How Many Patients Diagnosed with Multiple Sclerosis are Really Suffering from B12 Deficiency?

Dr Vernon Coleman

I am convinced that a high proportion of the patients diagnosed with multiple sclerosis are actually suffering from B12 deficiency. I believe that the normal value for the B12 blood test in the UK is wrong and many patients who are told they have no problems are actually deficient in B12. Incidentally, I also believe that taking B12 sublingually once a week is a better and more efficient way of treating B12 deficiency than taking B12 supplements by injection every two or three months.

The following essay is taken from my book `The Dementia Myth’:

`Let me start this chapter with two certainties.

First, it is reliably estimated that between 3% and 5% of the population are deficient in vitamin B12. Some experts put the figure as high as 10% and it is suggested that at least a fifth of all those over the age of 60 have low vitamin B12. The certainty is that vitamin B12 deficiency is an epidemic.

Second, it is an established fact that individuals who are deficient in vitamin B12 are likely to suffer from a wide range of symptoms with dementia being one of the most significant of those symptoms.

So, around the world, how many of the many millions said to be suffering from Alzheimer’s disease are in reality simply vitamin B12 deficient and could be cured with a short course of injections?

Your guess is as good as mine but we have to be talking about several hundred thousand patients in the UK alone. I’d suspect that the real figure is around 500,000.

If I am right that means that Alzheimer’s disease is nowhere near as common as it is said to be and that half a million patients with Alzheimer’s disease could have been cured with a simple two week course of injections.

The symptoms produced by vitamin B12 deficiency are many and varied. Vitamin B12 is absolutely essential for the human body to function properly. (There is an appendix at the back of this book in which I have listed some of the symptoms most commonly associated with vitamin B12 deficiency.)

The symptoms I am most concerned with in this book are obviously those which relate to mental issues – specifically those which could be diagnosed as dementia.

So, why is vitamin B12 deficiency being overlooked?

That’s simple.

There are three simple reasons and one underlying and more complicated reason.

First, most doctors don’t bother to test for vitamin B12 deficiency. There is a cheap and simple blood test available but doctors don’t usually take the trouble to order it. If you don’t test for vitamin B12 deficiency you won’t ever find it.

Second, normal figures vary from laboratory to laboratory. This is lunacy, of course. But it’s what happens. If samples of your blood are sent to two laboratories the chances are that the acceptable ‘normal’ figures will be different.

Third, the laboratories which do the blood tests usually give the wrong ‘normal’ result figures. They have been doing this for years. If a doctor sends a blood sample to a laboratory he will probably be told that a patient is only deficient in vitamin B12 if the result shows a reading of under 180 or so. And that is just plain wrong. It has been reliably established that a patient who has a blood reading of under 350-400 is almost certainly dangerously short of vitamin B12. And the shortage can be remedied with a few very cheap injections of vitamin B12.

When a patient’s vitamin B12 level is down below 350, they will be quite ill. Indeed, at that point a patient will be showing severe signs of deficiency. But the patient won’t be treated until their vitamin B12 level is down below 180.

In its ‘Cobalamin and Folate Guidelines’, the British Committee for Standards in Haematology says: ‘The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status since there is no ‘gold standard’ test to define deficiency’.

Many experts now seem to think that symptoms rather than blood levels should be the deciding factor in deciding treatment. A study of the literature shows a clear conclusion that long-term blood levels probably need to be at least 350-400 and that the standard lab figures for vitamin B12 deficiency are far too low.

An article in the British Journal of Haematology in 2014 (‘Guidelines for the diagnosis and treatment of cobalamin and folate disorders’) suggests that doctors should consider treating patients who have vitamin B12 levels in the ‘low-normal’ range rather than the lower figures still being recommended by laboratories.

My conclusion is that it is a tragedy that laboratories persist in recommending 180 as a trigger point for treatment.

And since local laboratories and GPs like to look at test results before planning treatment (it makes them feel like scientists and gives them something to hold onto when they contemplate the possibility of legal action for malpractice), all the patients whose vitamin B12 levels are shown to be above 180 will be told that they are not short of vitamin B12 but have something else wrong with them.

(The precise figure varies from country to country and, within the NHS, from one district to another. As though to complicate and confuse things still further, different laboratories measure vitamin B12 in different ways. Here, I have quoted figures for pg/ml but vitamin B12 is also measured in pmol/L and ng/L. To avoid all these complications I have chosen the most common figure – which is 180 pg/ml.)

