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 Megadose B12 Therapy 
The following is one in an ongoing series of columns entitled Nutritional Medicine & Longevity by . View all columns in series

"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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