i dont know

look , im not sure about much at all of late.

[FlipperTD]

Scientist, not medic.

Ooh, 'D Latum', the fish tapeworm! In over 40 years [in the UK] I had never seen one, but we had records of a case and an x-ray that showed the parasite, because not only does it compete for B12, but it managed to swallow some of the Barium contrast and hold on to it! Anyone of my vintage learned about it, but we never learned that it's associated with under-cooked/raw fish in a particular recipe that it uncommon here. So, although we all learned about it, we never saw it.

Likewise, we all learned about Malaria, but living in a non-endemic country, it wasn't the first thing that came to mind. Once you'd seen/missed a case with dreadful consequences, we were primed.

A 'fascinating fact' about the fish tapeworm: somewhere in the back of my mind, I recall that freeze-dried fish tapeworms have been used as a source of B12! Thankfully, we have the likes of pharmaceutical companies who make huge [relatively] amounts of B12 for therapeutic use, so this 'fascinating fact' can remain as a bit of historical knowledge.

[Cherylclaire Forum Support in reply to FlipperTD]

Fish tapeworm: I remember reading about this being found in someone who ate a lot of fish-based sushi ! So perhaps now a more common cause than it was previously in the UK.

Another case of disappearing extrinsic-factor B12, quite common, I think, when looked for:

One of the causes of raised/high Methylmalonic acid (MMA), small intestine bacterial overgrowth (SIBO) is a vitamin-devouring bacteria. It likes vitamin B12 and the fat-soluble vitamins.

It can be tested for: a fasting series of hydrogen breath-tests every 20-30 minutes (after drinking a sugar solution) over the course of about 3 or 4 hours. They can be charted, giving a profile, so same-day results can usually be given.

The treatment for SIBO is courses of antibiotics - which usually have to be altered between courses as the bacteria become immune. Some antibiotics can also deplete B12, so not any easy solution.

Difficult to eradicate - and I should imagine that probiotics are also required later.

This must be an expensive test, lengthy and labour-intensive with restricted patient numbers for each test session. It is available on the NHS: I was referred from haematology after tests found continued raised MMA despite frequent B12 injections - so SIBO needed ruling in/out.

[FlipperTD in reply to Cherylclaire]

Of course! Sushi consumption has now reached epidemic proportions, and I do wonder exactly what goes into it, and what goes with it, into it... No criticism of the Sushi chefs intended, of course, but to be honest, somehow, Sushi isn't for me although I've eaten some in the past. My local ASDA has a sign telling us that all their Sushi is made fresh every day [I should hope it is, dear ASDA!]

There's more things going on in the background than we realise. I knew about Giardia Lamblyia from the scientific side of it, but only really learned about it when I picked it up in Tenerife. Likewise, I learned a great deal about Campylobacter [more than I ever wanted to know] when I picked it up in Cyprus.

[Cherylclaire Forum Support in reply to FlipperTD]

Similarly, doctors and consultants with B12 deficiency have a more healthy respect for the power and range of symptoms - from hair-loss down to numb toes.

Sorry to hear of your personal acquaintance with Giardia Lamblyia and Campylobacter -a cousin of Helicobacter, by any chance ? Awful family.

I once had something called "carrot surprise" as a starter in a restaurant in Greece. The "surprise" part of that lasted two or three days !

With you on sushi. Nothing funny about the amuse-bouche or come to that, nouvelle cuisine either. I like an adult-sized dinner.

[FlipperTD in reply to Cherylclaire]

I discussed the Campylo/Helico possibility with the GP trainee who had a good background in lab stuff. The link, if there is one, is distant, but the Campylo probably increased the sale of 'bathroom stationery'. It cleared up, and then came back, and then I was given an antibiotic that was worse than the infection. We live and learn.

[Cherylclaire Forum Support in reply to FlipperTD]

Yes. I have learnt the power of carrots to ruin your holiday. Who knew ?

[FlipperTD in reply to Cherylclaire]

Everyone who has been down the Campylobacter route describes exactly the same symptoms and outcome, but as long as you don't then go and read that one of the knock-ons is Guillain-Barré syndrome, and I know a few who have had that too.

[wedgewood in reply to Cherylclaire]

A friend of mine had severe B12 deficiency caused by eating smoked salmon almost daily, in Italy . ( she worked in a hotel ,and could eat whatever she fancied ! ) She had got the fish tape-worm from under-smoked salmon !

Hasn’t put her off smoked salmon , but she only eats it if it has been frozen first .

[FlipperTD in reply to wedgewood]

We freeze ours too!

[Cherylclaire Forum Support in reply to wedgewood]

Thanks -probably where I got the half-remembered story from originally !