It is not surprising that one recent survey showed that 14% of the patients who were eventually diagnosed with symptoms caused by vitamin B12 deficiency waited more than ten years for the diagnosis to be made. During that decade or more they suffered constantly from mental and physical symptoms and their conditions deteriorated steadily.

And it is not surprising that in a paper published in the British Journal of Haematology, 2014 and entitled ‘Guidelines for the diagnosis and treatment and cobalamin and folate disorders’ the authors (V. Devalia, M. Hamilton and A. Molloy) concluded: ‘We suggest that physicians should consider treating patients who show symptoms but have vitamin B12 levels…in the low-normal range up to approximately 300 pmol/l…’.

That seems to be a decent compromise. The advice seems to me to be: ‘since our recommended blood levels are so useless we suggest that you ignore them and pretty much rely on how the patient feels’.

However, it doesn’t seem as though many doctors know any of this and so older patients who are short of vitamin B12, and who are showing mental signs of being deficient in vitamin B12, are usually just diagnosed as suffering from dementia.

And, of course, the medical default diagnosis for dementia is Alzheimer’s disease.

So the patient gets put into a long stay residential home and is given regular and expensive doses of drugs which won’t do much (if any) good but which are much more profitable than a course of vitamin B12 injections.

Meanwhile, the younger patients who are short of vitamin B12 and who are showing physical signs such as muscle weakness and instability, and probably some mental signs too, will be diagnosed as suffering from multiple sclerosis because that is the default diagnosis for these symptoms in patients under 60 years of age.

And, like Alzheimer’s disease, there is no specific test for multiple sclerosis.

Isn’t that just wonderfully convenient?

And these patients, now labelled as suffering from multiple sclerosis, will either struggle on at home or they will be put into some sort of residential care. And wherever they are they will be prescribed regular and expensive drugs which probably won’t make much if any difference to their condition but which will be hugely profitable for the companies which make them.

(As an aside, is it impossible that all multiple sclerosis patients might be suffering from undiagnosed vitamin B12 deficiency? Both disorders have problems caused by demyelination and the symptoms involved with multiple sclerosis and vitamin B12 deficiency are identical.)

So, that’s how medicine works these days.

This isn’t going to change until a patient sues a laboratory and complains that their misleading reading resulted in a good deal of unnecessary mental and physical suffering.

And there is no doubt that mental and physical suffering occurs.

When a patient’s blood level of vitamin B12 is below 350, their body will already be starting to show signs of damage. And the damage will be serious. Around three quarters of patients with low vitamin B12 will suffer neurological symptoms, for vitamin B12 deficiency causes megaloblastic anaemia and demyelinating disease. (It is the demyelination which means that vitamin B12 shortage leads to symptoms which are identical to those seen with multiple sclerosis.)

If this sounds too awful to be true let me provide you with some evidence.

The New England Journal of Medicine reported in 2013 that patients with B12 deficiency develop demyelinating disease (hence the reason why so many patients are diagnosed as suffering from MS) and that patients frequently complain of muscle weakness, paraesthesia and gait problems.

The Journal of Clinical Psychiatry reported in 2009 that patients who are low in vitamin B12 suffer from neuropsychiatric disorders as well as neuropathy. Specifically listed problems include depression, dementia, auditory hallucinations, suicidal thoughts, mental impairment and psychosis.

Numerous papers in reputable medical journals have established a clear link between vitamin B12 deficiency and psychosis with many reporting that patients with low vitamin B12 may suffer from suicidal thoughts and hallucinations and then be wrongly diagnosed and treated as suffering from schizophrenia.

That’s the bad news.

The good news, of course, is that if patients are given vitamin B12 (usually by a simple, cheap injection) they will get better quickly and their symptoms will be reversed. The injections are given regularly until there is clear improvement in the patient’s symptoms and blood levels need to be monitored regularly.

So, why do doctors not do this simple test? Why are laboratories using the wrong measurements? Why are so many patients being mistreated?

That, I am afraid, takes us to the underlying, complicated reason.

The fact is that the drug companies which control the medical establishment (and which also control much postgraduate medical education and, through their advertising budgets, keep the medical journals alive) know that there is very little profit to be made out of identifying and treating vitamin B12 deficiency. Vitamin supplements and high dose injections are not patented and so they are very cheap. No one makes much money out of them.

