Six Commonly Missed Diagnoses: B12 Deficiency

Posted 05/14/2012

You’re pretty sure you know your body and you tell your doctor you’re just not feeling right. You’re tired, maybe a little depressed, a bit achy. Maybe your digestion is “off.” The list of foods you can’t seem to enjoy is definitely longer. Your doctor’s empathic, not at all dismissive of your symptoms, but after a physical exam and some apparently appropriate tests she can’t find anything really wrong.

On the surface, this is reassuring. After all, the main reason we do go to doctors is to ascertain that nothing serious is going on. Still, could she be overlooking something?

After decades of treating patients with longstanding but undiagnosed chronic symptoms, here’s the first of six overlooked diagnoses I see most frequently in our patients at WholeHealth Chicago.

Low Levels of Vitamin B-12
One of the eight B vitamins, B-12 is involved in the metabolism of every cell in your body. Years ago B-12 was called “maturation factor” because cells need B-12 to mature from being young and ineffectual whippersnappers to fully functioning and mature.

B-12 deficiencies affect three major systems in your body: your blood, nervous system, and, less often, gastrointestinal tract. These three are targets because their cells either have a high turnover rate (blood and intestinal lining) or need a lot of B-12 to function smoothly (nervous system). The symptoms of low B-12 levels are related to each of these areas.

  • Low B-12’s effect on your blood is a specific type of anemia called megaloblastic anemia (as distinct from the more common iron deficiency anemia). A megaloblast is an immature, undeveloped red blood cell, large and bulky (megalo=large, blast=immature form). Remember, B-12 is needed for this cell to mature, so with insufficient B-12 megaloblasts accumulate in your blood. Symptoms are the same as for anemia from any cause, including fatigue, breathlessness, and lightheadedness. Your skin becomes a pale yellow, most likely because the red cells that do make it to maturity are very fragile and easily broken, releasing their yellow bilirubin pigment.
  • In your nervous system, B-12 deficiency causes symptoms affecting your nerves (numbness, tingling, tremors, balance problems) and your mind (depression, brain fog, mood swings, and, in rare cases, hallucinations and psychosis).
  • In your gastrointestinal tract, you might experience digestive symptoms and weight loss because you’re not absorbing food efficiently.

The irony is that with all these there’s usually just one predominant symptom, and making a connection to low B-12 can easily be delayed until other symptoms start to appear. For example, if your only symptom is tingling in your hands, you might undergo all sorts of diagnostic tests before your doctor thinks “Maybe we should check her B-12 level.”

What causes B-12 deficiency?
The list of causes is lengthy, but by far the most frequent culprit is a dietary one. Vegetarians who aren’t paying attention to the B-12 in their food choices will have downward-drifting B-12 levels, and virtually all vegans not taking Vitamin B-12 supplements ultimately develop deficiencies. Even the various vegan organizations acknowledge it’s not possible to get adequate B-12 while following a strictly vegan diet, and that’s because the richest sources are animal products.

Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells. These cells produce a substance called intrinsic factor, necessary for B-12 absorption. Also, since you need stomach acid to absorb B-12, long-term use of acid-suppressing proton pump inhibitors (Nexium, etc.) can lead to B-12 deficiency, as can chronic intestinal conditions like Crohn’s disease, celiac disease, and intestinal parasites.

The missed diagnosis
The main danger of missing this diagnosis is that (while quite rare) the damage to your nerves and even brain can be permanent. Other serious consequences: your anemia can get so severe it causes heart failure and collapse. Or you could be misdiagnosed with a major depressive disorder or even psychosis and take unneeded psychiatric medications for months (or years) before someone notices you look yellow-ish and you’re finally diagnosed with megaloblastic anemia.

