B12 deficiency, the fantasy & the reality

The BBC came to the first day of the 2016 conference and as part of their report they needed to get a ‘balanced’ view of B12 deficiency so they interviewed a GP. This slide below shows the statement provided.

IMG_3100

As you can see, this GP from the RCGP (Royal College of GP’s) has stated that;  “GPs are highly trained individuals and I have absolutely no doubt of their ability to diagnose and thereafter treat vitamin B12 deficiency.”

The fact is that from experience, we know that this is a fantasy, many of our GP’s know that this is a fantasy and I’m sure that even the doctor speaking those words knows that the statement he gave (or was given) is a fantasy.

There is no doubt that GP’s are highly trained – but they are not highly trained in nutrition, and certainly not in B12 deficiency. How can they be when it doesn’t feature in their curriculum?

The stark reality for B12 deficient patients, not just in the UK but globally, is that for the vast majority of clinicians including consultants, doctors, nurses, medical students and even NHS Nutritionists,  education in nutrition is sparse and in the case of vitamin B12, it can be non existent. Even some privately trained nutritionists do not understand the essential need for B12 injections rather than oral supplements in those who cannot absorb B12 from food.

Unless a clinician has a personal interest; suffers from this condition themselves or they have a family member with it,  they very often have no idea of the many causes and symptoms of B12 deficiency or of the seriousness of it. They may be exposed to limited information on just pernicious anaemia which, in reality, represents the very tiny tip of the iceberg.

Myths are learnt or picked up during their careers;

That too much B12 is toxic, that levels over 2000 post injection are ‘dangerously high’

That the symptoms experienced are psychosomatic

That B12 is a placebo and that the more you have the more you want

That 4 injections a year means you have a vast store of B12 in your liver, enough to last you years

That even though you include B12 in your diet, that your deficiency is dietary

That you can now miraculously absorb B12 now because their computer says so.

This is all incorrect.

An example of the reality for many patients is contained in the letter below. This was sent to me (and launched my website www.b12deficiency.info) there are even worse examples contained within the letters page.

You can see from this letter that my GP contacted a gastroenterologist, a ‘Specialist’ who should (in an ideal world) know a little about B12 deficiency and the gut, however, he felt I should see a psychotherapist and be prescribed anti depressants for my B12 deficiency symptoms. He came to this conclusion without ever meeting me. Bizarre practice?

My GP perhaps contacted this gastroenterologist because she felt her own knowledge was not enough or she needed someone else take the responsibility? I feel she was let down by someone else whose knowledge ‘was not enough’ either.

Specialist letter (2)

My GP thought the suggestions in the letter were reasonable until I pointed out that yes, I could spend £50 talking to a psychotherapist but what I would be saying is “I’m here because my GP won’t give me the B12 injections I need.”  I also asked my doctor why she thought her memory was more important to her than mine was to me. Thankfully I was prescribed more frequent B12 injections.

Many people write to me to ask “who is the best specialist for me to ask my GP to refer me to regarding B12 deficiency”. The answer to that can only be; ‘the specialist who understands what it means to be B12 deficient’ and tragically, the experience for so many is that those are few and far between. Too many patients find themselves out in the cold, desperately under treated or misdiagnosed with other conditions simply due to a lack of education and awareness.
Our clinicians have been done a great disservice, it’s complete madness that nutrition is not the biggest part of medical training.
If we look at this from the GP’s point of view and consider the long years of intensive training,  a patient tries to tell them they’re missing something so fundamental.  They might think it ridiculous that this seemingly enormous potential for misdiagnosis of B12 deficiency were fantasy on the patients part. Surely if it was so important then surely it wouldn’t have been missing from their education, it would have warranted in-depth learning and be a part of all modules and not just the couple of hours they may actually spend on the subject?

How can our GP’s look for something they don’t know they should be looking for? If their eyes haven’t been opened by personal experience and their peers dismiss B12 deficiency as a nonsense afflicting hypochondriacs, then the chances are that they might conclude this too.

I want to share this Ted Talk on ‘The Power of Generalism’ by Dr Ayan Panja with you because it served to remind me of the daily challenges and wide ranging skills that GP’s have. Due to the my own experience and that of those who write to me, I am guilty of forgetting this from time to time.

 

In the UK the average GP is allocated around seven minutes to with each patient. This includes listening to the complaint, diagnosing and prescribing. This is unsatisfactory for both parties. Sometimes it is easy to forget the previous kindness and excellence of our individual GP’s when the gaping chasm of knowledge of B12 deficiency looms.

This situation can lead to a drastic change in the patient-doctor relationship. The emails I receive every day very rarely champion the GP or the specialist. They are from desperately ill people who are being, dismissed, under treated and generally given short shrift. This needs to change but the ‘system’ is not making this easy for either party.

There are GP’s who are able to treat B12 deficiency correctly as per patients symptoms, there are others who feel their hands are tied and there are some who presume that they know how the patient feels, better than their patient.

Some enlightened GP’s are fully aware of the terrible hand dealt to B12 deficient patients and if we could all work together on this then our relationships would remain intact.

I feel my job with the website is to help patients to remain under the care of their doctors. In order to do this, some patients have to try and educate, sometimes this is an insurmountable task and patients end up ‘going it alone’. This is far from ideal.

There are ‘powers that be’ in the NHS, the government and other agencies who are well aware of the situation and scale of the B12 deficiency problem. Thousands of us have reported it and there are countless journals spanning decades backing up what we say,  but so far it remains suppressed. The comment from the GP to the BBC bears this out.

By working together we can make a difference.

Best wishes Tracey

www.b12deficiency.info

Facebook – https://www.facebook.com/b12deficiency.info/

Twitter – @B12info

If you need any help or information, please email me at tracey@b12deficiency.info

If you are interested in attending next years conference (September) please register your interest via conference@b12deficiency.info

Remember there is no clinical evidence for our restricted treatment – your doctor may not be aware of this and might be inclined to increase the frequency if they were?

http://www.b12deficiency.info/blog/2016/09/28/the-tanks-empty-but-i-can-smell-petrol-so-you-have-90-days-more-driving-ahead-of-you/

 

‘The tank’s empty but I can smell petrol so you have 90 days more driving ahead of you’ …..

If this advice were given by a garage we’d know they were kidding –  but a similar instruction is given in the UK to too many B12 deficient patients regarding their treatment.

