Giving You Back YOUR Life

BOOK Vitamin B12 deficiency in clinical practice - Book - Table of Contents

If you are looking for a particular Case Study or Table, then check this page to work out which chapter to download.

Note that the first number in the tble or case study number is the chapter number - so "Figure i-" are in the Introduction, "Case 2" are in Chapter 2, and "Table A2" are in the appendices (appendix 2).  The page numbers are also given

 

Patient brief case studies

Case 2-1 Neuropsychiatric symptoms and alopecia. 53

Case 2-2 Lupus, rheumatoid arthritis and Raynaud’s disease. 54

Case 3-1 Benefit of therapeutic trial in a case of Bell’s Palsy. 71

Case 3-2 Example of patient needing unusually high number of loading doses. 72

Case 3-3 Oral treatment inadequate: injections needed. 73

Case 4-1 Gastrointestinal symptoms and speech difficulties. 94

Case 4-2 Difficulty swallowing, weight loss, fatigue and depression. 95

Case 5-1 Teenage female: delayed periods. 104

Case 5-2 Cardiomyopathy and mitral-aortic defect in pregnant mother 105

Case 5-3 Vital role of vitamin B12 and folic acid in fertility. 105

Case 5-4 Vegetarian mother from London. 107

Case 5-5 Neural tube defect in severe vitamin B12 deficiency. 110

Case 5-6 Child treated and mother diagnosed. 114

Case 5-7 Vitamin B12 deficiency in the Mason family. 116

Case 5-8 Mother champions the case for her daughters. 117

Case 5-9 Inherited vitamin B12 deficiency in the Storey family. 118

Case 5-10 The inheritance of deficiency across four generations. 119

Case 6-1 SACD - not stroke or MS (Chelsea Chicken) 139

Case 6-2 Left oculomotor nerve paralysis. 140

Case 6-3 “Incurable with various symptoms” – Brenda Berry. 140

Case 6-4 MS/SACD - three different presentations in same family. 143

Case 6-5 MS-like presentation - Wendy Imms. 145

Case 6-6 When it’s hard to go on - Linda Skilton. 145

Case 6-7 Lhermitte's Sign - shooting pain. 149

Case 6-8 Glossopharyngeal nerve pathology causing persistent cough. 149

Case 7-1 Vitamin B12 deficiency with two autoimmune conditions. 166

Case 7-2 Common immunodeficiency. 167

Case 7-3 Importance of timely intervention in hypoadrenalism.. 170

Case 7-4 End-stage Addisonian Crisis presentation. 174

Case 7-5 Classic case of APS: Angela Abraham.. 182

Case 7-6 Undiagnosed APS with hypoadrenalism leading to irreversible damage: Leanne Walker (née Chandy) 185

Case 7-7 Rapid results from treatment – vitamin B12 deficiency and hypoadrenalism.. 189

Case 8-1 Neuropsychiatric symptoms prominent 197

List of Tables

Table i-1 The order of importance of components vital to life. 1

Table i-2 Relationship between B12 and folate levels in blood serum measurements. 7

Table 1-1 Physiologic roles and deficiency signs of B-complex vitamins. 28

Table 1-2 The most commonly used forms of B12 attached to different ions. 29

Table 2-1 One Minute Health Check. 57

Table 3-1 Recommended daily amounts of vitamin B12. 78

Table 3-2 How long does it take for symptoms to heal?. 79

Table 5-1 Supplementation with vitamin B12: current UK guidance. 120

Table 5-2 Characteristics of vitamin B12 and folate (vitamin B9) deficiency. 122

Table 5-3 Suggested specific vitamin B12 replacement for the pregnant mother 128

Table 6-1 Some possible inadvertent misdiagnoses of SACD.. 137

Table 6-2 Comparison of Multiple Sclerosis and vitamin B12 deficiency symptoms. 150

Table 7-1 Prevalence of vitamin B12 deficiency and myxoedema among patients with hypoadrenalism, 1981-2014. 163

