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I am an MD, a nutritional physician, and a psychiatrist (Canadian-board-certified) who has been studying vitamin B12 extensively since 1976, and applying that knowledge in my private nutritional, metabolic and psychiatric practice in Tucson AZ since 1994 (and Portsmouth VA before that). 

This book is an outstanding compilation of anecdotes, references and experiences on the "underground devastator" of our society. The reason why this is not common knowledge in the medical profession in the US is because the laboratory "normal range" is way too low. In Japan the range is 2.5 times higher at its low end - and Japan has very little "Alzheimer's Dementia", and less depression and bipolar disorders, than we do in the US. 

In the 26 years that I have been investigating B12, memory disorders and depressive/ bipolar illnesses, NO patient who came to me with a memory problem (early Alzheimer's) has gone on to Alzheimer's dementia, and I have a near-perfect track record in helping people overcome depression and bipolar disorders. These outcomes are largely due to my permanent optimization of every patient's serum B12 level. 

Congratulations to Ms Sally Pacholok RN on an outstanding recording of most of the important facts and treatments for this serious condition. I believe it to be the best book out there for a combination of both medical and lay readers on this condition. 

[To anyone reading this review: Please do not simply go and buy B12 tablets or lozenges and start taking them, before getting an accurate serum level measured.] 

John V Dommisse MD, MBChB, FRCP(C) 
Tucson, AZ, USA 

Could it Be B12, An Epidemic of MisDiagnoses by Sally M. Pacholok R.N. and Jeffrey J Stuart D.O. 

A good friend of ours had a sudden unrelenting pain in her leg which baffled her doctors. After many months of suffering, and many failed treatments and medications, she tried inexpensive vitamin B12 injections which immediately worked, providing complete relief. Occasionally the pain returns and reminds her it's time for another B12 injection. The injections are easy with a small syringe and tiny needle, and the B12 is injected under the skin twice a week. 

There are many more stories of B12 misdiagnosis in Pacholok's book. Nurse Pacholok first describes her own ordeal with pernicious anemia and B12 deficiency which motivated her to become an expert on the topic. Working within the health care system, she was appalled at the numbers of patients with obvious signs and symptoms of B12 deficiency who were misdiagnosed. 

Finding the medical system apathetic and unresponsive to her advice about B12 deficiency, Pacholok wrote this book to empower medical consumers and to educate their physicians. Pacholok is on a crusade to change medical practice to routinely screen for B12 deficiency, and her book is one giant step in that direction. 

Vitamin B12 deficiency is estimated to affect 10%-15% of individuals over the age of 60 years. 40% of elderly hospitalized patients have low or borderline serum B12 levels, and 50% of long term vegetarians have B12 deficiency. 

B12 absorption depends on many cofactors, so it is possible to take adequate amounts of B12 in the diet, and still have a B12 deficiency. Absorption of B12 requires gastric acid, so anything which reduces gastric acid production such as gastric surgery, atrophic gastritis, or antacid drugs could produce B12 deficiency. The very popular antacid drug Prilosec (omeprazole) has been clearly shown to decrease B12 absorption. Other antacid pills such as Prevacid, Protonix, antac, Nexium, Aciphex, Zantec, Tagamet, Pepcid, Maalox, mylanta, reduce gastric acid, inhibit B12 absorption and may produce B12 deficiency. Drugs such as Metformin and other diabetes drugs can cause B12 deficiency. The anesthetic agent, Nitrous Oxide, or "laughing gas", used in dental or surgical procedures causes B12 deficiency 

Pernicious anemia is the second most common cause of B12 deficiency. This is an autoimmune disease with loss of Intrinsic Factor, in which antibodies damage the stomach lining interrupting the B12 absorption mechanism. 

Other people at risk for B12 deficiency include vegetarians, people with eating disorders such as bulemia and anorexia, inflammatory bowel disease with malabsorption (ie. crohn's). 

Auto-immune diseases such as Hashimoto's thyroiditis may be associated with B12 deficiency(pernicious anemia). 

