One of the many problems B-12 deficient people can develop is peripheral neuropathy (PN). If B-12 deficiency is not eliminated while the damage is minor, it is common for the spinal cord to become damaged. Eventually, if still untreated, irreversible damage to the central nervous system is likely to result in heart failure and/or Alzheimer's-like symptoms and death. Research during recent decades has shown that people who have neurologic damage as a result of B-12 malabsorption are misdiagnosed even more often than thought previously. They are being allowed to worsen unnecessarily for lack of a safe and inexpensive vitamin.

People who have neurological symptoms should be tested and/or treated immediately (not after weeks, months or years of other testing or waiting). If testing is not possible, they should take at least 1000 mcg B-12 each day while continuing to look at other possibilities. If B-12 deficiency is the cause, they will almost surely stop the damage within weeks and then their bodies will have an opportunity to begin a months-long (years in more serious cases) process of repair. The earlier deficiency is treated, the more likely is complete repair.

IF YOU DECIDE TO OBTAIN TESTING:

Many doctors think that a B12 serum result within "normal" range rules out deficiency----it clearly does not, especially in a patient with neurological symptoms. Many doctors think that ruling out anemia eliminates the possibility of B-12 deficiency--on the contrary, people low in B-12 who do not become anemic are more at risk for severe neurologic damage. Many patients are damaged, even disabled while testing well into "normal" B-12 serum range. Rare patients are deficient even when blood levels are high, because B-12 does not work in the blood; it works in the tissues. Some people can absorb B-12, but they cannot deliver it from blood to tissues.

TESTING:

If the B-12 serum result is clearly low, B12 therapy should be given immediately and follow up tests should be scheduled within a month or so. B-12 treatment shoould be continued, because most people who malabsorb continue to do so for life. Please obtain copies of your B12 and other lab results. Hearing "It's normal" or "Everything is fine" from most doctors is meaningless, because they don't know how to diagnose deficiency.

If follow-up testing cannot be obtained right away, the patient should consider taking at least 1000 mcg of B-12 on the chance that it is needed. If deficiency is causing the damage, sufficient doses of B-12 will stop the damage and usually there will eventually some degree (sometimes 100%) of recovery. If testing is done after B12 has been taken, the results will probably be normal. That does NOT mean that the person was not deficient prior to taking the vitamin or will not become deficient again if it is stopped.

B12 is safe and inexpensive. Too little of it is very dangerous. A more detailed description of diagnostic procedures for your doctor is available in current medical textbooks, such as Goldman: Cecil Textbook of Medicine, 21st Ed., Copyright © 2000, W. B. Saunders Company. Even more detail is available in "Laboratory Diagnosis of Vitamin B-12 and Folate Deficiency" by Christopher F. Snow, Archives of Internal Medicine, June 28, 1999 v159 i12 pl289. Your doctor can obtain Dr. Snow's article from the site of the American Medical Association: http://www.ama-assn.org Once the damage has been stopped, it is time to look for the cause of malabsorption or failure to convert, transport or store B12 normally.

FREQUENTLY MISSED:

Many doctors who know that B-12 deficiency can cause neurological damage believe that it only happens to elderly people. It can happen at any age, but it most often happens after age 40 and from there increases in frequency. Ironically, when elderly people show the signs of neuropathy, many doctors just assume it is age, and don't diagnose and treat them either!

There are several problems, causing people to go undiagnosed until very serious damage is done.

1. Many doctors don't know that testing for B-12 is important.
2. Many doctors think that a B-12 test result within a "normal" range is sufficient.
3. Many doctors just check for anemia, thinking that anyone who has B-12 deficiency is anemic.
4. Some doctors don't even know that malabsorption of B-12 exists (Inexcusable. The knowledge that it does is older than the doctors).

Methylmalonic acid and homocysteine should be tested; if either or both are high, the B-12 level is probably significantly lower than the B-12 test indicated. The tests may provide peace of mind by showing that the patient is deficient by laboratory standards, but a small percentage of people are damaged even while testing normal, so after my reading of medical literature, my experience, and speaking with many people, including patients and experts, I think that anyone with neurological symptoms should take B-12 (at least 1000 mcg) and B complex at a different time of day, regardless of B-12 result.

It is good to be tested, unless the patient has to spend a lot of time fighting to get proper testing, in which case it is better just to take the vitamin (and keep taking it) in hopes of stopping the damage and allowing repairs to begin. But after testing, I would take 1000 mcg B-12 daily regardless of the results. The longer deficiency persists and worsens, the worse the damage will be. Proper functioning of one vitamin is dependent on the others, so it is a good idea to supplement the other B vitamins in appropriate amounts.

Rose Ann Fuhrman
rose@sonic.net

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