Table 7-2 Blood levels of cortisol and ACTH.. 178

Table 7-3 Hypoadrenalism: Stages of disease progression. 178

Table 7-4 Angela Abraham – timeline summary. 184

Table 7-5 Leanne Walker (née Chandy) – timeline summary. 187

Table 8-1 Comparison of characteristics of dementia and vitamin B12 deficiency. 202

Table A1-1 Confirming B12 deficiency. 260

Table A1-2 One Minute Health Check symptoms. 264

Table A2-1 Diagnosis using results of symptoms table – please circle condition and cortisol level to diagnose stage. 268

Table A2-2 Stage 3 dose of hydrocortisone. 270

Table A2-3 Stage 5 dose of hydrocortisone. 272

Table A2-4 Stage 6 dose of hydrocortisone. 273

List of Figures

All figures drawn and © by the author (Hugo Minney) unless otherwise attributed

Figure i-1 Dr Chandy meets Mother Teresa. 18

Figure 1-1 The role of vitamin B12 in the human body systems. 24

Figure 1-2 Cobalamin molecule. 26

Figure 1-3 Detail of cobalamin molecule. 27

Figure 2-1 The range of categories of vitamin B12 deficiency signs and symptoms. 43

Figure 2-2 Entero-hepatic circulation. 51

Figure 2-3 Decision Tree. 58

Figure 3-1 Key points regarding treatment 66

Figure 3-2 Cyanocobalamin illustrating a possible structure which affects bioavailability. 69

Figure 3-3 Hydroxocobalamin illustrating a possible structure which affects bioavailability. 69

Figure 3-4 Adenosylcobalamin illustrating a possible structure which affects bioavailability. 70

Figure 4-1 The Addisonian Criteria for diagnosing megaloblastic anaemia. 86

Figure 4-2 Chandy criteria for diagnosing vitamin B12 deficiency. 86

Figure 5-1 Preventive programme summary. 102

Figure 6-1 Key points regarding B12 deficiency and neurological disorders. 131

Figure 6-2 Family history of vitamin B12 deficiency identified in seven generations. 142

Figure 7-1 Visual Reference Diagram: Vitamin B12 and the endocrine glands. 162

Figure 7-2 Autoimmune progressive damage. 166

Figure 7-3 The hypothalamic-pituitary-adrenal (HPA) axis. 169

Figure 7-4 Newspaper report: Death from undiagnosed Addison’s disease. 171

Figure 7-5 Causes of hypoadrenalism: factors affecting HPA Axis. 172

Figure 8-1 Relationships between autoimmune diseases and dementia. 195

Figure 8-2 Role of vitamin B12 in the conversion of homocysteine to SAMe. 198

Figure 8-3 nerve transmission when myelin sheath is damaged. 198

Figure 9-1 Prevention is better than cure. 209

List of Charts

Charts prepared by the author (Hugo Minney) from patient data at Shinwell Medical Practice

Chart  3-1 Frequency of B12 injections required. 74

Chart  3-2 Effect of vitamin B12 recycling efficiency on frequency of injections. 75

Chart  5-1 Glenise Mason, blood vitamin B12 and folate levels (note B12 supplementation only, folate follows B12 even without folate supplements) 111

Chart  5-2 Patient A, blood vitamin B12 and folate levels (note B12 supplementation only, folate level follows B12 level) 112

Chart  7-1 Cortisol daily cycle (circadian rhythm) in a healthy human. 169

Chart  7-2 Results of multiple SSTs on a single patient 183

Chart  7-3 Short Synacthen Test - hypoadrenal 185

Chart  7-4 Early morning cortisol with hypoadrenalism.. 186

List of Boxes

Box i-1 Dr Joseph Chandy: Timeline. 19

Box i-2 Presentations about the observations of B12 deficiency which raise awareness. 21

Box 2-1 Document Letter from Professor A. D. Smith. 61

Box 3-1 Extracts from the Shinwell Medical Practice Patient Survey 2008-9. 82

Box 7-1 Types of APS. 165

Box 7-2 Hypoadrenalism questionnaire. 177

Box 7-3 JFK and Addison’s disease. 190

What's in the book

The book distils 46 years of clinical practice as a GP in this part of County Durham, looking after many generations of the same family.  During that time, Dr Chandy observed that

