{"id":4673,"date":"2012-05-14T14:19:27","date_gmt":"2012-05-14T19:19:27","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=4673"},"modified":"2022-06-06T14:52:23","modified_gmt":"2022-06-06T19:52:23","slug":"six-commonly-missed-diagnoses-b12-deficiency","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency","title":{"rendered":"Six Commonly Missed Diagnoses: B12 Deficiency"},"content":{"rendered":"\n<p>Posted 05\/14\/2012<\/p>\n\n\n\n<p>You\u2019re pretty sure you know your body and you tell your doctor you\u2019re just not feeling right. You\u2019re tired, maybe a little depressed, a bit achy. Maybe your digestion is \u201coff.\u201d The list of foods you can\u2019t seem to enjoy is definitely longer. Your doctor\u2019s empathic, not at all dismissive of your symptoms, but after a physical exam and some apparently appropriate tests she can\u2019t find anything really wrong.<\/p>\n\n\n\n<p>On the surface, this is reassuring. After all, the main reason we do go to doctors is to ascertain that <em>nothing serious <\/em>is going on. Still, could she be overlooking something?<\/p>\n\n\n\n<p>After decades of treating patients with longstanding but undiagnosed chronic symptoms, here\u2019s the first of six overlooked diagnoses I see most frequently in our patients at WholeHealth Chicago.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Low Levels of Vitamin B-12<\/strong><\/h3>\n\n\n\n<p>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 \u201cmaturation factor\u201d because cells need B-12 to mature from being young and ineffectual whippersnappers to fully functioning and mature.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Low B-12\u2019s effect on your blood<\/strong> 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.<\/li><li><strong>In your nervous system<\/strong>, 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).<\/li><li><strong>In your gastrointestinal tract<\/strong>, you might experience digestive symptoms and weight loss because you\u2019re not absorbing food efficiently.<\/li><\/ul>\n\n\n\n<p>The irony is that with all these there\u2019s 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 \u201cMaybe we should check her B-12 level.\u201d<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What causes B-12 deficiency?<\/strong><\/h3>\n\n\n\n<p>The list of causes is lengthy, but by far the most frequent culprit is a dietary one. Vegetarians who aren\u2019t 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\u2019s not possible to get adequate B-12 while following a strictly vegan diet, and that\u2019s because the richest sources are animal products.<\/p>\n\n\n\n<p>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\u2019s disease, celiac disease, and intestinal parasites.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>The missed diagnosis<\/strong><\/h3>\n\n\n\n<p>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\u2019re finally diagnosed with megaloblastic anemia.<\/p>\n\n\n\n<p>There are four reasons why this diagnosis is missed:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Although it\u2019s not an expensive test, B-12 isn\u2019t measured during routine blood tests. Doctors generally don\u2019t order a B-12 evaluation if there\u2019s 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.<\/li><li>Doctors rarely ask (and patients rarely volunteer) information about their eating habits. In medical school, we\u2019re taught that the US diet is \u201cplenty good enough to prevent any vitamin deficiencies.\u201d To which I now respond, \u201cHa!\u201d I agree most of us eat plenty of food (obesity levels are still on the rise), but it\u2019s 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\u2019t know your eating habits you won\u2019t be tested.<\/li><li>Like many blood tests, there\u2019s 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\u2019ll see this type of erroneous overreliance on \u201cnormals\u201d in other frequently missed diagnoses, like hypothyroidism, vitamin D deficiency, gluten intolerance, adrenal fatigue.<\/li><li>Taking the B vitamin folic acid (folate) or eating a lot of <a href=\"https:\/\/www.whfoods.com\/genpage.php?tname=nutrient&amp;dbid=63\" target=\"_blank\" rel=\"noopener\">folate-containing foods<\/a> 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\u2019ll 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.<\/li><\/ol>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Treatment is easy <\/strong><\/h3>\n\n\n\n<p>It\u2019s 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.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>In my own practice, a deficient patient receives a series of four B-12 injections (or four B-12 containing <a href=\"https:\/\/wholehealthchicago.com\/services\/infusion-therapy\">Meyer\u2019s Cocktails<\/a>) and also starts (and maintains herself on) a daily B-12 chewable tablet. Usually within a month her levels are back to normal.<\/p>\n\n\n\n<p>There\u2019s more to come in the Commonly Missed Diagnoses series. Next week: overlooked diagnosis #2, vitamin D deficiency<\/p>\n\n\n\n<p>Be well,<\/p>\n\n\n\n<p><em>David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Posted 05\/14\/2012 You\u2019re pretty sure you know your body and you tell your doctor you\u2019re just not feeling right. You\u2019re tired, maybe a little depressed, a bit achy. Maybe your digestion is \u201coff.\u201d The list of foods you can\u2019t seem to enjoy is definitely longer. Your doctor\u2019s empathic, not at all dismissive of your symptoms, [&hellip;]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,130,3,2315,2314,70],"tags":[1385,1740,2321,2319,1386,2322,2320],"class_list":["post-4673","post","type-post","status-publish","format-standard","hentry","category-blog","category-integrative-medicine","category-knowledge-base","category-most-comments","category-most-view","category-s","tag-b12","tag-b12-deficiency","tag-gastrointestinal-tract","tag-low-levels-of-vitamin-b-12","tag-megoblastic-anemia","tag-meyers-cocktails","tag-nervous-system"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\r\n<title>Six Commonly Missed Diagnoses: B12 Deficiency<\/title>\r\n<meta name=\"description\" content=\"Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells.