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
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
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
Whats 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.