Vitamin B12 deficiency can cause unusual neurological symptoms such as tremor, gait disturbance, severe pain, and can mimic MS (multiple sclerosis) or even Parkinson's Syndrome. The physical signs and symptoms can often mimic other diseases and the diagnosis is frequently missed. 

B12 deficiency damages the myelin sheath around the nerve fibers, this is a soft fatty insulating material which is also damaged in demyelinating diseases such as multiple sclerosis. 

B12 deficiency can cause mental changes such as irritability, apathy, sleepiness, paranoia, personality changes, depression (including post-partum depression), memory loss, dementia, cognitive dysfunction or deterioration, fuzzy thinking, psychosis, dementia, hallucinations, violent behavior, in children; autistic behavior, developmental delay. 

B12 deficiency can cause neurological signs and symptoms of abnormal sensations (pain, tingling, and/or numbness of legs, arms trunk or anywhere),diminished sense of touch, pain or temperature (may mimic diabetic neuropathy Charcot foot), loss of position sense, weakness, clumsiness, tremor, any symptoms which may mimic parkinson's or multiple sclerosis, spasticity of muscles, incontinence, paralysis, vision changes, damage to optic nerve (optic neuritis). 

Atherosclerotic vascular disease is increased by B12 deficiency including; Coronary artery disease, TIAs, CVA, heart attack, heart failure, claudication, all associated with elevated homocysteine levels caused by B12 deficiency. 

B12 deficiency causes Megaloblastic Anemia (enlarged red blood cells with anemia). In this type of anemia, the red blood cells are fewer in number, yet they are larger in diameter (this large size is called megaloblastic and is measured on the CBC with the mean corpuscular volume, MCV). The anemia can cause fatigue, and weakness. 

Cervical Dysplasia and increased risk for other dysplasias and cancers are associated with B12 deficiency. B12 supplementation is cancer prevention. 

Most doctors do not test for B12, and if they do a test it is the serum B12 which may be unreliable because of the wide normal range. A more accurate test, urinary methyl malonic acid was developed by Eric Norman MD, and is inexpensive and widely available (MMA). The Methyl Malonic Acid MMA is elevated in the urine and serum in patients with B12 deficiency. Pacholok makes the case that everyone presenting for medical care should be routinely screened for B12 deficiency with the MMA, serum B12 and Homocysteine tests. 

Treatment is Curative: 

Treatment with inexpensive B12 injections or sublingual tablets is curative. Recent work by Kuzminski showed that daily 2 mg. oral B12 serves as well as monthly 1 mg intramuscular B12 injections. Serum Homocysteine is elevated in B12 deficiency. It is important to discover B12 deficiency early, since nerve damage can be irreversible if not discovered right away. 

In conclusion, this is the definitive book on B12 deficiency, diagnosis and treatment for the lay reader and for the interested physician. As a result of reading this book, I now routinely test serum B12 and Urinary MMA on ALL patients, and have been surprised to find many symptomatic B12 deficient patients completely missed by the medical system. Needles to say, it is very gratifying to see ill patients completely recover with B12 injections. 

I applaud the authors on a job well done, bringing B12 deficiency to the attention of the public, and no doubt saving many lives in the process. This book will make a positive impact on the nations's health, and change medical practice for the better. The only thing I would change about the book is to give Sally a name that is easier to pronounce. 