There are four reasons why this diagnosis is missed:

  1. Although it’s not an expensive test, B-12 isn’t measured during routine blood tests. Doctors generally don’t order a B-12 evaluation if there’s no evidence of anemia (which would be picked up on a routine blood test). However, the fatigue and nervous system and gastrointestinal symptoms can precede anemia by months.
  2. Doctors rarely ask (and patients rarely volunteer) information about their eating habits. In medical school, we’re taught that the US diet is “plenty good enough to prevent any vitamin deficiencies.” To which I now respond, “Ha!” I agree most of us eat plenty of food (obesity levels are still on the rise), but it’s often food whose nutritional value has been castrated. Also, all vegetarians and vegans should be regularly tested for possible B-12 deficiency, but if your doc doesn’t know your eating habits you won’t be tested.
  3. Like many blood tests, there’s considerable disagreement about normal levels of B-12. Most labs test B-12 levels between 200 pg/ml (picograms per milliliter) and 800 pg/ml. Someone at 250 pg/ml would be classified as normal, but symptoms can start appearing at 350 pg/ml. In Japan, normal B-12 was recently raised to 500 pg/ml and higher. We’ll see this type of erroneous overreliance on “normals” in other frequently missed diagnoses, like hypothyroidism, vitamin D deficiency, gluten intolerance, adrenal fatigue.
  4. Taking the B vitamin folic acid (folate) or eating a lot of folate-containing foods without adding B-12 can actually mask the symptoms of a developing B-12 deficiency. Although folate will keep your blood count normal even if your B-12 is falling, the folate will not protect your brain and nervous system. You’ll have no evidence of megaloblastic anemia (because of the folate), but your symptoms of numbness, tingling, balance problems, and emotional issues will continue unchecked. By eating so many folate-containing green vegetables, beans, and lentils, vegetarians and vegans inadvertently mask their own slowly developing B-12 deficiency.

Treatment is easy
It’s virtually impossible to take too much B-12 as any excess of this water-soluble vitamin is eliminated via urine. Nutritional guru Alan Gaby, MD, has commented that the only way too much B-12 will kill you is if you fill your bathtub with it and drown.

Foods high in B-12 are animal products: meat, poultry, seafood, dairy, and eggs, with eggs having the least. Because all animals store B-12 in their livers, eating liver is an excellent (though not particularly popular) treatment for B-12 deficiency. Your grandmother or great-grandmother likely remembers a time when her doctor told someone in the family to eat more liver.

And since people with low B-12 are likely to also have gastrointestinal symptoms that interfere with B-12 absorption, the best way to quickly increase (and maintain) B-12 levels are with B-12 injections, chewable tablets, or the recently released nasal sprays and skin patches.

In my own practice, a deficient patient receives a series of four B-12 injections (or four B-12 containing Meyer’s Cocktails) and also starts (and maintains herself on) a daily B-12 chewable tablet. Usually within a month her levels are back to normal.

There’s more to come in the Commonly Missed Diagnoses series. Next week: overlooked diagnosis #2, vitamin D deficiency

Be well,

David Edelberg, MD

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393 comments on “Six Commonly Missed Diagnoses: B12 Deficiency
  1. Kristin D says:

    I stumbled across this thread while searching my symptoms. I have had many low B12 symptoms over the last few months (although I didn’t know that’s what they were) but they have gotten bad in the last couple weeks. I am exhausted – being out of bed for more than an hour or two at a time wears me out. My head feels heavy and just weird (I described it to my doctor as being dizzy but it’s not really dizziness – more off balance), my eyes are spaced out and tired (but I can see fine), I am having brain fog, and my hands and feet go to sleep easily. I had an MRI that I am still waiting on the results of and the bloodwork my doctor did came back normal except he said my B12 level of 382 is low and told me to supplement with 1000 mcg daily. I should also mention that I have a 3 month old baby that I am exclusively breastfeeding. I bought 2500 mcg sublingual methylcobalamin that I have been using twice a day for the last few days. My doctor wants me to follow up with a neurologist as he says a b12 level of 382 wouldn’t be causing the symptoms I’m having. In your experience, can a level like mine be causing these symptoms? After doing some research, it appears that many doctors think the minimum normal levels in the United States for b12 are set too low. I am a busy mom of 3 and don’t have time to be down so much of the time! I am going to call my doctor in the morning and beg for a b12 shot. Would a shot help me immediately? Any insight you can offer will be much appreciated.