NICE and BNF Guidelines advocate a maintenance dose for patients with neurological symptoms is one injection every two months. This is very often ignored and a move straight to a three monthly maintenance dose (after a 6 injection loading dose), is the norm. This is based on NO CLINICAL EVIDENCE whatsoever yet it appears to be set in stone.

I have spent quite some time trying to find the research for the bizarre idea that four B12 injections per year as a maintenance dose is ‘optimal treatment’, since this restricted regime harms those who are in dire need of a nutrient their systems are starved of. The term ‘optimal treatment’ is used to describe our quarterly maintenance dose in a series of GP audits which I blogged about earlier this year.
It was decided that district nurses time could be saved by lessening the frequency of B12 injections given, so this was eventually adopted nationally without any care for the patient. Our UK maintenance dose guidelines are based on cash saving exercises.

At the end of this blog post are the replies I have from various agencies; NHS England, Public Health England, Health Select Committee, British National Formulary, NICE, to the question;

“Please can you show me the clinical evidence which states that the three monthly maintenance dosage for B12 deficiency is optimal treatment.”

You will see that everybody addressed passes the buck and thinks that someone else has this elusive information which so many doctors adhere to. The emails take a circular route which, of course, yield no result whatsoever since there is no clinical evidence.

In a letter to my MP, Sir Bruce Keogh of NHS England stated “Most patients respond well to quarterly injections”, but where is his source?

It’s quite obvious that a great many patients do extremely badly on 3 monthly injections. Patients who email me with the subject line; ’Desperate’, ‘please help’ or ‘Am I going mad?’  And the 1000’s of members of online support groups are also testament to this.

A serum B12 level can show as ‘within range’ for weeks or even months after a single B12 injection or even a single oral supplement.  This can fool doctors into thinking there is plenty of B12 circulating and available to draw upon when, in reality, there isn’t any B12 available to the patient.

If you want to understand the complexities of B12 deficiency then this document on the enterohepatic circulation of B12 will help.

This is what Kevin Byrne (author of the above) states –

“The problem arises when you start to believe that the damage accruing from a long term deteriorative process can be fixed with a handful of injections, and when you take serum levels as a direct measure of the functioning of a distant, complex organic process.”

Many clinicians do not understand that;

• When a B12 injection is given, the majority is excreted via the bladder & bowel within 24 hours.
• B12 is water-soluble, non toxic & costs pennies.
• Progression of nerve damage is inevitable in patients who are starved of B12.
• B12 is vital for life, is required to produce healthy red blood cells and for DNA synthesis.

Both patients and clinicians are being led up the garden path;

The vast majority of GP’s are not fully educated on this very common, debilitating condition and they think they are advising patients correctly based on the limited information they were taught.

There are enlightened doctors who know that 3 monthly injections are a tortuous proposition for many patients they see and they treat appropriately by symptoms.

Worryingly there are also doctors who are informed, who want to treat patients appropriately but feel their hands are tied, either by their colleagues or by even more restrictive ’practice guidelines’ which appear to take precedence over National Guidelines. Or, these doctors are terrified of being reported to the GMC for ‘unusual prescribing’, quite bizarre when what we are discussing is a non toxic essential vitamin.

Evidence of this clinical evidence is nowhere to be found, It simply does not exist. It is a myth generated to save time and money and has had the opposite effect, costing the NHS and in turn society, millions if not billions of pounds. This is due to the inevitable misdiagnoses that occur when doctors fail to understand that four injections a year will never be enough to heal damaged nerves in many patients.

Trying to put a forest fire out with a teaspoon of water would be just as futile.

What other group of patients with a serious debilitating condition would be subjected to the same illogical and harmful treatment regime?

Whilst the vast majority of clinicians lack up to date knowledge of B12 deficiency & whilst treatment of this condition remains so illogically and harmfully restrictive, it becomes even more essential for patients to be able to access injectable B12 over the counter in the UK.

Patients don’t want more injections than they need, they just want to be able to function and get on with life. It is time once again, to shine a very bright light on exactly why UK patients are kept chronically ill and unable to work on this ridiculously low frequency, based on no clinical evidence whatsoever.

If you are in the UK, you can help by sharing this information with your MP and by asking them to contact my MP, Nicky Morgan (nicky.morgan.mp@parliament.uk) so that they can work together on this urgent issue.

Many thanks Tracey
www.b12deficiency.info

Emails below;

To: Health Committee <HEALTHCOM@parliament.uk> (Dr Sarah Wollaston)
Subject: Re: Clinical evidence for B12 treatment

Dear Victoria

Thank you for your email and the link. However you misunderstood my question. I am asking for “clinical evidence” not “clinical guidelines”.
Please can you point me in the direction of the clinical evidence that states that a three monthly maintenance dose of a 1ml b12 injection is optimal treatment for B12 deficiency? I recall Sarah stating to one of her constituents that she is aware of this evidence.

Best wishes
Tracey
www.b12deficiency.info

Health Select committee (Dr Sarah Wollaston)

<HEALTHCOM@parliament.uk> wrote:

Dear Tracey

I have asked Sarah’s office but unfortunately between us all we can’t track this information, you will need to contact NHS England/Department of Health.

Sorry I couldn’t help.

Best wishes

Victoria

Public Health England;

Hi

Thanks for your email to Public Health England. This falls outside our remit, however we are unsure who you should approach. It might be something NHS England can help you with.

Regards

PHE Enquiries.

NHS England:

Dear Tracey

Thank you for your email of 8 August within which you requested information about the clinical evidence regarding the two and three monthly maintenance doses for B12 deficiency.

NHS England is unable to advise regarding this matter and it is recommended you contact National Institute for health and Care Excellence. Contact details are available at: https://www.nice.org.uk/guidance
Further information regarding B!2 can be reviewed at: https://www.nice.org.uk/search?q=b12

I am sorry I am unable to assist you further and trust the information above is sufficient to progress your enquiry.

NICE;
(Please note I cut a whole load of this enormous email out to save you falling asleep – It was the text from the page highlighted)

Dear Tracey

Thank you for contacting NICE.

NICE produces a range of guidance and information products, including clinical guidelines, which are recommendations on how healthcare and other professionals should care for people with specific conditions. Our clinical guideline topics are referred to us by the NHS England. I can confirm that we have not been asked to develop a guideline relating to the care of people with B12 deficiency.