Jeffrey Dach MD 

As a primary care physician I read Ms. Pacholok's book "Could It 
Be B12?" with great interest. In the early 1950's a vitamin B12 shot was a sign-off gesture by many primary care doctors at the close of a Pt's visit. It seemed as though everyone got a B12 shot for no apparent documented reason. You must understand that laboratory testing in those days was awkward, expensive, and impractical. My own mother went monthly to our family GP for her routine B12 shot. She swore by it. As progress in medicine was made it became apparent that either the United States was the world's capital of pernicious anemia or perhaps B12 shots were a doctor's way to make a fast buck. With this type of prevailing sentiment anyone who wanted to be taken seriously as an ethical physician shunned the practice of "routine" Vitamin B12 shots. I do believe this stigma prevails to this day. Just mention B12 deficiency as a possible cause for any disorder and you're likely to see a smirk come across the doctor's face as those mental neurons flash back in recollection of those charlatans of an earlier era. But now unlike then we have an easily obtainable and accurate test for Vitamin B12 deficiency. I do believe medicine's nihilistic attitude toward B12 based on the past makes for a mental block on behalf of a lot of doctors to even consider B12 deficiency on their list of differential diagnoses. This is unfortunate. My only advice to the public is as Ms. Pacholok advocates: 1. Avoid shot gun B12 therapy; 2. Insist that you and your loved ones with signs and symptoms get tested. It's the right thing to do. I enjoyed the book and give it a 5 star rating. 
Dr. Anonymous 

"Could It Be B12?" saved my son from a future of mental retardation and a sub-par life. We caught Jack's B12 deficiency in its early stages, thanks to this book. Unfortunately, because many of the horrific side effects of a B-12 deficiency hadn't yet completely manifested, we got dismissed by many doctors. They were looking for telltale signs of prolonged B12 deficiency (enlarged mean corpuscular volume (MCV) and anaemia) though these are only present when B12 has wreaked permanant havoc on the body; I was only too glad that we discovered Jack's deficiency BEFORE we reached this stage. 

The doctors are sadly very uninterested in vitamins (they aren't "pushed" by huge pharmaceutical companies with drug reps who take our doctors golfing on a weekly basis) and feel they are too simplistic, in many ways, to cause the significant damage that they do, when a person is deficient. Interesting though that medical history is full of diseases that are solely caused by vitamin deficiency: beri-beri, pellegra, kashiworka (sp?), scurvy, etc. Vitamin deficiencies most definitely can cause disease, and certainly death. 

Without a doubt, B12 is a vitamin that is essential to life and wellbeing; it serves the Central Nervous System (of which our brain is a part) and the circulatory system (red blood cells); B12 is necessary for BRAIN AND BLOOD. B12 deficiency can cause such terrible symptoms as outlined in this book (the list is literally too long to include). Our son, specifically, was developing a trend toward microcephaly - his head circumference was dropping growth curves. HIS BRAIN WAS NOT GROWING. His B-12 level was only mildly low, and his MMA was definitely elevated, but not nearly the highest the "specialists" had seen - they were happy to nod dismissively at us and push us out the door. I was infuriated, of course. Jack was not developing mentally as he should and was beginning to miss milestones. But, at 7-9 months of age, this is all very subjective. We changed his diet to a B-12 rich one (with meat, eggs, cheese, and milk) and we got a series of hydroxycobalamin injections - his head jumped up on the growth chart, and he started waving, pointing, holding the phone to his ear, etc. 

But, then we went to a miniscule "maintenance" dose of B12 and his head started falling growth curves again, his development again slowed (as noted by his physical therapist). I went to specialist after specialist, telling them he needed more B12, and they are all so DISGUSTINGLY unfamiliar with B12 deficiency that they were scratching their heads, and said we must have mismeasured his head time and again. This scares me to the bone. I am SURE there are other babies out there with small heads, with brains that should grown, but aren't able to do because they are deficient in B12, who will live sad lives as mentally challenged people, FOR NO REASON, and with a simple cure of added B12 by oral supplement (in high doses), or injections, and diet changes to B12 rich foods. 

As B12 deficiency progresses, it leads to definite microcephaly, and if it goes on too long, when and if B12 treatment is finally administered, the brain will definitely grow (proving B12's role in brain growth), but the brain damage cannot be corrected - it is permanent, and was never meant to be, not genetically written in stone, but just because B12 was deficient - a completely fixable condition - isn't that TRAGIC? 