  2. cliffmaurer says:

    Hi Kristin –

    Your B12 levels can, in my opinion, cause symptoms like yours, but of course you and your doctor should rule out other causes (the MRI your had and your blood work should be a good starting point for this). B12 levels can take weeks, even months to increase. Injections of B12 can help, but rarely are results immediate. If you’re in the Chicago area, we’d be happy to help if you feel that you’re not getting results.

    Best of luck to you!
    Dr M

  3. Jean Elizabeth Gittins says:

    I cannot tolerate injections- if there is an alternative – which in the event of B12 deficiency I choose B12 Oral Spray – contains Methylcobalamin which is highly recommended. Doctors are not aware of these – you need to purchase the sprays – don’t expect to get them on script!

  4. Jen says:

    Hello, I’ve been following this thread for a while as a lot of my symptoms match with a B12 deficiency. Since May I have had tingling, pins and needles, some numbness and increased floaters in my vision as well as generally tired eyes but I can see ok. My B12 was at 204 but my doctor doesn’t think that is low, really, just a little less than ideal and I m waiting for an MRI to check what’s happening so I am hoping that will be ok. I have been taking 1000mcg a day of B12 for a month now, and wondered how long it normally takes to see a difference in Neurological symptoms…? Also, I have actually stopped taking it for a few days as the symptoms appeared to worsen – I had quite a lot of facial tingling, particularly in my hair line and more burning in my foot than normal. Could these be side-effects of taking a B12 supplement? I have stopped taking them to see if it improves and it does seem to have done. Thank you for your advice and thank you for this blog, it’s very useful indeed.

    Kind regards

  5. Teresa says:

    Hi Jen,

    I had similar symptoms and it took well over a year for the symptoms to go away. I have a MTHFR genetic mutation, so I was taking methylcobalamin 5000 mcg daily, along with methyl folate. Both should be taken together.

  6. Saanjh says:

    This post is very correct. Doctor misdiagnosed my B12 deficiency as depression & he prescribed me antidepressants & anxiolytic. Another neurologist prescribed me vit. 12 & i was completely fine without antidepressants.

  7. Gillian says:

    Just stumbled across this, I have vitb12 deficiency and I am meant to get injections every 12 weeks but my symptoms of pains in my hands feet come back at around 8weeks, had to practically beg my gp to give me injection early she compromised at 10weeks. Is it common to need injections sooner? Is it harmful to get them sooner? It helped so much when I got it at 10 weeks, but I’m at 8 weeks again just now and it’s agony!

  8. Teresa says:

    Get yourself some sublingual methyl b12 tabs and take them to prevent the symptoms. They work as good as the shots, and are much more affordable.

  9. Lindsey says:

    For everyone on this thread, I recommend checking out the Pernicious Anemia/B12 Deficiency group on Facebook. It has loads of information and thousands of people talking about their symptoms and treatment. You do not have to have pernicious anemia in order to join the group. They talk about B12 deficiency caused by other things, as well.

  10. Ava says:

    I’m only 20
    and I have severe vitamin b-12 deficiency
    It was missed for years out of my blood tests and when jchanged GP it was noticed immediately
    I started getting injections there and then but a few months after my exhaustion had gotten worse and I had numb feet a sore tongue wasn’t extremely pale and constant pins and needles
    A full year after I got properly diagnosed with perperhial nerve damage I can barely walk
    My balance is so bad I’ve to get help to the toilet
    I’ve had so many falls and now getting a wheelchair
    I’ve bad degeneration of the spinal cord and don’t know if I’ll ever heal
    They are still investigating the cause but seen to think it’s a mixture of diet and stomach absorption problems as it runs in the family aswell
    Just said I’d share my story

  11. Teresa says:

    Are you also being treated for folate deficiency? Ask your doctor to test you. You might want to add methylfolate to what you are doing.