I believe that the resource that you have located is clinical knowledge summary (CKS) on Anaemia – B12 and folate deficiency. CKS are developed by an external company and we work with the publisher to make them available on the NICE Evidence Services website, as a source of advice for health professionals working in primary care, while they may refer to NICE guidance (if there is any that is relevant), they also use many other sources. It is important to note that they do not constitute NICE guidance.

The evidence behind the recommendations in the CKS is presented underneath the recommendations under a subheading ‘Basis for recommendation’. I hope this is helpful.

Kind regards
Janet

(I didn’t find it helpful obviously, they point towards lots of journals who don’t have the evidence we require and to the BNF; here is their response below; )

BNF British National Formulary

Thank you for your email to BNF Publications.

Unfortunately we are unable to access our archives to check what evidence base was used to determine the 3 monthly dosage of hydroxocobalamin.

BNF content will be reviewed in line with the SPCs for future updates of the BNF.

Kind regards,

BNF Publications

You will see from my previous blog on this subject that I also asked all the Marketing Authorisation holders  who provide injectable B12 in the UK where their evidence for the three monthly maintenance dose came from and each of them drew a blank too.

http://www.b12deficiency.info/blog/2016/02/16/uk-b12-deficient-patients-paltry-3-monthly-maintenance-dose-of-b12-injections-is-based-on-cash-not-care/

 

B12deficiency.info 2016 Conference 17th and 18th June – Education for all, B12, methylation and thyroid.

I am delighted to announce our second event and Sally Pacholok will be with us again!

email-banner

The conference will attempt to address the gaps in the diagnosing and understanding of these conditions and the effects on both physical and mental health.

Please note: This is NOT a two day conference, an identical programme will run each day.

Ticket price £62.00
Includes: Presentations, lunch, refreshments, attendance certificate for CPD and free on site parking.


This conference is for all with an interest in the subjects both personally and professionally.

If you are a patient you will learn more about your condition. If you work with people in any field of mental or physical health then this conference will provide high clinical relevance and an attendance certificate for CPD.

It has been arranged by Tracey Witty of www.b12deficiency.info to promote greater awareness and understanding of B12 deficiency, methylation and thyroid disease.

PLEASE NOTE: There is no sponsorship from, nor affiliations to pharmaceutical or vitamin companies at this event (or throughout www.b12deficiency.info).

The speakers are highly knowledgeable, experienced and engaging. They will discuss the multi-systemic and polyglandular nature of the conditions, diagnosis and misdiagnosis.

Q&A time with the speakers is scheduled.

In addition to our speakers we will hear from three patients who will present their own case studies.

Last years attendees said; – Thanks for organising the excellent conference, the speakers were all very engaging and enthusiastic. I don’t think I have ever been at a conference that so many people stayed until the end, especially on a Saturday!

– I am an acupuncturist and during the conference I realised that my training in B12 deficiency was woefully inadequate. Knowing so much more about B12 and methylation has completely changed my practice!

Meet the Speakers

Sally Pacholok RN BSN
Presentation on –
The effect of B12 deficiency on all body systems. Symptoms, causes, those at risk and common misdiagnoses.

Sally was a licensed Advanced Emergency Medical Technician and worked as a paramedic prior to and during nursing school.

In 1985 aged 22, Sally diagnosed herself with vitamin B12 deficiency, after her doctors had failed to identify her condition. Over the past two decades, she has frequently found untreated B12 deficiency in the patients she cares for and has campaigned to raise awareness of this all too common debilitating neurological condition.

During her presentation Sally will be using case studies to show how b12 deficiency affects people of all ages, including babies and children. She will also be reviewing the pathophysiology, signs, symptoms, risk factors, causes, diagnosis, differential diagnosis and treatment.

Sally’s book inspired Emmy winning film producer Elissa Leonard to produce a documentary on misdiagnosed B12 deficiency in 2011 click to watch. Elissa then went on to produce a feature film based on Sally’s life click to watch.

Anne Pemberton
Functional Medicine Practitioner MSc, PGCE (Autism), RGN.
Presentation on –
Genetic Polymorphisms in Chronic fatigue and Autism: Supporting the role of B12 and Folate and their connection to HPU (Kryptopyrroles).
 

Anne spent the first 25 years of her working life as a registered nurse in cardiac intensive care. Her son’s diagnosis of autism and the lack of medical help was the catalyst for Anne’s decision to retrain as a functional medicine practitioner.

Anne is now the Course Director on the MSc in Nutritional Therapy at the Northern College of Acupuncture in York. She also runs a busy international clinic, with special interest in CFS (chronic fatigue syndrome) and autism.

Anne uses nutrigenomics data from 23andme.com alongside appropriate functional testing, in order to establish each person’s individual health requirements. She has co-written the first UK based practitioner nutrigenomics course in the UK which is delivered twice yearly in York and London. Anne has also co-authored a book with Dr Damien Downing ‘The vitamin Cure for Digestive Disease’.

Dr. Afshan Ahmad BSc, PhD.
Presentation on –
The effect of thyroid replacement in patients with ‘normal’ thyroid chemistry and clinical signs and symptoms of hypothyroidism.

Development for Vaccine Research Trust, a charity established in 1982 which supports research into why a group of people present with signs and symptoms of hypothyroidism but continue to have blood tests within the reference range. She co-founded Vaccine Research International Plc and helped Dr Gordon Skinner in his thyroid clinic in Birmingham, working closely with him in his dealings with the GMC. In 2000, they published a paper on the effect of thyroid replacement in patients with ‘normal’ thyroid chemistry and clinical signs and symptoms of hypothyroidism.

Afshan qualified with a BSc degree in Immunology and Microbiology from London University in 1983 and joined Dr Gordon Skinner’s vaccine research group at the Medical School, University of Birmingham in 1985, she completed her PhD in Medical Microbiology in 1999.

Dr Joanne Younge
Associate Specialist Old Age Psychiatrist.
Presentation on –
Audit on B12 and folate deficiency in the elderly.

Joanne graduated from Queen’s University, Belfast, in 1996 and is an Associate Specialist Old Age Psychiatrist in an NHS Trust.