I cannot overstress the fact that for many years now the pharmaceutical industry has pretty well owned the medical profession; it has certainly taken out a long lease on the medical establishment. The drug companies control how doctors practice and, most important of all, they control the way that doctors think.

If doctors do not routinely test their patients for vitamin B12 deficiency (and they do not) then a large number of patients who have physical and mental symptoms caused by a shortage of vitamin B12 will be diagnosed as suffering from other conditions – most commonly and most notably Alzheimer’s disease and multiple sclerosis.

Multiple sclerosis is, like Alzheimer’s disease, a disorder for which there is no specific test. It is a diagnosis which ought to be made when all other possibilities have been discounted.

But, these are profitable diseases. Patients with both disorders tend to live a long time. These are truly chronic disorders. And there are drugs available (very expensive drugs) which appear to provide some relief. The drugs don’t cure the disease. The chronic nature of the disease means that patients suffer for years (sometimes for decades). Their symptoms and signs gradually get worse. But the chronic nature of their disease also means that the drug companies make enormous profits out of them.

And so multiple sclerosis is a default diagnosis for thousands of patients – in just the same way that Alzheimer’s disease is a default diagnosis for patients with dementia.

You will not be surprised to learn that, as with Alzheimer’s disease, multiple sclerosis is a disease which has attracted some large charities. And those charities receive a good deal of money from drug companies.

It is impossible to be precise but I would guess that probably half the patients who have been diagnosed as suffering from multiple sclerosis could have been cured if their vitamin B12 levels had been assessed and they had been treated with vitamin B12 injections. I can’t think of a safer medicine with which to treat people. Vitamin B12 is water soluble and any excess is merely excreted in the urine. I haven’t been able to find any evidence of anyone ever dying (or becoming seriously ill) as a result of treatment with vitamin B12. It is that rarest and most wonderful of treatments: a cheap and safe drug.

As I mentioned at the start of this chapter, vitamin B12 deficiency is very common. It affects millions of people. The symptoms of vitamin B12 deficiency vary from patient to patient but include the following: fatigue; weakness, especially in arms and legs; sore tongue; nausea; appetite loss; weight loss; bleeding gums; numbness and tingling in hands and feet; difficulty in maintaining balance; pale lips; pale tongue; pale gums; yellow eyes and skin; shortness of breath; depression; confusion and dementia; headache; poor memory. The first obvious signs of B12 deficiency might be pins and needles or coldness in the hands and feet, fatigue and weakness, poor concentration or even psychosis.

There are many reasons for the deficiency.

Some patients cannot absorb the vitamin (either because of an absence of intrinsic factor in their stomachs or because their small intestines are damaged in some way and cannot absorb it) and some patients are deficient because their diets don’t contain enough of the foods which contain vitamin B12. Since vitamin B12 deficiency is common in those who follow a vegan diet it is likely that the current fashion for veganism will increase the occurrence of vitamin B12 deficiency.

At least one in five people over the age of 60 is likely to have a dangerously low level of vitamin B12 in their blood, but doctors prefer to check cholesterol levels.

Checking cholesterol levels is now hugely popular (and is an industry in itself) and millions of patients who have levels regarded as high are being treated – most commonly with drugs called statins. The drug companies are making an absolute fortune out of drugs prescribed to control cholesterol levels.

There are a few problems with this policy.

First, the evidence showing that cholesterol levels are significant is rather wobbly. And there are a good many independent doctors who believe that cholesterol levels are pretty meaningless. There are even arguments about different types of cholesterol – good cholesterol and bad cholesterol.

Second, there is evidence showing that reducing cholesterol levels can be dangerous. Patients whose cholesterol levels are reduced can become ill. This information isn’t new and it isn’t hidden. Indeed I wrote about it in my book How To Stop Your Doctor Killing You which was first published in 1996.

Third, the drugs most commonly used to reduce cholesterol levels are the statins. And they can cause a number of problems. Once again I wrote about statins in How To Stop Your Doctor Killing You in 1996.

So, here is yet more evidence showing that doctors do tests that are likely to produce evidence which is helpful to drug companies – rather than doing tests to produce evidence which helps patients. The only certainty is that treating cholesterol levels is an enormously profitable business and quite a growth industry.

If doctors really cared about the health of their patients they would leave cholesterol alone and put their effort into testing for the amount of vitamin B12 in the blood.

Taken from The Dementia Myth by Vernon Coleman. To purchase a copy CLICK HERE

Copyright Vernon Coleman November 2023