B12 has an important role in DNA synthesis and the production of red blood cells. In the form of Hydroxocobalamin, it has an exceptional ability to identify and bind to toxins in the body, removing them in urine and sacrificing itself in the process. This is demonstrated in the use of Cyanokit which is an intravenous 5g dose of hydroxocobalamin licensed for use as an antidote to cyanide poisoning.
Nitrous Oxide (N20, ‘Laughing gas’)
The effects of prolonged use of nitrous oxide during labour, in an undiagnosed B12 deficient mother can have devastating consequences including rapid neuropsychiatric deterioration. This gas irreversibly oxidises the cobalt ion of B12 from the +1 active state to the +2 and +3 inactive states rendering it useless to the body. The increased use of this gas recreationally ('hippy crack’/‘whippets') and associated deaths are unfortunately rarely connected to B12 depletion, despite the many journals documenting the effect of nitrous oxide on B12 levels.
Carbon monoxide (CO)
For six years Belinda Goldsmid and her family were chronically exposed to products of combustion, including carbon monoxide (CO). It was leaking into their home from a poorly installed and situated boiler flue. This had devastating health and social effects. When Belinda contacted me she was being significantly under treated for her neurological symptoms of B12 deficiency caused by, or exacerbated by, this prolonged exposure. Once armed with information from the site, Belinda was able to access correct treatment and is now experiencing phenomenal improvement of her previous debilitating symptoms. Belinda asked for my help in finding research papers documenting the use of B12 as a treatment for toxic exposure, including the silent killer carbon monoxide. That request resulted in this important addition to the site.
Carbon monoxide (CO) binds to haemoglobin molecules in red blood cells. Blood cells contaminated with CO are unable to transport oxygen and this causes damage to the brain and heart and organs start to die through lack of oxygen. Oxygen therapy is given in order to displace CO from the haemoglobin.
NICE Guidelines recommend only oxygen therapy for victims of Carbon Monoxide poisoning, but what you read here will show that it’s time for an urgent update.
Are you being exposed?
Could you be an unknowing victim of carbon monoxide poisoning or other gas, chemical or mould toxin? Has your pet become ill or died unexpectedly? Do you have a diagnosis of fibromyalgia, CFS, ME, dementia, psychosis, Parkinson’s, Alzheimer’s, paralysis? These diagnosis may have been arrived at due to the symptoms caused by toxins and the resulting lack of vitamin B12.
Toxic exposure can cause death and at lower levels these gases can be difficult to detect, silently causing severe damage to health.
If you feel much better when outside of your home/workplace then it would be very wise to have all heating and cooking appliances/flues checked and to install a high quality CO alarm in your property. If you haven’t had B12 deficiency thoroughly explored then this would be advised too. There are many charities working hard to raise awareness of Carbon monoxide poisoning.
The similarities of the symptoms of poison victims and B12 deficient patients are profound. This is due to the resulting behaviour of B12 and other antioxidants when toxins are present. This unfortunately increases the potential for misdiagnosis.
If an undiagnosed B12 deficient patient is poisoned by carbon monoxide or other toxin it may mean that health decline in an already compromised system, is accelerated further than in a patient who doesn't have an underlying B12 deficiency. If toxic exposure is the sole reason for B12 deficiency, hopefully this would mean that once the deficiency is corrected and symptoms are reversed that recovery is complete. For patients who have methylation problems or other causes for B12 deficiency then treatment is for life.
Potential for misdiagnosis
Poison victims face the same problems with achieving a diagnosis as B12 deficient patients since the low level of knowledge of toxicology appears to be on a par with that of B12 deficiency amongst health care professionals. Toxic gases which have a severe effect on health may have left the body before they can be detected in blood or breath, or because these detection methods do not feature on the doctor's radar. Healthcare professionals may not have been taught to recognise the symptoms and the patient may also be totally unaware of being poisoned.
Patients who are exposed to toxins and B12 deficient patients present with many overlapping symptoms. Due to lack of knowledge, the manifestation of these symptoms which are often viewed as ’non-specific’, such as depression, chronic fatigue, or chronic pain, may make it difficult for GP's to diagnose correctly. Consequently these patients might never be screened for B12 deficiency. The situation is not helped by these particularly harmful NICE Guideline - Do Not Do Recommendations which further compound the problem.
This makes the potential for misdiagnosis and subsequent incorrect treatment incredibly high. Poison victims may be labelled as ‘heartsink’ patients by their doctors due to their relentless quest for an answer to their puzzling health problems.