Joanne is a Cognitive Behaviour Therapy (CBT) Clinical Lecturer at Queen’s University in Northern Ireland. Her main interest is improving care for patients, either through quality improvement initiatives, using Institute for Healthcare Improvement methodology, or audit.

She co-authored ‘CBT for mild to moderate depression and anxiety’ in 2014 and an audit on improving patient safety, ‘The impact of introducing a Lithium care pathway’, was published as an example of shared learning on the National Institute of Health and Care Excellence (NICE) website in 2015.

The introduction of an electronic care record, with better access to blood results, and improved insight into the potential impact of deficiencies prompted an audit into B12 and folate deficiency in the elderly patients referred to the local service. She is hopeful that the audit, presented at the conference, will have an impact on improving patient care in the future.

_______________________________________________________

To book your place click here

To read more please visit the conference page.

I look forward to seeing you there!

Tracey

B12 deficiency can strike at any age, it is not confined to women over 60

 

b12-child-port

Signs & symptoms in infants and children
(List supplied by Sally M Pacholok R.N & Dr Jeffrey Stuart co authors of ‘What’s wrong with my child?’

• Developmental delay or regression
• Apathy – Irritability
• Hypotonia (decreased muscle tone)
• Weakness
• Tremor
• Involuntary movements
• Seizures (fits)
• Ataxia (Neurological disorder affecting balance, coordination and speech)
• Anorexia and other eating disorders
• Failure to thrive
• Poor weight gain
• Poor head growth
• Poor socialisation
• Poor motor skills
• Language delay
• Speech problems
• Lower IQ – Mental retardation
• Anaemia
• Macrocytosis (large red blood cells) Note – need not be present!

 

For more information on ‘Red Flags‘ in children please visit

www.b12deficiency.info/children-and-b12/

 

b12-child-land

 

Please see our posters page to share, download and print these posters.

Raising awareness ; http://www.b12deficiency.info/how-you-can-help/

Dennis Skinner MP for Bolsover has signed the B12 OTC petition!! Will your MP do the same?

B12-life-web
Just in case you don’t receive the update for the petition, see below;
After a call out to B12 deficient patients to sign and share this petition (https://www.change.org/p/ian-hudson-please-make-our-life-saving-injectable-vitamin-b12-hydroxocobalamin-available-over-the-counter?)to get us over the 10,000 signature threshold I am delighted that we have 11,341 supporters as I write this update.
Huge thanks to each and every one of you!
Your sharing of this petition does a fantastic job of raising awareness of B12 deficiency every day.
Steph Whiting, a B12 deficient patient struggling to access B12 injections, sent the petition link to her MP, Dennis Skinner. Dennis was completely unaware of this very common condition and the awful predicament of under treatment that UK patients face, so he signed to show his support.
I badger my local MP and MEP regularly, but more help is needed and if UK and international supporters could take the time to email or tweet we can really make a difference in moving this campaign forward!
May I suggest Tweeters use the following;
@DennisSkinnerMP has signed this injectable B12 OTC petition http://chn.ge/1phNgE6, will you? #B12 OTC petition
Please target at the very least, the MP’s listed below via Twitter. (Twitter names listed below for your convenience).
David Cameron – Prime Minister
Jeremy Hunt – Secretary of State for Health
Jeremy Corbyn – Leader of the Labour Party
Jane Ellison  – Parliamentary Under-Secretary (Department of Health)
Luciana Berger MP – Shadow Minister for (mental Health)
UK Tweeters, please add your local MP and MEP to this list too.
You can find your MP’s contact details by using this tool;
and your MEP contact details here;- http://www.europarl.org.uk/en/your-meps.html
@jeremy_hunt
@david_cameron
@jeremycorbyn
@janeellisonmp
@lucianaberger
Please consider emailing too – there is a template at the bottom if you wish to use it,  please add your own experience/reasons for asking for support. You may care for someone who is B12 deficient so this may need re wording for your particular situation.
UK supporters please contact all the above and your own MP and MEP
Please email;
Jeremy Hunt –
huntj@parliament.uk
Jeremy Corbyn –
corbynj@parliament.uk
Luciana Berger –
luciana.berger.mp@parliament.uk
Jane Ellison MP –
jane.ellison.mp@parliament.uk
David Cameron- sadly no direct email address exists publicly so there is a form to fill in here;   http://www.witneyconservatives.com/contact
UK supporters – Perhaps you could give your local MP a call too?
Lets not restrict this campaign though – tweet, email or call anyone you can think of who may help to spread the word and make this happen.
Celebrities are powerful so let’s try to get them on board too!
Finally, when you receive your email replies please consider forwarding to me at tracey@b12deficiency.info
Again, huge thanks to all 11,341 supporters – you are amazing!
Tracey witty
www.b12deficiency.info
EMAIL TEMPLATE
Dear *
Dennis Skinner MP, has signed this petition;
https://www.change.org/p/ian-hudson-please-make-our-life-saving-injectable-vitamin-b12-hydroxocobalamin-available-over-the-counter? in support of UK B12 deficient patients who are unable to buy their life saving, Injectable vitamin B12 OTC. We cannot absorb B12 from food so injections are essential for life.
Most countries around the world allow their citizens to buy this essential, harmless injectable vitamin without prescription, from pharmacies.
Due to out dated NICE Guidelines and GP’s (and other health care professionals) lack of knowledge of B12 deficiency, many patients are restricted to just four B12 injections per year, even though the body needs B12 every day! This level of treatment is clearly nowhere near enough to maintain health and consequently many patients remain mentally ill, bed bound, cognitively impaired, and unable to work or look after their children.
Please sign and show us your support;
If you have the time to watch even the first 5 minutes of this film;
You will see just how devastating the effects of B12 deficiency can be. It is an easily treated, serious neurological condition but patients are very often dismissed, neglected and labelled hypochondriacs.
Just imagine the health care savings if you can help to make this happen.
For more information on this very common neurological condition please see www.b12deficiency.info
Yours sincerely

B12 deficiency at the heart of the matter

This little fella spent a long lime in hospital as a child following a diagnosis of Perthes disease (Legg-Calvé-Perthes disease).  Perthes is a childhood hip disorder caused by a disruption of blood flow to the ball of the hip joint.

By the time he was 30 years old he had suffered his first heart attack.

He died aged 37 following his third.