\" \/>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Six Commonly Missed Diagnoses: B12 Deficiency\" \/>\r\n<meta property=\"og:description\" content=\"Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells.\" \/>\r\n<meta property=\"og:url\" content=\"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency\" \/>\r\n<meta property=\"og:site_name\" content=\"WholeHealth Chicago\" \/>\r\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/wholehealthchicago\" \/>\r\n<meta property=\"article:published_time\" content=\"2012-05-14T19:19:27+00:00\" \/>\r\n<meta property=\"article:modified_time\" content=\"2022-06-06T19:52:23+00:00\" \/>\r\n<meta name=\"author\" content=\"wholehealthchicago\" \/>\r\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\r\n<meta name=\"twitter:creator\" content=\"@wholehealthchi\" \/>\r\n<meta name=\"twitter:site\" content=\"@wholehealthchi\" \/>\r\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"wholehealthchicago\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\r\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency\",\"url\":\"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency\",\"name\":\"Six Commonly Missed Diagnoses: B12 Deficiency\",\"isPartOf\":{\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/#website\"},\"datePublished\":\"2012-05-14T19:19:27+00:00\",\"dateModified\":\"2022-06-06T19:52:23+00:00\",\"author\":{\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/#\/schema\/person\/8f28cef347f94e6801d2bdd38b9cea19\"},\"description\":\"Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells.\",\"breadcrumb\":{\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/wholehealthchicago.com\/blog\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Six Commonly Missed Diagnoses: B12 Deficiency\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/#website\",\"url\":\"https:\/\/wholehealthchicago.com\/blog\/\",\"name\":\"WholeHealth Chicago\",\"description\":\"WholeHealth Chicago is the Midwest&#039;s oldest and most respected center for integrative care, successfully blending the latest advances in conventional medicine with a wide range of clinically proven alternative therapies.\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/wholehealthchicago.com\/blog\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/#\/schema\/person\/8f28cef347f94e6801d2bdd38b9cea19\",\"name\":\"wholehealthchicago\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/wholehealthchicago.com\/blog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/b63bce17acaeb51f185933c60fa6fa86c347679a70b79ec51e5b772e271a469f?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/b63bce17acaeb51f185933c60fa6fa86c347679a70b79ec51e5b772e271a469f?s=96&d=mm&r=g\",\"caption\":\"wholehealthchicago\"},\"url\":\"https:\/\/wholehealthchicago.com\/blog\/author\/wholehealthchicago\"}]}<\/script>\r\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Six Commonly Missed Diagnoses: B12 Deficiency","description":"Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency","og_locale":"en_US","og_type":"article","og_title":"Six Commonly Missed Diagnoses: B12 Deficiency","og_description":"Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells.","og_url":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency","og_site_name":"WholeHealth Chicago","article_publisher":"https:\/\/www.facebook.com\/wholehealthchicago","article_published_time":"2012-05-14T19:19:27+00:00","article_modified_time":"2022-06-06T19:52:23+00:00","author":"wholehealthchicago","twitter_card":"summary_large_image","twitter_creator":"@wholehealthchi","twitter_site":"@wholehealthchi","twitter_misc":{"Written by":"wholehealthchicago","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency","url":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency","name":"Six Commonly Missed Diagnoses: B12 Deficiency","isPartOf":{"@id":"https:\/\/wholehealthchicago.com\/blog\/#website"},"datePublished":"2012-05-14T19:19:27+00:00","dateModified":"2022-06-06T19:52:23+00:00","author":{"@id":"https:\/\/wholehealthchicago.com\/blog\/#\/schema\/person\/8f28cef347f94e6801d2bdd38b9cea19"},"description":"Other causes of B-12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells.","breadcrumb":{"@id":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/wholehealthchicago.com\/blog\/2012\/05\/14\/six-commonly-missed-diagnoses-b12-deficiency#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/wholehealthchicago.com\/blog"},{"@type":"ListItem","position":2,"name":"Six Commonly Missed Diagnoses: B12 Deficiency"}]},{"@type":"WebSite","@id":"https:\/\/wholehealthchicago.com\/blog\/#website","url":"https:\/\/wholehealthchicago.com\/blog\/","name":"WholeHealth Chicago","description":"WholeHealth Chicago is the Midwest&#039;s oldest and most respected center for integrative care, successfully blending the latest advances in conventional medicine with a wide range of clinically proven alternative therapies.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/wholehealthchicago.com\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/wholehealthchicago.com\/blog\/#\/schema\/person\/8f28cef347f94e6801d2bdd38b9cea19","name":"wholehealthchicago","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/wholehealthchicago.com\/blog\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/b63bce17acaeb51f185933c60fa6fa86c347679a70b79ec51e5b772e271a469f?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b63bce17acaeb51f185933c60fa6fa86c347679a70b79ec51e5b772e271a469f?s=96&d=mm&r=g","caption":"wholehealthchicago"},"url":"https:\/\/wholehealthchicago.com\/blog\/author\/wholehealthchicago"}]}},"_links":{"self":[{"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/posts\/4673","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/users\/2087"}],"replies":[{"embeddable":true,"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/comments?post=4673"}],"version-history":[{"count":3,"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/posts\/4673\/revisions"}],"predecessor-version":[{"id":30266,"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/posts\/4673\/revisions\/30266"}],"wp:attachment":[{"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/media?parent=4673"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/categories?post=4673"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wholehealthchicago.com\/blog\/wp-json\/wp\/v2\/tags?post=4673"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}