  • B12 deficiency could occur, and be cured, in people who didn’t have macrocytosis (following the presentation of his observations, university researchers have confirmed this and it’s now common knowledge)
  • B12 deficiency is far more widespread than previously thought – conditions like MS, ME, anxiety, dementia, and many others may actually be B12 deficiency, and cured by supplementing with Vitamin B12, rather than the cocktail of symptom-suppressing drugs often used today
  • Every person is unique and different, and treatment should be tailored to the individual.  Some people are fine on tablets, some people need injections, some people need injections more than weekly.  A blanket “one injection every 3 months” simply doesn’t work for some
  • Because Dr Chandy cared for patients over such a long amount of time, he could observe the progression of symptoms and the effects of treatment.  We did patient surveys and compiled medical history on over 1000 people suffering from B12 deficiency (and cured from it) over the period.

The book goes through major human life stages: fertility and pregnancy; neurological disorders; autoimmune disease; neuropsychiatric disorders; cancer and shows, citing published research spanning over 200 years, that Vitamin B12 deficiency is overlooked as a cause of misery and ill-health (and death).  And that many people could live much fuller lives if only their doctors recognised this very common condition and treated it correctly. The treatment is very cheap, and very safe.  It’s transformative.

How to read it

First time through, read the Case Studies.  You can find them by the yellow backgrounds to the text.  Get to know the people.

Then look at the Chapter Key Points.  The first page of every chapter is a diagram with the key points of that chapter.

After this, read the text.  And you can read any chapter and come back to the others.

Because the book is free or cost of printing, the charity is still very grateful for any donations which help with running costs.

Are you B12 Deficient? Use our diagnstic calculator to find your diagnosis and how we can help you
Charity Events - View our calendar of events and see what is coming up for B12d
Success Stories - Read success stories on patients of Dr Chandy and other B12 Patients

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The Scottish Parliament discusses Pernicious Anaemia and vitamin B12 deficiency on Wednesday 7 March 2012.
This video is over 1 hour long and represents real political change - we are at last on our way.
Frankie tells of how she suffered, the tests she had to endure until doctors worked out what was wrong, and what a difference it has made.
The definitive and original guide to B12 deficiency, Dr Chandy interviewed by Chris Jackson of UK BBC Inside Out Team broadcast 31 Oct 2008.
Dr Joseph Chandy explains symptoms and shows the restorative effect on one patient (other patients' families have asked that we edit out their stories unfortunately)
Donna, like so many women, wants to live a normal life. Vitamin B12 could give her that chance.
The local MP (Grahame Morris MP for Easington - who was a BMS (BioMedical Scientist) in the labs at Sunderland Royal Infirmary) interviews people with B12 deficiency to hear their story (August 27 2010). Here Jane describes the symptoms, and how she can't wait for her next B12 injection (in fact, she knows that she needs injections every 2 weeks because she's keeping a diary of the symptoms). We're restricted how often the GP can give injections, which is why we want to raise awareness.
Susan gets very tired, which isn't much fun especially as she has so much to do. Here she tells her story.
New documentary out from Elissa Leonard in North America, featuring Sally Pacholok and many other internationally renowned experts.
Julia found her eyesight going as her eyes refused to focus on the same things as each other. She's been for all sorts of tests and treatment, but now that she's on B12 replacement therapy she's starting to see an improvement.
June describes her suffering when doctors didn't follow the standard protocol after any stomach or intestinal operation - to offer B12 replacement therapy
Janette first appeared in the BBC InsideOut documentary in October 2006. Since then the NHS has forced her doctor to withdraw B12 replacement therapy on a number of occasions, and she tells of her struggles with having B12 and then having it taken away.
She has bravely agreed to be filmed without her usual wig, but her memory is playing up because it is so long since her last injection.