  12. Daniella-Rose says:

    Hi Dr
    I’ve had low b12 months ago it was 230 ( active b12 was 32 ) I was getting numbness which has subsided after monthly injections.
    The last 4 months I have had chronic pain in my mid thoracic back around the ribcage. My ribs make loud snapping sounds when I raise my shoulders and I am in pain every day. Had X-ray but nothing showed. Is this a damage caused by b12 defiency? Or what would be your opinion?
    Daniella x

  13. Sherry says:

    Your total Vitamin B-12 level may have been within the norm however, it is important to test your active B -12 not your overall vitamin B-12. I would request methylmalonic acid (MMA) and holotranscobalamin (holoTC) blood test be done. These will give you a more accurate result & represent your true levels. The norm numbers are ridiculous, by the most go below the norm everyone has chalked you up as a mental case!
    My all time low B12 was 216. I could no longer work, worst right side face, neck, and shoulder pain, major balance issues, often had falls, I struggled to get out of bed, (but when I was there, I couldn’t sleep) my tongue felt like it was vibrating all the time, No short term memory and so on……. Once found, my neurologist started me on 1000 mg injections daily for a week and now weekly along with 1000 sublingual daily. Within 3 weeks my levels are over 1000! I feel so much better, physically and emotionally! I am just happy my friends and family stuck by my side when all test showed nothing and my primary doctor told me it was in my head! Only damage found thus far is crevicle issues; bulging disk and herniated disk. Now onto physical therapy- Rd to recovery! Don’t give up, my battle was over 2 years long and someone finally showed me the respect I deserved and listened to me. My hero is Dr. Sorab at U of M!

  14. Teresa says:

    I just had an interesting experience. I had been taking 5,000mcg of sublingual methylcobalamin, plus 15mg of methylfolate for over a year to treat MTHFR and nerve/stomach/balance issues. I went to an endocrinologist in early September, she measured my b12 level and it was over 2000. She panicked and told me to stop taking the methylcobalamin. After about 7 weeks, I started to have a lot of digestive issues that I chaulked up to something bad I ate. I began a diet I’ve used in the past to get my gut under control, but it wasn’t working. This week, my mouth became painful and I started not being able to sleep. I began becoming very tired. I started wracking my brain, trying to figure out what was causing my health crash. Then I started to get a nerve sensation in my cheek, and then it dawned on me. It might be the b12. I started taking it again, and my symptoms are resolving. I looked up the symptoms for B12 deficiency and my symptoms match. During my research, I also found out I might have pernicious anemia, on account of the fact I have another autoimmune disease: Graves. My question is: can low b12 symptoms come on that fast after just 8 weeks off a year of taking high dose sublingual methylcobalamin? Would it be reasonable to ask to be tested for pernicious anemia?

  15. Dr. R says:

    Teresa. I’d recommend you consult with your PCP regarding your symptoms, research and suspicions (pernicious anemia). Getting your B12 tested again is certainly worthwhile and would give you more information to go on.

  16. Greg says:

    So glad I stumbled on this site. Have been dealing with pins and needles for weeks. Fatigue for years. Sleep apnea with CPAP machine but still exhausted everyday. Mental fog for a long long time but worse lately. I have gastro issues and take proton pump inhibitor. Worried now that it’s affecting my body’s ability to breakdown food properly. In addition to symptoms above, I have autoimmune (psoriatic arthritis) issues, nail pitting, splitting, etc. Was put on low grade anxiety meds years ago as well (after stomach issues) and now wondering if this all relates to B12. Will be pushing doctor this week for extra testing.

  17. Krazy korny says:

    Have you been tested for diabetes. Diabetes 3 is my culprit. And with it. B12 is a real no no. And i only weigh 99 lbs. I just keep losing. Also have had ibs for 25 years. Be checked 4 diabetes.

  18. Any says:

    Teresa – if you were tested when taking B12 supplements, the test would have not been accurate but reflecting your supplementation. You were – and still are – most likely B12 deficient. Maybe get yourself checked for H. Pylori as well, it’s very common and can be a root cause for the B12 deficiency. And may explain the stomach issues.

