Health Care Professionals Ignorant of Dangerous Vitamin Deficiency

The following letter received by biomedical researcher and vitamin B12 expert Dr. Eric Norman vividly reveals the inadequate level of knowledge about B12 deficiency among health care professionals.
Some of the victims of this lack of knowledge are infants and toddlers who are left developmentally disabled for life. Some are young adults, mistakenly diagnosed as having multiple sclerosis or told, erroneously, that they are “incurably” infertile. Others are middle-aged men and women, tormented by balance problems, numb hands or feet, or mysterious shooting leg pains so agonizing that they can barely walk. Some are diagnosed with early-onset dementia or pre-Parkinson’s disease in their thirties or forties. Some are people so depressed that they try to kill themselves. Some appear to be full-blown schizophrenics. And still others are seniors living out their days in nursing homes, because their doctors think they have Alzheimer’s disease.

Dear Dr. Norman,
I only recently became interested in B12 related illness. I’m taken aback by what I did not know. Are you aware that most of us ordinary doctors know very little about B12-related illness? I, for example, have been in practice in internal medicine for 30 years and continue to be active. I am board-certified in both internal medicine and nephrology. I routinely earn 100-200 continued medical education credits annually through continued study. And, with all my education and experience, here’s what I didn’t know about B12 deficiency.
• I had no idea that the normally acceptable lab value of 200 (for a standard B12 blood test) might be too low.
• I did not know that a significant number of B12 deficient patients have B12 levels above 200.
• I did not know that B12 deficiency can cause neuropathy, depression, and cognitive dysfunction.
• I did not know that B12 deficient patients may have neuropsychiatric disease from B12 deficiency in the absence of hematologic abnormalities.
• I did not know that tingling of the hands and feet may be the first sign of B12 deficiency.
• I did not know that nexium and other agents that reduce acid in the stomach can lead to B12 deficiency.
• I did not know that nitrous oxide anesthesia can precipitate acute B12 deficiency.
What is going on? Do you have an explanation for this phenomenon? Why do we physicians know so little about this topic? Do you have any suggestions regarding physician education?

A new book on this phenomenon, Could It Be B12? An Epidemic of Misdiagnoses by registered nurse Sally M. Pacholok and physician Jeffrey J. Stuart, explains how often this simple-to-cure deficiency is overlooked. According to the authors, millions are victims of B12 deficiency—many of them are patients of doctors who mistakenly ruled out B12 deficiency with common but nonconclusive blood tests or who never considered the diagnosis at all.
Pacholok and Stuart recommend establishing standard screening for B12 deficiency using a simple urine test which they say will alleviate most of this tragedy.
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