I am ever hopeful that we caught Jack's deficieny in time. As I watched his head circumference percentiles dropping again, I went back to the doctors. I could get no doctor to up Jack's tiny dose of B12, though they all agreed you cannot overdose on B12 and too much is not harmful in any way; they were just ignorant, and decided since they didn't know about B12 it must not be a problem; we've all heard of the God-complex. 

Fortunately, B12 is available at health food stores, and I began adding it to his bottles. His head steadily grew from the 8th percentile to now between the 23 and 25th where it has remained for the last 5-6 months. We were on a downward trend (I graphed his head circumference percentiles) leading to a mentally retarded child with permanent brain damage. Without this book, I would not have been able to help my son. He will remain on B12 supplementation for the rest of his life, and will always eat B12 rich foods in my house. 

I thank God for Sally and her book; I feel that it was placed in our hands for a reason, part of which was to help our son, part of which was to help others learn about B12 deficiency and its crucial role in health and well being and DEVELOPMENT! I actively try to educate parents, because there is no reason for some of the brain damage that is occuring in babies and children out there - it shouldn't be happening, and it is! 

There isn't a person out there who should think they don't need this book. You CANNOT and SHOULD NOT think your doctor will know enough about this to keep on top of it. Doctors are just people, and they make mistakes each day. 

Sally Pacholok and her husband, Jeffrey Stuart, have done us all a remarkable kindness in authoring this book, and continuing their crusade to educate doctors and improve medical practice on the front of B12. I would urge you not to wait for them to catch up, though, but to read this book and take charge of your own health. You, too, might feel compelled to spread the news. 

Thank-you for listening to our story, and best wishes, 
Kelly 
(Jack's mom)

Recently I was diagnosed with B12 deficiency, after struggling with anemia, exhaustion, and a decreased immune system for much of my 20's. I can hardly believe what a difference B12 shots have made in my life. I'm half Scandinavian, and at least one of my Norwegian cousins has this deficiency, too, which can run in families. I have been researching everything I could find on B12 deficiency. Sally Pacholok, RN, and her husband, Jeffery Stuart, DO, have written a well-researched book on the symptoms, diagnostic tests, and treatment for B12. I wish the book dealt a little more with some of the recovery process, but the book is very thorough and well-researched. 

The 13 chapters are as follows: 
1. An Invisible Epidemic 
2. Is It Aging--or Is It B12 Deficiency? 
3. Deadly Mimic: When B12 Deficiency Masquerades as Multiple Sclerosis or Other Neurological Disorders 
4. Am I Losing My Mind? When B12 Deficiency Causes Mental Illness 
5. Stroke, Heart Disease, and Other Vascular Problems: The B12-Homocysteine Connection 
6. Lost Children: When B12 Deficiency Causes Developmental Disabilities or Learning Problems 
7. Vitamin B12 and Cancer, Impaired Immune Function, and Autoimmune Disease 
8. Under the Knife: Why Low B12 Levels Make Surgery Dangerous 
9. Can't Conceive? How B12 Deficiency Contributes to Male and Female Infertility 
10. Protecting Yourself: Are You at Risk for Vitamin B12 Deficiency?
11. Information for Physicians 
12. Speculation: The Possible Role of Vitamin B12 in Autism 
13. A Call for a United Effort 

This book is well-written, interspersing case studies/stories with research, and is a fairly easy read. If you have B12 deficiency, or have family or patients with B12 deficiency, this book is highly recommended. 

Before the availability of the internet for easier research, I never found a good explanation of the workings of B12 in the body (for non-medically-trained people to understand). Most of the physicians I encountered had no good working knowledge of Pernicious Anemia. 

This book is an excellent reference for how B12 works, why it is essential that it be absorbed properly, and a long list of other considerations, including possible serious wrong diagnoses, in which B12 mal-absorption should be examined. 

Other reviewers have pointed out the readability, devotion to accuracy, and the helpful tone of this useful book. If you or a loved one has any condition related to B12, I think you will be glad to read this book. For some of us, this knowledge will make the difference between a healthy life and a miserable one.

