, sometimes they do not.
There are problems with using the serum b12 test anyway and that's recently been the subject of much discussion.
When you have a b12 injection, just because your blood is full doesn't mean your nerves and cells have been repaired. In some cases damage can be permanent.

In short b12 deficiency is a neurological condition rather than a haematological one. They have been getting it all back to front.

Recent paper out in the BMJ 4th September 2014 by Hunt shows the misconceptions up regarding the issues because it gives an outline of the metabolic functions of b12 in the abstract. If you tap in pdf to a search engine with the above info you just might be able to pull up the full paper.

So, b12 deficiency is potentially very dangerous and can result in permanent physical or mental injury. It is not always fully reversible.

And, as TraumaDoc points out, it can be mistaken for Tabes - the reason it was prevalent with dentists is that Nitrous Oxide oxidises b12. If you haven't got much to start with and then come into contact with NO then your condition will worsen.

Only touched on the subject but thought I would attempt to help out.

DannyX

I know it's 12 years since anyone posted anything on B12 deficiency (or Pernicious Anemia) here but I was wondering if any of the contributors have any further insights into this ailment. My dad was recently diagnosed with it and got a series of b12 injections. Since then he has deteriorated neurologically and his behaviour has become unpredictable and irrational (non-violent),

Chloe52

https://www.boards.ie/discussion/2056458121/vitamin-b12-deficiency

Hey! I got to know about Vitamin B12 deficiency a lot —I've dealt with it too.

In my case, adding B12-rich foods and supplements helped a lot. Also, practicing relaxation techniques and ensuring I get enough vitamins overall seemed to help maintain my levels. And if you're worried, talking to a doctor is always a good idea. Hope it helps!

Gloria10

https://www.boards.ie/discussion/comment/122063744#Comment_122063744

From my experience, dealing with B12 deficiency can be rough, but I'm glad you found things that helped. I try to stay optimistic in any situations. Also, I tried to add more B12-rich foods to my diet, so I started eating more meat and fish, drinking milk, and ensuring I drink enough water. In addition to food, I made sure to get enough of all the important vitamins, not just B12. I tried many pills and drops myself, and they all did a great job. But what's more, I found that maintaining a healthy lifestyle overall seemed to keep my levels in check. That includes things like hitting the gym in the morning and practicing meditation. By the way, have you considered exploring Canadian Pharmacy B2B for your supplement needs? They might have some options that could complement your regimen nicely. It really helped me a lot! Take care.

dickdasr1234

https://www.boards.ie/discussion/comment/75651652#Comment_75651652

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