  19. Teresa says:

    I was tested for H Pylori and it was negative. I don’t have diabetes. I did have an endoscopy which showed chronic gastritis. It was thought that I might have celiac, but that test was negative. I was put on PPIs for awhile, but now I take betaineHCL with pepsin at every meal. Could be hypothyroidism from radioactive iodine treatment for Graves disease. My replacement dose keeps getting lowered because my TSH keeps going lower. Is this all related? No one ever tested mr for pernicious anemia. Probably because my serum b12 was always high, even though I had high MCV tests starting 10 years ago.. Now I know that was MTHFR talking. I have an appointment in December. I’ll let you know what happens. Meanwhile, I’m taking 10mg of sublingual methycobalamin a day. I’m feeling much better. Low b12 is seriously bad, and as in my case, it is most definitely a missed diagnosis. Thank you for this forum.

  20. Lannie says:

    I’m so glad I found this page. I’ve been having some strange symptoms the past 2 years now. It started with being sick and having diarrhea every day then the anxiety set in. I’m feeling some weird type of dizziness, my legs and back hurt all the tine and feel kinda shaky when I walk. I’m exausted all the time but can’t seem to sleep. I’m waking up at least 3-5 times at night after I do finally fall asleep. My short term memory is horrible, I feel weak and bruise easily. My doc took a blood sample 6 months ago and said everything was fine and it’s just anxiety but I really don’t think so.

  21. Teresa says:

    How long should you stop taking b12 before a test? Does taking b12 throw off a pernicious anemia test?

  22. Greg says:

    Teresa…good point re: taking B12 and testing…would imagine it would throw off tests…would love a dr’s point of view

  23. Lindsey says:

    I’m not a doctor but I’ve read a ton about B12 supplementing. Taking oral supplements jacks up the amount of B12 in your blood stream pretty quickly, and it will show up in your blood serum levels. My level went from 280 to 1100 in just a few weeks on oral supplements. That doesn’t necessarily mean the B12 has fixed your deficiency by that point, either. If you want a true idea of whether you have a deficiency, unfortunately you are supposed to be off oral supplements for several months before the test.

  24. Teresa says:

    I just found a Dr’s post that said you should wait 2 to 3 weeks after stopping the active b12 before you get tested.

  25. Angie says:

    Has anybody suffered nausea with low b12,I’ve started injections today first of 5 and I’m hoping soon enough I start to feel more me again!

  26. Vasilios says:

    I was a vegan for over a year and I regret it now it’s an incomplete diet and lacks key nutrients . I have been eating meat as recently as 3 months but I think I’m deficient in b 12 because I’ve been weight lifting daily and suddenly I was getting tingling sensations on my feet and hands and I feel exhausted and very weak with gastro intestinal issues with stomach aches so does anyone who has had low b12 think that this is my issue . I also feel a bit blue and I was born with thalasaemia minor which is a low haem count so I’m thinking I’m down in b12

  27. Teresa says:

    My b12 issues started slowly after going vegan with my husband. Started with gut and stomach issues, then fatigue, then balance problems, then face paralysis and numbness/tingling in face. Taking b12 has reversed all that after three years. I tried to stop using the b12 for two months and all the symptoms returned. I take 5,000 mcgs of methylcobalamin daily (steer away from cyanocabalamin), 15mg of methylfolate (steer away from folic acid), and a fully active b complex.

  28. greg says:

    I imagine going vegan meant that you would have to take supplements to make up for the lack of nutrients you would normally get from meat, etc. Removing meat etc would very likely lead to deficiencies.

  29. Teresa says:

    Greg,
    I also have a MTHR defect, so I have to avoid synthetic b vitamins. Vegan or not, I have to stay away from synthetic foods, like enriched bread.