Born 1937 - Died 1973

 Born 1937 – Died 1973

 

Just prior to his first heart attack he experienced intense jaw pain whilst digging the garden and his face drained of colour. In between the 2nd and 3rd attacks he experienced flu-like symptoms but no chest pain and none of the other classic symptoms associated with heart attack. These details were a surprise to me and may be to you too.

This handsome young man was my dad and I inherited many things from him including his hair, a love of woolly jumpers and furniture making skills. (I don’t make a habit of keeping model aeroplanes under my bed though).

Amongst those interesting traits, I also inherited a clotting disorder; Factor V Leiden (FVL) and a myriad of genetic polymorphisms many of which are connected to B12 and folate methylation. (MTHFR, MTRR, MTR,CBS, and BHMT, to name a few).

No one knew why my dad had heart attacks and died so young and it has long remained a mystery, apart from his limp left over from Perthes disease, he appeared to be a fit and healthy young man.

I learned that I had FVL when I was trying to conceive and found that Perthes’ disease also has a connection to FVL. (see refs below).

With the help of genetic testing and the unravelling of my own medical history since being diagnosed as B12 deficient, there are now clear indications of  my dad’s underlying B12 and folate methylation problems.

These coupled with an undiagnosed clotting disorder could have contributed to – or could perhaps be the cause of his death? I wouldn’t mind betting that he had a sky-high homocysteine level but it’s doubtful that testing for this would have been on any radar and even today it’s tricky (if not impossible) to persuade a GP to test.

High homocysteine is known to be strong risk factor for cardiovascular disease, it is a an amino acid which rises to a toxic level in patients with low, B12, B6 and B9 (folate).  If a high homocysteine level is present and the patient also has FVL then research shows there is an even greater risk of Cardiovascular problems.

I was thankful that the GP I saw upon diagnosis of my B12 deficiency seemed to understand the problems associated with FVL and low B12 and I was reassuringly told -‘We’ll have to look after you’. Sadly this statement was quickly forgotten and the silly games regarding strict rationing of life giving B12 injections began.

I contacted many cardiologists to invite them to the conference we held in May but there was a total lack of interest. They receive millions of pounds in research grants but they don’t appear to want to look at the basics. It is a crying shame they didn’t hear Sally Pacholok and Malcolm Kendrick speak, but when their research money comes from pharmaceutical companies I expect they feel their hands are tied.

On health questionnaires we are often asked if we have a history of certain conditions, it seems that with a shrug of the GP’s shoulders, you must understand that you may succumb to heart attack, Alzheimer’s, or bipolar if they are prevalent conditions in your family (they are in mine). That you just have to take it on the chin and await what comes your way.

Many of us who read and research B12 deficiency, join up the dots early. We know that these conditions and many more can all be related to low B12 and that if we are given vital B12 injections at the frequency we need then we can live healthily and happily. We may also feel that the outcome for many of our loved ones might have been different had the full knowledge of B12 deficiency been available to the clinicians in charge of their care.

We want our doctors to discover and understand this too so we send them journals, advise them to read ‘Could it be B12?’ We lay the facts out in black and white, but we are often ignored, ridiculed and neglected. We understand that this action of trying to educate is irritating to doctors but what else can we do?

We are fighting for our lives whilst we wait for the medical community to catch up.

To see who is at risk of B12 deficiency, please click here http://www.b12deficiency.info/who-is-at-risk/ 

Raising awareness; http://www.b12deficiency.info/how-you-can-help/

Please sign and share this petition, let’s get it over 10,000 signatures; https://www.change.org/p/ian-hudson-please-make-our-life-saving-injectable-vitamin-b12-hydroxocobalamin-available-over-the-counter?

Ann Intern Med. 1997 Nov 15;127(10):895-903.
Factor V Leiden mutation and the risks for thromboembolic disease: a clinical perspective.
Price DT1, Ridker PM.
http://www.ncbi.nlm.nih.gov/pubmed/9382368
J Orthop Res. 2014 Jan;32(1):1-7. doi: 10.1002/jor.22473. Epub 2013 Aug 27.
Meta-analysis of hypercoagulability genetic polymorphisms in Perthes disease.
Woratanarat P1, Thaveeratitharm C, Woratanarat T, Angsanuntsukh C, Attia J, Thakkinstian A.
http://www.ncbi.nlm.nih.gov/pubmed/23983171
J Bone Joint Surg Am. 2004 Dec;86-A(12):2642-7.
Legg-Calve-Perthes disease and thrombophilia.
Balasa VV1, Gruppo RA, Glueck CJ, Wang P, Roy DR, Wall EJ, Mehlman CT, Crawford AH.
http://www.ncbi.nlm.nih.gov/pubmed/15590848
Acta Orthop Belg. 2007 Oct;73(5):612-7.
Thrombophilia and Legg-Calvé-Perthes disease: is it a causative factor and does it affect the severity of the disease?
Moens P1, Defoort K, Vancampenhout A, Peerlinck K, Fabry G.
http://www.ncbi.nlm.nih.gov/pubmed/18019917
J Pediatr Orthop. 2007 Oct-Nov;27(7):834-7.
Legg-Calve-Perthes disease, venous and arterial thrombi, and the factor V Leiden mutation in a four-generation kindred.
Glueck CJ1, Tracy T, Wang P.
http://www.ncbi.nlm.nih.gov/pubmed/17878795
Thromb J. 2014 Dec 16;12(1):30. doi: 10.1186/s12959-014-0030-0. eCollection 2014.
Severe hyperhomocysteinemia due to cystathionine β-synthase deficiency, and Factor V Leiden mutation in a patient with recurrent venous thrombosis.
Awan Z1, Aljenedil S2, Rosenblatt DS3, Cusson J4, Gilfix BM2, Genest J5.
http://www.ncbi.nlm.nih.gov/pubmed/25516723
Clin Chem Lab Med. 2003 Oct;41(10):1357-62.
The risk of venous thromboembolism associated with the factor V Leiden mutation and low B-vitamin status.
Obeid R1, Hakki T, Jouma M, Herrmann W.
http://www.ncbi.nlm.nih.gov/pubmed/14580166
J Med Assoc Thai. 2000 May;83(5):536-42.
Association between serum homocysteine, vitamin B12, folate and Thai coronary artery disease patients.
Leowattana W1, Mahanonda N, Bhuripunyo K, Pokum S.
http://www.ncbi.nlm.nih.gov/pubmed/10863900
Mini Rev Med Chem. 2012 Sep 1;12(10):997-1006.
Role of polymorphisms in factor V (FV Leiden), prothrombin, plasminogen activator inhibitor type-1 (PAI-1), methylenetetrahydrofolate reductase (MTHFR) and cystathionine β-synthase (CBS) genes as risk factors for thrombophilias.
Miranda-Vilela AL1.
http://www.ncbi.nlm.nih.gov/pubmed/22512572

Understanding what it feels like to be B12 and folate deficient

Over the weekend I was ambushed by a sickness bug, I was in pain, exhausted and miserable with a screaming headache – however I knew it would pass and that I would be free of feeling like a rag doll in a matter of days.

