"I
have recently reviewed all my recent cases in which low levels
of B12 were found. Yours is one of them. I know that my assistant
called you on two occasions to remind you to follow-up on the
finding of a very low B12 level (78 pg vs. laboratory normal
of 150-800 pg/ml). Recent findings support a revised range of
normal of at least 250 pg and some authorities recommend maintaining
blood levels of 1000 pg in order to prevent memory loss and
nerve problems.
"I want to be sure that you let your local doctor
know about the low B12 test result and that you get follow-up
blood tests until the level is repeatedly over 500 and preferably
over 1000 pg/ml. I have seen a few patients lose their memory
function permanently because of B12 deficiency. The outcome
is similar to Alzheimer’s although it can be preceded by depression,
paranoia and other signs of mental illness, which you have had.
Permanent nerve and spinal cord damage can also occur if B12
deficiency is not treated; therefore be sure to show this letter
to your doctor."
This particular woman was seen on two occasions in June 1993. She
gave a history of 3 psychotic episodes. The first occurred after
her first child was born and was considered a "post-partum psychosis."
After two weeks in a psychiatric ward she was maintained on Haldol
therapy for six months, during which time she nursed her son. Three
years later she gave birth to a daughter and again had post-partum
symptoms of insomnia and anxiety but without mania or psychosis.
She had been vegetarian since 1982 and returned to a B12-deficient
vegan diet each time after weaning.
She functioned well until 1993 when she developed insomnia, which
after a week led to mania and confusion. She settled down after
treatment with Stelazine and consulted me 3 months later, no longer
on medication. Her diet was devoid of flesh foods and milk except
3 cups of sweetened yogurt and 3 eggs a week. She drank bottled
water and no soft drinks or refined sugar, other than in the flavored
yogurt. Her diet was low in methionine and vitamin B12. At the same
time it was high in brassica vegetables, of the cabbage and mustard
families, which are cyanogens, similar to cassava, which was recently
implicated as a cause of blindness and nerve damage in a serious
epidemic in Cuba. Economic hardship deprived Cubans of milk and
meat and forced them to eat cassava when they ran out of grain.
The cyanogens in foods are of special importance given her additional
history of migraine and visual loss twice a year since 1980. She
may have been having eye damage similar to that in Cuba, but milder
because of protection by protein intake from grains and yogurt.
Mother Nature provides sulfur from the amino acid, methionine, to
conver cyanide to inactive thiocyanate. Though methionine is low
in her vegetarian diet, conservation of methionine from homocystine
is possible, though it uses up precious B12, folic acid, and B6
and she was low in all these nutrients. I suspect a genetic factor
in her illness also, for her father was alcoholic and committed
suicide, a tragedy that often reflects familial B6 defects. In fact,
her own B6 activity was tested and found to be deficient along with
her B12 deficiency!
Yeast infections were diagnosed two years earlier, before the onset
of her migraine headaches, and she was treated with antifungal drugs.
It is not widely known that these drugs also destroy B12. Luckily
she also was in the habit of eating spirulina, blue green algae,
which is one of the few vegetable sources of vitamin B12, and she
improved as a result. Spirulina was an especially lucky choice because
her lifestyle also exposed her to the combustion products of a wood-burning
stove, which releases PCP (pentachlorophenol), a wood preservative.
This chemical is another one that destroys B12; and since it is
inhaled in the fumes, it travels directly from lungs to the brain
to do its damage.
The fact that she reported serious memory loss, inability to recall
names, dates and phone numbers, since her third psychotic episode,
is ominous. The fact of her lack of follow-through is a further
omen. The failure of her family to insist on additional medical
care also bodes a gloomy prognosis for this young wife and mother.
When a patient with a brain-threatening disease is evasive about
follow-up, it is wise to assume that she is lacking insight or is
in denial to a psychotic extent. The only way to verify the extent
of the loss of mental capacity is by means of formal testing; because
it is usual for such people to cover-up their memory gaps and fool
even their families and doctors until they reach a crisis and deteriorate,
possibly beyond the point of full recovery.
A doctor has no power to intervene against the wishes of the patient
and family when and if they decline treatment as in this case. I
made two telephone calls and wrote a note to the patient defining
the terrible consequences of inadequate treatment. I had expected
this also to inform the primary care physician but when I called
a year later no follow-up treatment had been done and no follow-up
vitamin B12 measurements had been made. Luckily this woman has not
had a relapse into dementia, presumably because her body absorbed
enough B12 from my treatments to maintain her; but she is on borrowed
time.
In the space of 10 years and 3 hospitalizations for psychosis, under
the care of at least three different physicians, including a psychiatrist
who has followed this case for the entire time, no test for B12
was ordered for this patient before she consulted me. The psychiatrists
treated her only with anti-psychotic drugs and she recovered reasonably
well each time, so they let it go at that.
An orthomolecular psychiatrist puts nutrition first, tests for nutrient-related
disorders, and often finds the cause behind the disease. Until orthomolecular
thinking becomes part of orthodox medical education, American physicians
will too often miss-out on vitamin B12 and other nutrient deficiencies.
Of course it is important to prevent any damage from vitamin overdoses,
but it is a lot more likely and even more important to prevent neurological
damage from B12 deficiency. The fact that vitamin deficiency horror
stories are still occurring at all these days is testimony to a
major failure of American medical education and practice, the failure
to "put nutrition first."
©2000 Richard A. Kunin, M.D.
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