I can say in all honesty that this book saved my life. No really...it really really did. After four and a half years of expensive heart tests and taking doctor prescribed cardio drugs I was getting progressively weaker and weaker - to the point where I was so weak that it was difficult to walk across the room anymore and my heart fluttered and leaped (palpitations)and raced constantly. The heart racing constantly woke me up at night and I could not get enough sleep and it raced and palpitated after meals making me not even want to eat anymore - even through I had to eat constantly because of terrible hypoglycemic symptoms and high blood sugar at times. I had constant panic attacks and shaking and trembling of my arms/hands and legs. The doctors I consulted said I was anxious and that I needed to calm down and basically poo-pooed my symptoms and treated me like a hysterical female. They said my symptoms were caused by Supra Ventricular Tachyacardia (SVT), hypoglycemia, menopause, hypothyroid(?), you name it...I was given a plethoria of drugs and sent home while I continued to decline in health and morale. My life had become unbearable but still I struggled on - until I came across this most excellent and wonderful book. I asked my internist to please test me for B12 deficiency and guess what - I was pretty badly deficient. I do not even take the B12 shots - I started taking the oral (sublingual) pills dissolved under my tongue and now three months later I am like a new person. My symptoms are either totally gone or hugely diminished. I am so grateful that the heart symptoms and the hypoglycemia symptoms are totally gone and I can actually sleep through the night and walk across the room without my legs trembling and without falling down - and all of my panic attack symptoms completely vanished. When I went back and told my docotr this she acted like she didn't believe me - but it is all too true. 
The scary part is that if allowed to continue my symptoms would have become permanent. In my home state a woman recently sued her doctors for allowing her to become permently disabled and wheelchair bound for the rest of her life - all because of a B12 deficiency not diagnosed...so please read this book. It made all the difference in my life...love, good health and blessings to everyone.

Not long ago I was suffering from occasional memory loss, tremors, and was having difficulty with thinking clearly...and I'm only 45. Eventually my speech was also affected and I started to have trouble finding the exact words that I wanted to say. With all of these symptoms, seeing a neurologist was a logical step. Since my MRI was normal, she ordered additional testing but also wanted to test my Vitamin B12 level, since low levels can cause memory loss. That lab made all the difference in the world and it came back that I have Vitamin B12 deficiency. 

Vitamin B12 deficiency is more serious than you think, and if you read this book, you'll find out why. This deficiency mimics many diseases that may or may not sound familiar: memory loss, forgetfulness, tremors, depression, psychosis, fatigue, infertility, and gastrointestinal problems, just to name a few. All it takes is a simple blood test to find out. 

The good news is that B12 deficiency is treatable, curable (in most cases) and inexpensive to treat. After being treated for the past few months I have recovered between 85-90%, so there is hope! Time is an important factor though--if you have B12 deficiency and do not treat it, the damage that it does can be permanent, so early treatment is the key. 

I urge anyone who has these symptoms to get this simple test and read this book. It could change your life or someone you love. 

A Jan 2009 follow-up: 
It has now been a few years since I was initially diagnosed and am doing well. I can always tell if I am running low on my levels (a rarity) because one of the first signs is difficulty with finding the right words. Initially I was found to be allergic to the injectable form of cyanocobalamin (severe rash) and so I had to switch to oral (sublingual form) Methylcobalamin, a very effective form of B12. Taking between 2-3 tabs (2-3 mg or 2000-3000mcgs) have kept my levels normal for years. This is a lifelong deal. Once, when I went off my B12 for testing and other purposes, my levels plunged by more than half in just one week, so always make sure you take your B12 daily.

Many puzzling medical cases could have been solved with careful screening for B12 deficiency. As a physician, I am ashamed to admit that we've overlooked B12 problems or just dismissed the possibility that something so simple could have such devaststing consequences. This book should be a staple on the shelves of all medical libraries and offices, as it reminds us to start simple when trying to make a diagnosis.