It occurred to me that what I was experiencing would be just a tenth of what some B12 deficient patients suffer every day of their lives, particularly those who remain undiagnosed, misdiagnosed or indeed those who remain desperately under treated on the paltry 4 injections a year that they are allowed.

I consider myself incredibly lucky that my B12 and folate deficiency symptoms never caused me to experience chronic fatigue but there are thousands of people who live with this every day.

I have no children to look after, but can you imagine feeling like death and having to carry on and look after a family, hold down a job, function when it is almost impossible to breathe, think, walk or stay awake? Many struggle to hold onto their jobs and their families when they are not treated correctly.

When asked to describe how it felt to be B12 deficient a friend, Lynne Wood, described a scenario which perfectly illustrates this, she explained that if you were to tie a sack of spuds (potatoes) to the back of each leg, each arm and to the back of your head and then go about your working day it may come close to what she felt like. I am sure many will identify with this.

I heard an account of a GP being asked (in a social setting) if he gave B12 injections to patients who requested them earlier, his response – “It depends what they’re like”,  so he based medical judgement and treatment on whether or not the patient was to his liking rather than on the manifested pain and suffering. Surely this disgustingly sadistic approach is rare and the neglect B12 deficient patients face is usually as a result of ignorance.

What continues to floor me everyday is that thousands of B12 deficient patients are neglected and refused additional life saving B12 injections despite pleading for respite from their symptoms. I know of patients who are sent away for being even two days early for their quarterly injection, can you imagine this? What caring person in their right mind, would keep someone in pain and suffering when the treatment is so simple, cheap and effective?

This deeply ingrained ignorance which filters down from doctors to nurses creates a barbaric situation for patients.

A dog taken to the vets in such a terrible state might actually be put down – however we all know that a vet is taught far more about B12 deficiency than many of the doctors that B12 deficient patients encounter.

On a lighter note – although a little disturbing, someone wrote to tell me that the health food shop had run out of B12 supplements and so she was advised to take double the dose of B6……… Unbelievable!!

 

If you need an excellent support group please consider joining Pat Kornic’s group – https://www.facebook.com/groups/PAB12DSupportGroup/?fref=nf

Raising awareness:http://www.b12deficiency.info/how-you-can-help/

If you want to be in charge of your own health please sign and share this petition – https://www.change.org/p/ian-hudson-please-make-our-life-saving-injectable-vitamin-b12-hydroxocobalamin-available-over-the-counter?

 

B12 and Thyroid conference 2015 – an enormous success, incredible feedback and a game changer!

 

I want to say a huge thank you to the fantastic four; Sally Pacholok, Lorraine Cleaver, Umahro Cadogan, and Dr Malcolm Kendrick – who all have more than one thing in common;

A passion for educating and exposing truth, unflappable tenacity and humour!

Sally Pacholok, as we with B12 deficiency know, is an inspiring educator who diagnosed her own condition and is completely dedicated to raising awareness of this condition. The vast amount of information Sally imparts in just 2 hours, is incredible.

Her time in the UK was spent working almost solidly and even during her sparse free time managed to help patients in a profound way. Anyone reading this who would like Sally to speak at an event then please get in touch, you won’t look back!

Lorraine Cleaver told us of her shocking experience of thyroid disease, her planned suicide and her road back to health after appalling treatment due to ignorance. She also recounted Jill’s story, which echoed her own experience as Jill remained undiagnosed with B12 deficiency and Graves disease for years. Jill was subjected to ECT (Electroconvulsive therapy) in place of what her body required. This presentation was profoundly moving.

Umahro Cadogan became so ill in his teens that he too had to become his own doctor. He has made it his life’s work to educate himself and others on nutrition and nutrigenomics. His presentation on methylation, a hugely complex subject, was expertly delivered making it accessible to all.

Dr Malcolm Kendrick talked about the shocking state of accepted medical data. He is the kind of GP we all want, sensible, caring, humorous. He sorts the wheat from the chaff and is determined to shine the light on the dark corners of medicine. I have followed his blog for years and if you don’t already, then sign up!

IMG_9888

Pic. Dr Jeffrey Stuart, Sally Pacholok, Umahro Cadogan and me.

Just a couple of hours after the conference emails started to arrive from delegates and I was stunned and delighted, here is the first;

“ Thanks for organising the excellent conference today. I was delighted to attend and learnt a lot and met some lovely people. The speakers were all very engaging and enthusiastic.

I don’t think I have ever been at a conference that so many people stayed until the end, especially on a Saturday! That is testament to the line-up you organised. Well done. I hope it makes a difference.“

 Dr J Younge –

Well, judging by my inbox there has already been a huge shift – the day really can be labelled ‘A Game Changer’!

Dr J Younge sums it up perfectly, the delegates were completely engaged right up until the end.

For those of you who attended you will know that there was an impressive (and surprising) number of health professionals across all disciplines who attended and who thankfully took the time to write;

“Congratulations on organising a really interesting day.

The speakers were excellent and inspiring and gave us plenty to think about!”

Dr S Williams

For those of you who couldn’t attend – I promise there will be more events in the future. (I have never done this before, but I really enjoyed it!)

It worked because of the quality and mix of the speakers, and because of the connection between all of the subjects. Those who came are now determined to make a change.

It was a fantastic day and I have learnt a lot about how to make it even better next time.

Heartfelt thanks to Dr Jeffrey Stuart and of course to Damian Witty.

Thanks to all who supported me in organising this event – you are priceless!

Tracey x

www.b12deficiency.info is my passion, highlighting mental health, fertility, pregnancy and children is a must.

