I like to pick subject matter for my newsletters from real issues patients bring to me. Over the past two weeks, I have had several patients bring me lab work showing that they have anemia. The confusing thing is that the exact type or cause of the anemia has not been obvious from the lab work. Usually, the labs show simple clear patterns of results that point diagnostically to the underlying cause of an anemia. Iron deficiency anemia, blood-loss-caused anemia, megaloblastic or B12/folic acid anemia, and sickle cell anemia, all typically show very clear patterns in blood work. But these last couple of weeks have shown me only partial results rather than clear patterns.
The first thing I do when I am confronted with conf using blood work results is pick up my functional medicine blood chemistry manual to compare the lab normal values to actual healthy values. Most people are not aware that what your lab tests report as a normal range has nothing to do with what the healthy range is. Lab normals are revised each year based on what the average values were for all the people who took that same test last year. Normal defines a range that 95% of last year’s tests fall into. For example, the majority of people have either had covid or been vaccinated for it. That means that the average person now has spike protein from covid or the vaccine floating around in their blood. A lab test these days would say that spike protein in your blood is normal. Five years ago spike protein would be very abnormal to find in a person’s blood. Spike protein is not healthy, yet by lab normals, you are normal if you have it today. All sorts of toxic poisons are now considered normal simply because the average person has been exposed to them. So normal has nothing to do with what would be considered healthy.
Functional blood value ranges are derived by chemist s and researchers working with healthy populations to determine what our blood values should be for us to be healthy. Generally, functional values for blood work are much narrower than lab normals. That is part of what I was finding with my patients. Lab results that the lab was saying were just fine, were not fine at all. That is the first step. Once we find things outside the healthy range, we must figure out why they are wacko. Part of that challenge is that blood tests are just a snapshot in time. Blood chemistry is changing all day long in response to what you are doing, eating, mood, sleep quality, time of day, and so on. Health conditions get better and worse from day to day, so lab values reflect that constant variation. This is a theme I harp on so often — the body is so much more complex than Dr. Google or the 5 minutes you get in your GP’s office can figure out. Real diagnosis requires a lot of trial and error to find out what is going on.
Today I want to focus on one consideration I had with o ne of my patient’s blood tests. The test showed that the blood cells’ size was bigger than healthy. The size was still within the normal range, but not within the healthy range. The most likely reason for a blood cell being too big is that it did not form right in the bone marrow due to a deficiency of vitamin B12 or folic acid. Now the biggest symptom most anemia patients have is fatigue, and this patient had been fighting that for over a year. B12 deficiency also specifically attacks the nervous system because without enough B12 the body is not able to properly form the insulating myelin sheath around the nerves, so things short out. Appropriate questions then become things like: Do you have any tingling or pins and needles in your arms or legs, hands or feet? Have you lost any of your sense of touch anywhere? Is your gait wobbly? Do you have difficulty walking? Any unusual stiffness or clumsiness in your arms or legs? Are you experiencing any memory loss, hallucinations, or paranoia? These would all be nerve compromise signs that suggest a possible B12 problem.
Other diagnostic questions would include asking about how much meat you eat. All vegans have B12 deficiency unless they are supplementing with B12. B12 is only found in meat/ seafood products. It is formed by certain bacteria in the gut, and animals that ferment their foods before the food enters the small intestine can pick it up from these friendly bacteria. Unfortunately, that is not us. Vegetarians are less likely to have a B12 deficiency because some get into eggs and dairy foods. However, the B12 in eggs is only 9% absorbable for some reason. In America, it is estimated that about 30% of the population has some level of B12 deficiency. In some countries that number goes as high as 80%. Many countries in Africa have required B12 supplementation in their wheat and corn food products because of how widespread this deficiency is.
I have mentioned this concern with a few of my vegan patients, and a common response is that they use nutritional yeast to cover their B vitamin needs. I found that the B12 in nutri tional yeast is added, not created by the yeast. Consequently, the amount of B12 in nutritional yeast varies a lot between the various brands. Some brands, like Dr Fuhrman’s and Sari, have no B12 in them at all. Others, like NOW Foods and Thrive, have quite nice amounts of B12. Check this link for more brands rated.
The US tends to have more problems with excess food rather than not enough food. So why are almost a third of us facing a B12 deficiency concern? Well, for the B12 in our food  to be absorbed we have to have stomach acid and something called intrinsic factor being released in our stomach. Without this, most of the B12 in our diet will just pass right on through us. We will still pick up a little from passive absorption in the small intestine, but not enough. Certain popular drugs also block the absorption of B12. Think about the people you know. How many of them have issues with acid reflux and use antacids or medications to stop the acid production (H2 blockers or PPIs – proton pump inhibitors)? Well, when you stop the acid you also stop the absorption of B12. When your memory starts to go bad and you lose your balance, is it old age or is it the meds you have been on for years? How about the biggest blockbuster drug that stops B12 absorption, Metformin? How many people are on Metformin for their blood sugar problems? Two years ago we had almost 20 million people on Metformin. I am sure that has only gone up since then. Americans spent 5.18 billion on reflux drugs last year. So between blood sugar and acid reflux, we are drugging ourselves into a B12 crisis.
Okay, so what can we do about all this? The obvious answer is supplementation if you are in one of the at-risk group s. Usually, we are talking about drops under the tongue or a tiny tablet that dissolves under the tongue. However, if you have started developing any of the neurological symptom manifestations, you may need direct injection into the butt or thigh muscle of massive doses every couple of weeks to halt the progression of the nerve damage. After a few weeks, you can usually switch to an oral supplement form of B12. Since B12 is essential for the proper development of the brain of a developing fetus, B12 should be a part of the pregnancy vitamin protocol. The good news is that there has never been a reported problem with overdosing on B12, so it is very safe.
Considering what a huge problem B12 deficiency can be and considering how common it is even in this country, why ca n’t you get a B12 booster from your family physician anymore? Twenty years ago folks I knew would go to their personal MD and request a B12 shot without any problems. These days nobody seems to carry B12 in their office anymore. I suspect that insurance companies started denying payment for B12 injections because people wanted them to help support their energy. Insurance companies do not support you feeling good. They pay for specific disease treatment. B12 shots are still available from some practitioners, but not that many. I carry under the tongue drops in the office, but I can’t offer injectables under my license.
So that is the story on B12, at least the simple version of it.
Take care,
David
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After several years scooting around the house in a transport chair, we finally decided to move up to a traditional wheelchair. We avoided this since Ellen is only able to use her right  arm and hand. Trying to get around in a wheelchair with just one arm has you going in circles. But since she uses her legs to push herself around, we found the larger wheels move more easily, especially on carpet.
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