The Problems with the Symptoms, Diagnosis and Treatment of Vitamin B12 Deficiency by Martyn Hooper, founder of the Pernicious Anaemia Society
I’m going to make a bold statement. There are serious problems with the way in which Vitamin B12 deficiency is diagnosed and treated. There may even be what Sally Pacholok and Jeffrey Stuart describe in their book Could it Be B12? as ‘an epidemic of misdiagnoses’.
I know from first-hand experience how the symptoms of B12 deficiency can be ignored or associated with another disease, as I developed serious neurological damage through being severely deficient in B12 for a number of years. I underwent MRI scans and other expensive investigations with neurosurgeons, neurologists and seven or eight GPs. It was only when my sister, who is a nurse, eventually decided to take an armful of blood that I finally received a diagnosis of having ‘sub-acute combined degeneration of the cord secondary to pernicious anaemia’. Lacking this precious and essential vitamin can and does have very serious consequences. That is why it’s important to be aware of the symptoms of being B12 deficient in order to correct any deficiency early.
What does vitamin B12 do?
A normal healthy person will have normal and functioning parietal cells in his or her stomach. These cells will produce a protein called intrinsic factor, which binds to any animal product eaten, including meat, fish and dairy products, and produces vitamin B12. Vitamin B12 is essential to produce healthy red blood cells that transport oxygen around the body to wherever it is needed – which is just about everywhere. If you have a problem with your parietal cells, you won’t produce any intrinsic factor and then won’t be able to produce healthy red blood cells. People with pernicious anaemia either don’t produce the intrinsic factor at all, or – and nobody knows why this is – they produce intrinsic-factor antibodies that destroys the intrinsic factor they do produce.
You can, however, be at risk of B12 deficiency without having pernicious anaemia. One obvious group is vegans. However, most vegans are aware that they are at risk and take oral supplements to ensure that they get their source of B12 in an artificial form. But of course, if they have no intrinsic factor to ‘capture’ the B12, the supplements will be of no use. That is why people with pernicious anaemia have to have injections of B12 directly into their bloodstream.
Elderly people are at risk of developing gastric atrophy (this can also be caused by the gut pathogen Helicobacter pylori), which means the mucous lining of their stomach produce antibodies to both the intrinsic factor and parietal cells. And as the UK population becomes older, there is a case for routinely checking the B12 status of the elderly.
Long-term lack of B12 can also lead to the loss of the protective myelin sheath that surrounds nerves, which causes irreversible nerve damage. Sometimes that nerve damage leaves the patient unable to walk and with severe cognitive problems.
The symptoms of vitamin B12 deficiency
As you can see, B12 is a very important vitamin. It’s important therefore to recognise the early symptoms of deficiency and to be aware of the problems with these symptoms.
Firstly, symptoms don’t suddenly appear – they are insidious and ‘creep up’ on you and there are two consequences of this. The patient will make continual allowances and small adjustments to his or her life to accommodate the slowly emerging symptoms, and then these symptoms will often be attributed to advancing age or a busy modern lifestyle. The fact is that the first signs of B12 deficiency are often ignored – often for many years and sometimes with disastrous consequences. And don’t make the mistake of assuming this is only an adult problem – children and juveniles can and do suffer B12 deficiency due to pernicious anaemia.
Constant tiredness and continual fatigue are the most common symptoms experienced by members of the Pernicious Anaemia Society. The problem here is, as stated above, this tiredness and chronic fatigue can be attributed to a modern busy lifestyle. I know that I believed that the reason why I was continually tired was because I had turned 40 and I had such a busy life. I ignored these early symptoms and only reported to my doctor when my legs suddenly went numb and I had balance problems. The ......
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