 

For more information on the speakers please visit – http://www.b12deficiency.info/conference/

If you want to help us to access Hydroxobalamin OTC please sign and share this petition.

If you want to make the education of nutritional deficiencies for doctors compulsory and comprehensive please sign and share this petition too.

Lets continue to work together, we will make a difference.

http://www.b12deficiency.info/how-you-can-help/

B12 & Thyroid Conference – Wilful blindness, apathy or a case of short arms, deep pockets?

I am sorry I haven’t been here for a while, I have been arranging a conference on B12 deficiency, thyroid disease, genetics and data. (www.b12deficiency.info/conference)

Anyone who reads this blog knows how difficult it can be to access correct treatment and understanding of their condition.

I hoped (and still hope) that the 16th of May would go a little way towards helping to change this, however it seems I may be wrong!

The fact is, I have hand delivered personal invitations to nearly 200 GP’s local to the area. Others have emailed invitations, asked their own GP’s to attend and tweeted the event too, thank you all. I have sent hundreds of invitations via email to NHS organisations, health educators and healthcare professionals and the response has been DISMAL.

Amongst those who have booked are psychiatrists, pharmacists, acupuncturists and nurses, so all is not lost and there is still time for those who have been invited to stump up and turn up to what promises to be an excellent day. (I still have faith!)

I was warned that GP’s wouldn’t attend – that they are just not interested, that they only go to free events, usually free thanks to pharmaceutical sponsorship.  Who knows the real reason, perhaps they are all at weddings?

I do know there are some GP’s who are up to speed on both these conditions, however the vast majority are not. These petitions are testament to this fact –

Lorraine Cleaver – Effective thyroid and adrenal testing, diagnosis and treatment.
www.scottish.parliament.uk/GettingInvolved/Petitions/PE01463

Andrea MacArthur – Updating of Pernicious Anaemia-VitaminB12 Deficiency understanding & treatment.
www.scottish.parliament.uk/GettingInvolved/Petitions/petitionPDF/PE01408.pdf

Tracey Witty
www.change.org/p/ian-hudson-please-make-our-life-saving-injectable-vitamin-b12-hydroxocobalamin-available-over-the-counter?

Here’s what GP Margaret McCartney has to say on this subject –

Margaret McCartney: Forever indebted to pharma—doctors must take control of our own education

http://www.bmj.com/content/350/bmj.h1965 

“A colleague told me that attendance plummeted when she decided to end the pharma sponsorship of an annual educational event and to charge doctors £40 each instead. Are we so culturally attached to free education that we don’t care about the price? A £40 fee is hardly robbery, and free education is not worth the unwritten debt to sponsors.

At these events it’s also often unclear what vested interests speakers have until they flash a slide at the start of their talks. We should insist on seeing a full declaration of potential conflicts and sponsors before we sign up.

By deciding what we need and what we would like to learn, we can set our own agenda rather than be the recipients of someone else’s…..”

I wish I could shoulder the cost of this event and offer it for free but I can’t, however there are NO SPONSORS and NO AFFILIATION with anyone selling a drug or a supplement, it is not for profit.

Everything I do to raise awareness of B12 deficiency is personally funded by me and my husband Damian, because this condition has affected us so profoundly and because we care about those in the same boat (and indeed in the ‘connected boat’ of thyroid disease). There are many of us spending countless hours voluntarily, working to raise awareness and support sufferers of both conditions.

The £62 ticket price covers the cost of the event; food, refreshments, technical staff, technical equipment, building hire, printing, promoting, and the minimal expenses of four excellent speakers on interesting and vitally important topics.

  • Sally Pacholok RN BSN – The effect of B12 deficiency on all body systems. Symptoms, causes, those at risk and common misdiagnoses.
  • Lorraine Cleaver Expert Patient – Diagnosis and treatment of thyroid disease from a patient’s perspective.
  • Umahro Cadogan Adjunct Professor of Nutrition – Genetic polymorphisms and the role of B12 and folate in methylation.
  • Dr. Malcolm Kendrick MbChB, MRCGP GP – Doctoring data – how data are manipulated to present information in wildly inaccurate ways.

People who have an interest in the subjects, who are not health care professionals, do want to come and were previously excluded – I’m sorry this was a BIG MISTAKE.

Those of us with these conditions may be aware of the effects they have on mental health, fertility, children, cardiovascular health (etc,etc) but it seems that the vast majority of our GP’s and medical educators prefer to stay in the dark.

The aim was obviously to educate the people who in turn can help us. The polypharmacy we are subjected to thanks to this knowledge gap, is out of control. Patients are taking more and more drugs to modify symptoms while the root cause is ignored.

It is very clear that we, the patient, have to continue to learn as much as we can about our conditions in order that we can then try to teach those who ‘care’ for us.

I am saddened that this is the way it has to be and that even though we didn’t choose medicine as a career, we continue to be forced to study it.

Lest make this event a catalyst for change. If you can come we’d love to see you there.

Where: Loughborough University
When: Saturday May 16th (9am – 6pm)
Cost: £62
Inc: Lunch, free on-site parking, post conference webinar and attendance certificate (upon request)

For further information and booking please visit www.b12deficiency.info/conference

An obvious history of neglect – please help us to buy injectible B12 OTC, many doctors cannot or will not help us!

‘Somataform autonomic dysfunction in the form of neurosis’ or longstanding B12 deficiency?

Below you will see this patient’s medical history is clearly affected by B12 deficiency and yet over 30 years on, still NO ONE will listen and treat her accordingly.

You will see that from an early age (4 years) there are clear signs of B12 deficiency which sadly elude each clinician the patient comes into contact with – instead of vital B12 treatment this patient was subject to repeated consultant appointments, repeated accusations of hypochondria, desperate under treatment and over medication of drugs. Weigh all this up against ampoules of B12 costing just 55p –  the cost is phenomenal not just in life terms to the patient and her family –  but also the cost to the NHS.

If all our doctors left medical school with a full grounding in the very basics of Vitamins, minerals and enzymes then this enormous waste of NHS funds demonstrated here could be largely avoided.

The first red flags of B12 deficiency in the summary of notes are that the patient suffered;
• Faecal soiling
• Constipation
• Behavioural concerns

The treatment the patient received was;
• Lactulose
• Referral to a paediatrician
• Referral to educational psychologists

What the patient required was – to be tested for B12, folate and ferritin and then appropriate supplementation.