An added complication in achieving a correct diagnosis is that the serum B12 test does not differentiate between active and inactive B12, the toxin may have inactivated the available B12 in the body, rendering it useless, but this test result could still unfortunately, record a ‘within range’ level.
If the patient is known to have been poisoned by cyanide, carbon monoxide or other B12 depleting toxins they should be treated with hydroxocobalamin immediately as delayed treatment can cause irreversible damage. Victims should not be subjected to rigorous and time consuming testing to see whether B12 levels are low. As already stated If B12 is inactivated serum B12 levels may well appear to be ‘within range’ making this an unreliable diagnostic tool, MMA and homocysteine levels would be more reliable and a vitamin panel, heavy metal testing and as you will see below, Testing Nitric oxide levels would be very helpful.
The connection between toxins, B12 and Glutathione and the key villain in this story - Peroxynitrite.
A common factor in toxin poisoned victims and patients with chronic disease diagnoses, is excess Nitric Oxide, (NO) (not to be confused with nitrous oxide - N2O) Excess NO is peroxynitrite (ONOO-). Nitric oxide is a free radical which is essential to every cell. However when it is produced in excess, it’s incredibly harmful. This excess occurs when it combines with another free radical - Superoxide (02) to form peroxynitrite (ONOO-)
Peroxynitrite is highly toxic and causes mitochondrial damage. Research shows that high levels of Nitric oxide and peroxynitrite, are found in toxin poisoned victims and in many patients with chronic illnesses.
I have listed just a few conditions here and it's interesting to note that many of these have a relationship to both the symptoms and the common misdiagnoses of B12 deficiency.
Methlylation cycle blocks
You may have read about the NO/ONOO- relationship in CFS and ME diagnoses.
What is important to note here, is that Hydroxycobalamin is one of the most powerful scavengers of peroxynitrite (ONOO-) and the other important factor is B12 and its relationship with the amino acid glutathione. Glutathione is the most powerful antioxidant synthesised in the human body but it becomes depleted because it too scavenges peroxynitrite removing it from cells and excreting this harmful product in urine.
Glutathione is present in every cell in the body and is produced by the methylation cycle from methionine. In simple terms B12 is required as a co factor by the enzyme methionine synthase, this enzyme which is responsible for the regeneration of methionine from the amino acid homocysteine from which glutathione is eventually produced. When there isn’t enough B12 and folate, the activity of methionine synthase is affected and blocks the methylation cycle causing homocysteine to rise and a further block in folate metabolism, this means glutathione cannot be recycled or produced and remains depleted. (There are many biochemical exchanges involved in this complex process which I have not detailed here in order to keep this simple!)
So, the presence of Peroxynitrite reduces levels of both B12, and glutathione in the body as a direct result of their scavenging properties. In an undiagnosed B12 deficient patient or a poison victim this system causes terrible problems as the methylation cycle (which happens in every cell) requires enough B12, folate and B6 in order to produce glutathione from methionine. If B12 is not replaced then methylation is blocked and damage occurs unchecked.
Prescriptions of pharmaceutical drugs will never replace B12, however, aggressive treatment with hydroxocobalamin injections would give these patients the best chance of recovery and a return to normal life and health. Unfortunately without significant training for our doctors in either toxicology or nutrition (specifically B12 deficiency) the current situation means that these patients are slipping though a huge hole in this net, totally undetected. Many of our homeless are continually exposed to carbon monoxide from pollution day and night.
Many nutrients (vitamin C, magnesium etc) have antioxidant properties and are also depleted in poison victims. Although B12 may not be the whole story, it is certainly an excellent place to start. B12 works hand in hand with folate and other members of the family of B vitamins which are also known detoxifiers.
I hope this page help helps victims of toxic exposure in the home/workplace, through flood, fire, warfare or pollution, to access the treatment they need and to help healthcare professionals to understand that hydroxocobalamin could be the antidote for them.
If you know of anybody who may have been affected in this way please share this page and the What to do next page with them.
If you are a clinician reading this and you want to know more, please consider attending our conference. You will gain a wealth of information on B12, methylation and thyroid and how you can recognise their effects in your patients. Patients are also invited.
If you are a patient needing help in monitoring symptoms, or if you are a researcher with a study in mind based upon this information you might find our app really useful.
B12 The Antidote - References pdf