  30. Tracy says:

    I was contemplating going vegan (after being pescatarian for two years) so asked to have my B12 levels checked at my last physical, as a baseline. I was shocked to find out it was 225. My 83 yr old mom has started b12 shots due to dementia symptoms. Her level was 280. I also found out her mother and sister were found to have low b12 in midlife. Her mom had Parkinson’S. I also have low D, 28. My Dr seems pretty unconcerned. I know I could supplement, but I’d like to know WHY my levels are low.

  31. Ailsa says:

    Tracy,

    There are genetic markers for B12 issues and it may be that you have one or more genetic SNPs (snips – or anomalies) that disrupt the pathways for B12 conversion and related metabolic functions.

    B12 is incredibly complex and there are a range of genes that can cause B12 absorption and conversion issues in the body. B12 goes through about seven conversions in the body BEFORE it can be used metabolically to drive crucial metabolic processes (primarily the Krebs Cycle (aka the Citric Acid cycle) and the methylation cycle). A genetic SNP can disrupt absorption of one or both active forms of B12. One active form is methylcobalamin; the other is adenosylcobalamin.

    You may want to look into metabolic testing for MTHFR (folate metabolism) and relevant B12 metabolism issues to understand better what’s going on and then get genetic counselling if anything shows up (highly likely if you’re having B12 issues). 23andme may do these tests in the US, or, if not, then you should check to see what companies offer them.

    Based on your family history, there could easily be a problem with your absorption of adenosylcobalamin, which would cause disruptions to the central nervous system that happens over years or decades. A lot of neurodegenerative diseases have at least some B12 issues involved — some are almost entirely B12 related.

  32. Teresa says:

    Being vegan is not the healthy option that people think it is. Besides being deficient in B12, you are also not getting DHA, vitamin K2, and others that can have devastating effects on your health. My husband had been vegan for years, and now he has Parkinson’s, osteoporosis, and severe insomnia. He still refuses meat in the belief it will hurt him. It almost seems like what he has is an eating disorder, since he continues on this diet even though his health has nosedived. He ingests a ton of supplements, though.

  33. Jo says:

    Hi everyone. My symptoms started the day after the birth of my 3rd baby. Flashy lights in my eyes. Paresthesia in my left hand. Left side of face mouth teeth tongue. I get tingling in hands feet arms. bright light hurts my eyes.brain fog. Bad memory. Kidneys are also under strain. Due to see a neurologist in Feb.

  34. Suresh says:

    I have low b12 levels of 99 and I have tingling and numbness in my arms and hands . Iam soo worried about this shaking hands.. .. I took b12 injections for five days five injections 1000 mcg.. My Doctor gave tetrafol plus medicine for 4 months to improve b12 vitamin..and also i took Tremarogram test it shows 9-11hz essential frequency.. And im a software engineer.. My work is always on computer.. Somtimes,, using keyboard and mouse is little bit difficult for me.. im soo worried about my future because of this..Im going to depression because of this.. How long do I have to be without sleep and suffer from tingling and afraid in my arms and hands ?. If my b12 levels back normal after this medication,, then this tremors go away or not..? I will appreciate any advice and whats my real problem and how to cure this.. Thank you

  35. Dr E says:

    Hi Suresh
    The extent of nerve recovery depends on how long you have had symptoms AND maintaining B-12 at high levels. I would suggest getting tested for the MTHFR gene because if you are “positive” you may do better with methylated B-12 injections that the usually administered cyanocobalamin. Whichever you use, get the injections weekly until you are at about 2,000 and then every 2 weeks to maintain there

  36. Suresh says:

    Thanks for your suggestion DR E..

    My age is 25.. I had this shaking problem from the last 3 years.. For first 2 years it was little bit.. At first i thought that its a tremor.. But from last year it was increased.. Soo i went to doctor again.. He told me to take the test for b12 And i got 99 in the results level.. I took this test 2 weeks back in this month.. He gave me 5 injections for five consecutive days,, medicines tetrafol plus for 4 months.. And he also gave me betacap 40 mg for tremors.. While im using betacap.. Im feeling dizzy and im becoming sooo tired of this betacap( proponal).. I dont think its because of tremor. i think its because of b12 deficiency… What would u suggest for me is mediciens are good or injections.. Please help me on this.. Im soo afraid about my future.. I dont know the shaking problem is because of essential tremor or b12 deficiency..?. Please clearly explain how to cure this shaking problems.. How many months it wil take to cure this shaking problem.