At age 22 the patient presented with;
• Palpitations
• Dizziness
• SOB (Shortness of Breath)
• Sweating
• Nausea

The treatment received was;
• Detailed cardiological investigations
• 24h tape and Echocardiogram
• Beta blockers – The clinician’s findings were – ‘No abnormalities detected’
• Referral to a psychiatrist
• Offered appointments to consider SSRI’s – The clinician’s findings were – ‘somataform autonomic dysfunction in the form of cardiac neurosis’

What the patient required was, to be tested for B12, folate and ferritin and then given appropriate supplementation.
The doctor summarising the notes states that ‘The issues regarding her B12 started around 2000’ Finally the patient is tested for the real problem.
• A ‘routine’ blood test noted a raised MCV of 102
• B12 level was recorded at 160
• A few months later these tests were repeated
• MCV recorded at 103
• B12 at 211 ‘slightly low’

Instead of appropriate treatment for low B12 the patient is;
Referred to a cardiologist to ask an opinion on palpitations and this led to a referral to a consultant haematologist
This clinician notes the low B12 and a strong family history of autoimmune disease, sadly this CONSULTANT haematologist ’suspected that the B12 issue was nothing significant; however he repeated the B12 and measured intrinsic factor and parietal cell antibodies…’
When these results came back they were reported ‘FBC was normal, the MCV was only 94 and vitamin B12 was normal at 500. NO mention of intrinsic factor antibodies and parietal cell antibodies.
During pregnancy over a year later the patient was seen in an Obstetric Haematology clinic and the conclusion was that there was ‘no evidence of pernicious anaemia’ despite tests earlier in the year recording the following levels;
• HB 12.3
• MCV 110
• B12 – 192

Note that there is still no folate or ferritin mentioned here.

The patient at this point was discharged from the haematology clinic but was ‘started on vitamin b12 injections with a label of pernicious anaemia, although this was never proven’.

We readers at this point think the patient and her growing baby might at last have the chance after all these years of neglect to be treated correctly,  but as is very common for a B12 deficient patient there is NO COMMON SENSE in the vicinity!

What happens next is that two consultants get their heads together – they ask again for intrinsic factor and parietal cell antibodies to be tested. These results are recorded as ‘normal’ and ‘the vitamin B12 injections are stopped’. Couldn’t you just put your head in your hands and cry? These people are paid vast amounts of money to save lives but they do great harm to B12 deficient patients time and time again!

This poor patient was then retested for B12 another year later and found to have a B12 level of 137, this time someone lets the patient have B12 injections for 3 years, not enough B12 mind, but enough to keep her existing. Low folate is finally mentioned here now but it appears the GP is completely ignorant of the problems associated with folate deficiency too. The summary states that the GP is reluctant to treat with folic acid because of ‘precipitating neuropathy’.  It seems that not one clinician up to now, has given ‘two hoots’ about the neurological damage occurring due to the continual negligence concerning this patients OBVIOUS B12 deficiency induced neurological symptoms.

The notes summary show that the patient is fully aware of the problem her B12 deficiency causes, she rightly asks for loading doses to be given since she has neurological symptoms and knows that this is what the NICE and BNF guidelines dictate.  The way this patient is written about is appalling, at best she is an irritant at worst she is a hypochondriac who requires a mental health diagnosis.

The GP states that since joining the practice the patient has been;
• Seen by a rheumatologist
• Seen by ‘the’ psychiatrists
• Has had advice from haematologists
• Seen by endocrinologist
• Seen a couple of times by neurologists

The GP further states that ALL investigations have been NORMAL the GP goes on – ‘In conclusion I concur with the haematologist that pernicious anaemia has never been proven ……..and that he is inclined to believe the psychiatrist who diagnosed her as having somataform autonomic dysfunction in the form of neurosis. However, at this time I do not think it is just cardiac neurosis I think it is more generalise neurosis.’  The GP continues to be even more patronising in stating ‘I will await the full complement of investigations by the Endocrinologist and the neurologist before taking any further action. It might well be that she will need to be re directed to the psychiatrist …………She is very fixated on vitamin B12 being the cause of all her problems.’

Funny that, the patient is right, she knows that B12 deficiency is indeed the cause of her problems.

If we look at the evidence – this patient has presented with a mass of B12 deficiency and folate deficiency symptoms from a very young age, she has a ’strong’ family history of autoimmune conditions and she has had low serum B12 results and high MCV’s.  It really is very simple if you look in the right place for something and you LISTEN to your patient.

It is very unwise for clinicians to become fixated with inaccurate blood test results which are continually reported as ‘Normal’ despite being miles away from NORMAL. The fact is that there are many causes for B12 deficiency, pernicious anaemia is just one cause. This deficiency is VERY SERIOUS and requires exactly the same treatment whatever the cause!  It is clearly a good bet that pernicious anaemia is the cause in this patient’s case due to the family history of autoimmunity,  just about all the clinicians involved in her care prefer to think it is all in her mind.  This sort of neglect is not an isolated case and just goes to prove how important it is for UK patients to be allowed to buy B12 over the counter in order to be in charge of their own healing.

These clinicians have spent so long trying to prove something which is very difficult to prove in many patients due to the unreliability of diagnostic tests that it has meant that the patient has suffered and continues to suffer. Writing patients off as mentally ill,  when as a clinician you are failing to understand B12 deficiency and it’s affects, is a sign of a very poorly educated doctor.

Doctors please make sure you rule out B12 deficiency FIRST to save your patients from permanent neurological damage and our NHS a fortune!

http://www.b12deficiency.info/what-to-do-next/

Raising awareness; http://www.b12deficiency.info/how-you-can-help/

Pat Kornic’s excellent information on blood tests.

http://www.b12deficiency.info/assets/pat-kornic-testing-f.pdf

Please sign and share our petitions

https://www.change.org/p/dr-margaret-chan-who-niall-dickson-gmc-make-the-study-of-nutritional-deficiencies-comprehensive-and-compulsory-for-our-doctors-in-10-years-of-training-our-doctors-may-never-study-key-information

http://www.change.org/en-GB/petitions/ian-hudson-please-make-our-life-saving-injectable-vitamin-b12-hydroxocobalamin-available-over-the-counter

 

Summary of notes