Vitamin B12 status in health and disease: a critical review. Diagnosis of deficiency and insufficiency – clinical and laboratory pitfalls

[WiscGuy]

This is an extraordinary thorough review of B12 deficiency and B12 insufficiency, with an actual description of the difference, including severity of symptoms.

One interesting factoid is quoted here:

"In 1900, Russell noted characteristics of B12 deficiency that are overlooked with surprising frequency today: “some of the most typical cases presented no anemia throughout the course, others only late in the disease, while in other cases anemia was an obtrusive symptom … and preceded the nervous symptoms by many months” [Citation7]."

So this particular piece of information goes back to 1900, but still hasn't filtered down to most clinicians.

This is an insanely thorough review (266 references). Yet, when it comes to treatment, eg, injections every other day until no further improvement, the source cited is NICE.

Also, it appears that the most effective diagnostic tool for clinicians is the one suggested in "The Many Faces of Cobalamin Vitamin B12 Deficiency": if no other reasonable explanation of neurological symptoms is apparent, then make a detailed listing of symptoms, including an estimate of severity, and inject B12 every other day, checking after two or three months for any symptom improvement. Improvement validates diagnosis.

In my view, restoration of loss of balance, loss of sensation, etc should be the treatment goal, and there is no reason to reduce frequency of injections from every other day until those and other functions are restored, because there is no evidence that those functions cannot be restored with adequate treatment, and there is no harm in continuing treatment.

tandfonline.com/doi/full/10...

[Technoid]

Added to the collection, thanks 👍

[Nackapan]

😊 Thanks

[jade_s]

Since 1900! Very interesting. Thanks for the link!

[Orchard33]

Another precious nugget of info. Thanks.

[Wheat]

thanks for link re. Information.

[Cherylclaire Forum Support]

I agree.

The aim is surely to regain all that you can and then keep it. No medical professional should be satisfied with a frequency that demands cyclical deterioration from their patient. Especially not where the treatment itself is well-documented as being harmless.

Why is far more concern evident re a recovering patient having high B12, than a patient with low B12 having difficulty walking into the surgery ? It does not make sense at all.

Thanks for that, WiscGuy - I'll have a read.

[WiscGuy in reply to Cherylclaire]

"Why is far more concern evident re a recovering patient having high B12, than a patient with low B12 having difficulty walking into the surgery ? "

My guess is that doctors are used to using toxic substances to treat patients, and are used to balancing benefits with harmful effects. An example is treating bipolar disorder with lithium: there is very little room for error in obtaining control of the disorder, because just a little bit higher concentration of lithium damages internal organs. It is known that high serum B12 levels in a patient who is not supplementing B12 can indicate specific cancers, etc. Of course, the problem with this analogy is that lithium is toxic, and B12 is not, and while high levels of B12 can indicate other disorders, high levels of B12 do not cause disorders. It's just one more example of the amazing level of ignorance regarding B12 in the medical profession.

[bookish in reply to WiscGuy]

You can't help but wonder if those with high serum B12 levels and cancers etc ever have a test of homocysteine or MMA to try to see whether their other conditions are caused by/contributed to by functional B12/folate deficiency.

[WiscGuy in reply to bookish]

It's amazing to start searching the medical databases (via Google Scholar, a research database search engine) and discover the range of disorders in which B12 is implicated.

[Cherylclaire Forum Support in reply to bookish]

Lets hope so.

Luckily for me, the first GP ensured bowel cancer was not the cause of my symptoms; I was put on a 2-wk pathway early on.

The second GP found B12 deficiency, then later when I was unresponsive to treatment and getting worse, functional B12 deficiency was found by an MMA test. That allowed far more frequent injections.

The trouble with an MMA test is that it is very difficult to access from primary care - even for an experienced and determined GP - which inevitably then means delay. A wait for a secondary care appointment can take months, unless it is on a 2-wk pathway. Further, MMA tests are not available from every local laboratory - which is a concern if NICE are advising its use as a confirmatory test where B12 deficiency suspected, but serum B12 not (yet) below range. The advice is sound - but accessibility could prove problematic.

Alongside ferritin, folate, vitamin D and thyroid, my liver function was checked regularly. At least until the start of Covid.

[tomdickharry]

I read that abstract, and - please correct me if I've got it wrong - it appears to discredit any and all forms of supplementation, including injections.

[Budsa in reply to tomdickharry]

I have just re-read it and can't see how you could come to that conclusion. It is more about the inadequacy of available tests and their misinterpretation.

[tomdickharry in reply to Budsa]

I can't find it either. I think I got the wrong article somehow but can't even find that. Please excuse my old brain.

[brenanddave]

I agree! I am now on daily inj which has helped to control the burning pain that was moving nearly constantly around to different areas of my skin. It was becoming unbearable. Also as I am currently on a cruise for two weeks and doing a lot more activity snorkeling longer walks etc I have upped them to two injections during this time. It is helping me energy wise to have a reasonable amount of normality. I will go back to daily when I get home. Thanks for the info!