Book Review: Could It Be B12? – An Epidemic of Misdiagnoses (2nd Edition)

Author: Sally Pacholok, R.N., and Jeffrey Stuart, D.O.
Publisher: Quill Driver Books
Book Publication: 2011

This book was sent to Vitality by a reader who experienced a profound improvement in her health after being diagnosed with vitamin B12 deficiency, and after having read Could It Be B12?

Sally Pacholok, R.N. B.S.N., who co-wrote the book along with her husband, emergency medical doctor Jeffrey Stuart, D.O., knows only too well of which she writes. This second edition of Could It Be B12?, which comes 10+ years after the book’s original publication in 2005, follows on the heels of the author being diagnosed with pernicious anemia (an autoimmune form of vitamin B12 deficiency), and her subsequent recovery.

Pacholok explains she was fortunate that, due to her medical training, she was able to recognize the signs that things “weren’t right” in her body. She then embarked on an investigation into the cause, in spite of her doctor dismissing her concerns as “nothing to worry about.”

As a result, she will never suffer the horrible symptoms this disorder can cause. “Millions of other victims of B12 deficiency – many of them also victims of doctors who either mistakenly ruled out B12 deficiency with complete blood counts (CBC), or never considered the diagnosis at all – aren’t as lucky,” she writes.

The list of those suffering under a mistaken diagnosis is lengthy: infants and toddlers left developmentally disabled for life, young adults mistakenly diagnosed with multiple sclerosis or deemed ‘incurably’ infertile, middle aged men and women tormented by balance problems, early-onset dementia, pre-Parkinson’s disease, suicidal depression, schizophrenia, and the list goes on. Extensive research reveals that “B12 deficiency is very common – not just in seniors and middle-aged people, but even in teens, children, and infants.”

The incident that led to Pacholok’s decision to battle the apathy and ignorance of doctors with regard to this condition is both sad and enlightening. She was once asked to discharge a patient who’d been labeled by the preceding staff on shift as a “frequent flyer” – ie. someone who just “doesn’t want to go home”.

Pacholok’s examination of this woman, along with her lab results and her history, all indicated obvious signs of a B12 deficiency. This patient had been suffering for years from crippling symptoms, “every one of which could be explained by B12 deficiency”, and yet her doctors had failed to accurately test the patient for this disorder and thus correctly evaluate her. Instead they’d simply dismissed her as nuts. And this woman wasn’t the first with symptoms of B12 deficiency that Pacholok had seen dismissed by doctors; she was just the latest in a “long line of patients written off as hopeless by medical professionals”, says Pacholok.

Could It Be B12? provides an interesting insight into the medical world, including the rationale that drives some medical professionals. Some of the reasons given for misdiagnosis of this condition include: “They’re just old.”; “We can’t screen for everything.”; “His/her last doctor probably checked it.”; and lastly, “A complete blood count (CBC) is good enough.” This last rationale is one the author hones in on; she explains in detail why a CBC is not good enough when it comes to diagnosing B12 deficiency.

Equally eye-opening is what the authors have to say about dementia. There are few today who haven’t witnessed a loved one going through the agony of this debilitating disease. According to the authors, “dementia isn’t always incurable – even when doctors say it is.” They maintain studies suggest that “up to 60 percent of patients tentatively labeled as having ‘dementia’ actually have treatable and reversible disorders.” For every person with a true dementia, such as Alzheimer’s or Pick’s dementia (although even Alzheimer’s may be linked to B12), it’s likely there’s another ‘demented’ patient with a disorder that is curable. In many cases, that disorder is B12 deficiency.

Pacholok and Stuart also sound a cautionary note to vegetarians. Studies show that, as healthy as vegetarian, vegan, and macrobiotic diets are, those who adhere to them are sometimes falling short of getting the required amount of B12. They urge obstetricians and pediatricians to educate themselves on the subject: “As the numbers of vegetarian and vegan women grow, so too, almost inevitably, will the problem of babies suffering from preventable brain and nervous system damage when their mothers are not educated about proper B12 supplementation.”

Apparently it’s a common occurrence as evidence indicates “over 80 percent of those who have been vegans for two years or more are deficient in cobalamin [B12]”. The authors are quick to point out this is not a criticism of meat-free diets, which tend to be very  healthful; rather it’s a warning that, without adequate B12, these diets “can be a death sentence for both the adults and the children they love.”

Thoughtful research, a thoroughly detailed index, and an appendix with a lengthy list of credible documentation and citations to the medical literature are all included.

The last word goes to Kilmer S. McCully, M.D., author and winner of the 1998 Functional Medicine Linus Pauling Award: “I recommend this book to professionals and patients alike who are interested in finding the underlying cause, and cure, of many common diseases and conditions related to deficiency of vitamin B12.”