Apothercary 2016

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Treatment of Vitamin B12 Deficiency Time for a Reassessment? Jerome Burne is a medical writer and editor and is also on the executive committee of the Medical Journalists’ Association which holds its annual festive gathering at Apothecaries’ Hall. As far as the official medical guidelines are concerned vitamin B12 deficiency is pretty straightforward to diagnose and treat. Like any deficiency it certainly should be. But many patients report the current system fails to meet their needs, claiming the treatment they get is unreliable and inadequate. According to NHS choices the most common cause is a lack of ‘intrinsic factor’ in the stomach which is needed for B12 absorption from food, a condition known as pernicious anaemia. (http://www.nhs.uk/conditions/Anaemia-vitamin- B12-and-folate-deficiency/Pages/Introduction.aspx) Other causes recognised by the NHS include a diet very low in extractable B12 or a side effect of the drugs metformin – for diabetes – and the stomach acid suppressing PPIs. Recommended treatment is a limited number of replacement injections Complications, such as damage to the nervous system or during pregnancy, are said to be rare. Among the patients who don’t share this reassuring assessment is Tracey Witty. She runs a campaigning website http://www.b12deficiency.info that receives over 20,000 hits a month and paints a very different picture of the realities of life for those who are permanently unable to absorb vitamin B12 for a variety of reasons and have to rely on injections for life. Tracey Witty Witty suffered from a number of non-specific symptoms including memory problems, a sore swollen tongue and blurred vision. There are many others symptoms listed on her site which indicate a possible deficiency and should trigger a test for it but all too often don’t. These include tremor, numbness, confusion, dizziness, impotence, IBS, constipation and anaemia. 19
The range of symptoms is wide because being deficient in B12 can gradually cause very fundamental damage to the nervous system (loss of the myelin sheath) as well as problems with repair of DNA and with making new red blood cells. What that means is that if the problem isn’t correctly diagnosed and effectively treated, the long term results can be disastrous. As patients deteriorate they can be wrongly diagnosed with conditions such as diabetic neuropathy, bipolar disorder, Parkinson’s disease, blindness, paralysis and dementia. (doi:http://dx.doi.org/10.1136/bmj.g5226) What Witty claims is that she and tens of thousands of other patients aren’t being speedily diagnosed or properly treated. Instead they are ‘at the mercy of health professionals who are not educated adequately about this condition and as a result frequently label those who are deficient as lazy, depressed hypochondriacs.’ This can happen when patients visit their GP to say the supplement they have been given is not relieving their symptoms. The response is often to treat them with anti-depressants even though depression may be a perfectly reasonable response to their continuing symptoms and is also a well documented deficiency symptom. (http://www.twitlonger.com/show/n_1s0ggga) A correct diagnosis and being treated with a sufficient number of injections usually results in a seemingly miraculous recovery from such symptoms linked with a serious deficiency as: becoming mentally impaired, debilitating pain, being bed-ridden, chronic fatgue, memory loss and losing the ability to walk. Yet a recent survey (https://www.ncbi.nlm.nih.gov/pubmed/24732991) by the Pernicious Anaemia Society found that nearly 66% of 889 respondents were dissatisfied with current treatment and that 14% of patients had waited more than 10 years for a correct diagnosis. What’s going wrong, according to Witty, is that, rather than treating symptoms, doctors rely on unreliable blood tests to decide who is deficient and guidelines on how frequently injections need to be given that are not based on any research at all. Of course her critique can be dismissed as mere anecdotes, since she is not a medical researcher and has no clinical background; she trained as a furniture maker and upholsterer. But with extensive information available on the internet and increasing calls for patients to take more responsibility for their chronic conditions, her voice and those using her website deserve to be more widely heard. They provide just the kind of feedback that should be welcomed. http://www.b12deficiency.info/what-to-do-next Witty’s first encounter with B12 deficiency was not due her own problems but the result of the psychiatric problems one of her family was having. ‘My online researches suggested low B12 was a possible factor so I asked the GP to test for it,’ she says. ‘She refused. Subsequently I found a reluctance to test or treat was common. Later many other patients contacting me via the website reported experiencing the same problem.’ When the test was eventually carried out, the GP claimed the result showed she was normal. In fact it showed a deficiency. When her relative was sectioned the psychiatrist told Witty that B12 was not a relevant factor. But she won this battle too and after being given regular injections of vitamin B12 a dramatic recovery followed. The psychiatrist later agreed that lack of B12 was the culprit. This experience allowed Witty to understand that her own chronic B12 deficiency had been a factor in her failure to conceive rather than her doctor’s diagnosis of an early menopause. She arranged a gene test for herself which revealed several mutations, including MTHFR and MTRR, which interfered with absorption and meant she would require supplementation for life. 20
Page 1 and 2: 2016
Page 3 and 4: Contents The Court and the Livery C
Page 5 and 6: Editorial As I become older and wis
Page 7 and 8: emembering how the sight of medicin
Page 9 and 10: At home I have two children. Annabe
Page 11 and 12: around them. Their makeup is done a
Page 13 and 14: ehave differently stranded in a des
Page 15 and 16: Dr Henrietta Hughes, Prof Michael J
Page 17 and 18: The Galen Dinner, four Livery Dinne
Page 19 and 20: Past Master’s Report 2015-2016 Ev
Page 21: Treasurer’s Report What words cha
Page 25 and 26: So patients with classic symptoms o
Page 27 and 28: in the Royal Army Medical Corps (RA
Page 29 and 30: Three others who served in the RAMC
Page 31 and 32: CONCLUSION A high proportion of the
Page 33 and 34: Sabbatical in Assisi will have to c
Page 35 and 36: Faculty of the History and Philosop
Page 37 and 38: Curator’s Notes Nicholas Wood - C
Page 39 and 40: The Charity Committee Simon Bailey
Page 41 and 42: Due to the demand for additional ti
Page 43 and 44: psychosocial effects on those affec
Page 45 and 46: of historical medical interest, Ven
Page 47 and 48: In November, Simon Bailey organised
Page 49 and 50: Apothecaries on Vacation by Gillian
Page 51 and 52: Society Contacts Website: www.apoth

Apothercary 2016

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