  37. Brad says:

    My level is 480. I have lots of symptoms of tingling, depression, brain fog, gut issues. I know the normal range is 200-900 but would raising that level be beneficial?

  38. Muhammad says:

    Is there any doctor who help me to resolve my health problem and get well kindly make contact me I will send my vitamins and xray’s report . My WhatsApp nmbr 009203035883425

  39. cliffmaurer says:

    HI Muhammad – unfortunately we do not offer this kind of service over the telephone. Where are you located? Perhaps we can help you find someone near you.
    -Dr M

  40. cliffmaurer says:

    It’s possible that raising your level would help, but treatment should be based on a thorough evaluation to find out if there are other causes to these symptoms such as thyroid or other hormonal imbalances. If you’re in the Chicago area, any of the doctors at WHC could help.

    Best wishes!
    Dr M

  41. Kelly Jeanes says:

    I have recently been advised I have low B12 levels by my G.P and started injections. I started with swelling in my Right hand and joint pain. Sometimes my hand goes cold and blue. Pain and swelling has started in my left hand along with pain in both knees, feet and ankles. It feels like my skin is too small for my joints. Pain is worse first thing in the morning. Can all of these issues be from B12 deficiency ? I feel like i’m getting worse each day.

  42. cliffmaurer says:

    Hi Kelly – It sounds like this deserves some additional investigation to make certain that something else isn’t going on. It’s possible that these symptoms are linked to B12 deficiency but other causes should be ruled out by your doctor.
    Best,
    Dr M

  43. Frederick Howanitz says:

    MY sister has been diagnosed with pernicious anemia I have been treated for psychosis severe depressive episodes when I could not get out of bed for a couple years during my youth I have always wondered why I was so sick when starting at 17 for 2 years I was severely ill that for 2 whole years I was bedridden I am now 58 at 51 I got a pacemaker for a second degree heart the electrical system of the heart failed to work all of the symptoms tingling of the hands I had starting in elementary school I have had a very sore mouth at times for a long period of time that was severely painful felt like someone sliced the inside of my mouth and tongue with a razor blade last month I asked the Dr. could I have a B 12 shot well I have been walking and jogging a little ways never ver was into jogging ever but I will be going back once a month for the B 12 shot and have a super B complex vitamin that is USP verified which mean that the US pharmacopeia inspects the production and standard for the vitamin is the same inspections and production potency is done by the same as for drugs produced in the US The Dr. says that he was taught in medical school that the B 12 injection is the only method of resolving the deficiency he asked me to check with the local vitamin supplier what is the best supplement they have so I have just done my research and ordered USP verified which verifies the actual benefit of the vitamin while researching pernicious anemia for my sister wow I was looking at leukopenia because she hs recently been told that she has it and sure enough it is commonly misdiagnosed and this is not what she has obviously she has never gotten treatment for pernicious anemia now she is having face tremors her head and face have a no no movement back and forth movement of her face and head I see the tremors listed for the diagnosis I am very excited because for many years I have been treated for Bipolar illness and I recognize all the symptoms though severe symptoms for the diagnosis I will be Facebook page mentioned and I will continue to come back to this site for more information please anyone being treated for mental illness please let me know if this hs happened to you

  44. Suresh says:

    I posted my questions on december 24th and 26th… Dr.E or Dr.M or anyone could you please give me the answer.. Im so frustrated about my condition..Im in depression.. I dont know what wil happen in my future.. Please suggest me some ways to my life..

  45. Dr E says:

    Hi Suresh
    I did answer your query on the 24th. From your additional information, my only additional suggestion is that you get a second opinion from a neurologist. If, with injections and oral meds, you get your B-12 into a high normal range and there’s virtually no improvement, you need to be open to alternative diagnostic possibilities

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