Last year, on the 4th annual low-carb cruise, my wife picked up a book by Sally Pacholok, R.N., B.S.N., and Jeffry Stuart, D.O., entitled Could it be B12? It looked pretty interesting, so I ended up reading it before she did. I was pretty skeptical about the subject of the book (subtitle: “An Epidemic of Misdiagnoses”), but as I delved into the book, I concluded, despite the anecdotal nature of most of the evidence cited, that the authors had an important point to make.
The book is a little over 300 pages long, which is a bit longer than it really needs to be. However, that is not to say that the information is unimportant, only that the core message could easily be expressed in fewer words, and I will make an attempt to do exactly that right here.
Vitamin B12 is an essential vitamin of which the human body needs a relatively tiny amount. However, without that tiny amount of B12, the body does not function well, and exhibits symptoms that are commonly confused with other diseases, many of which are incurable. Profound B12 deficiency is crippling and life-threatening, but even sub-clinical deficiencies lead to disorders that severely lower quality of life. The book provides a very long (and very scary) list of disorders attributed to “gray zone” B12 levels. The authors contend that B12 deficiencies are not at all rare, especially in people who follow a vegetarian or vegan diet. You don’t even have to be on a vegan diet to have a deficiency, however. Just being over 60 or having bariatric surgery puts you at risk for B12 deficiency. There are also some other problems which contribute to B12 malabsorption, such as celiac disease or Crohn’s disease.
Vitamin B12 deficiency is relatively easy and inexpensive to diagnose. The 3 tests that together consistently and reliably identify B12 deficiency cost roughly $400, and the treatment for B12 deficiency is typically less than $200 per year even for extreme cases. If the author’s numbers are correct, then merely screening every patient with a preliminary diagnosis of Multiple Sclerosis would identify the 0.4% of those folks whose problem is not actually MS, and is easily correctable with B12 therapy. This would save more than 10,000 times the cost of B12 screening in MS treatments alone. That’s pretty significant. Just screening everyone yearly after age 60 for B12 deficiency could potentially save billions (with a B) of dollars in hospital, hospice, and nursing home expenses. Here, the payback can be better than 100,000 times the screening expense. That’s just the financial savings, and doesn’t consider improvement in the quality of life.
Since B12 treatment is cheap and completely harmless for those who don’t actually need it, it would seem that B12 supplementation would be something to simply do as a matter of routine for anybody who isn’t at the top of his or her game. However, that is not the case — although it used to be! (I can clearly recall my family doctor giving me a B12 shot just because I was feeling “under the weather.”) However, while widespread usage of B12 for that sort of thing became regarded as a placebo and a waste of money. Insurance companies began refusing to pay for B12 treatments, so doctors now avoid giving B12 injections even when they are clearly indicated.
Based on that, it would seem that the thing to do would be to simply get a high-dosage oral B12 supplement, which is available without a prescription, and start taking that. The authors contend that is a bad idea for several reasons. You might not need it, and in that case, it would be an unneeded (if otherwise harmless) expense. Another reason is that in the case of a severe deficiency, injections are far more effective (and not much more expensive). The authors also contend that self-diagnosis and treatment might actually make it more difficult to diagnose a B12 deficiency, and would deprive the rest of the world of some important data even if the diagnosis is correct and B12 supplements are needed.
My take on that last reason is that the medical profession is typically ignorant of B12 problems, and so extremely reluctant to prescribe it, that self-medication might be a reasonable thing to do. Plus, do you really want your insurance company to know that you have a health problem, especially one that is potentially life-threatening or crippling? Even if easily and inexpensively treated? My experience with that sort of thing is that the insurance companies definitely want to exclude coverage for anything that might actually happen. Worse, insurance companies routinely scour your medical records for anything that might be used to deny a claim. Here is a personal example of that: When my father died, a life insurance company from which he had bought a “burial policy” went back through his medical records to find a combination of prescriptions that they claimed was indicative of COPD, and denied the death claim, even though that had nothing to do with his cause of death.
Take-home lesson: What my insurance company doesn’t know can’t hurt me.
I give this book a lukewarm recommendation, mostly because (as I already mentioned) it is longer than it needs to be, and goes into gory detail about hundreds of anecdotal cases, which gets to be tiresomely redundant after a while. As real scientists are fond of saying, “the plural of anecdote is not data.” On the positive side, the book is inexpensive, it’s an easy read (if you skip over the hundreds of references), and the information is important, if only as the basis for encouraging collection of real data in the form of clinical trials.
P.S. Shortly after I read the book, I experimented with taking large-dose oral B12 myself just to see if it made any difference. I was surprised to discover a remarkable improvement in my hearing (link is to my violin-teaching blog).