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Feeling dizziness. Diagnosed high deficiency of Vitamin D3 and Vitamin B12. Had Vitamin B12 shot. Prescribed Cynacobalamin. Cause?

Answered by
Dr.
Dr. Pavan Kumar Gupta

General & Family Physician

Practicing since :1978

Answered : 6714 Questions

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Posted on Mon, 24 Jun 2013 in General Health
Question: Hello Doctor,

I have been suffering with this health condition for the past two years. I have consulted many doctors, specialists and have been taking various medications for over two years and nothing seems to be helping beyond a point of recovery. I am a software engineer. I was living in the US (New York) starting March 2010. Let me explain my health problem with proper timelines:
XXXXXXX 2011
---------------

In XXXXXXX 2011, I got some feeling of dizziness while I was roaming out on a hot day. The same dizziness happened couple of times on the days that followed, especially after I had taken lunch in the afternoon. i.e the dizziness happened immediately after I ate my lunch.

Tests run by my Urine showed the following abnormalities:

Cholesterol (High) 255 mg/dL Reference Range 100-199

Triglycerides (High) 168 mg/dL Reference Range 0-149

LDL Cholestral (High) 166 mg/dL Reference Range 0-99

Vitamin D, 25-Hydroxy (Low) 6.7 ng/mL Reference Range 32 - 100

Vitamin B12 (In the Borderline) 224 pg/mL Reference Range 211-946.

Methylmalonic Acid in Serum (High) 965 nmol/L Reference Range - 73-376.

My doctor told me I had high deficiency of Vitamin D3 and Vitamin B12. She gave me a Vitamin B12 shot (1000 mcg, methycobalamin) & started me on the following tablets

0000IU Vitamin D2 weekly tablets

1000mcg Cynacobalamin daily tables

The doctor referred me to a Cardiologist who ruled out all sorts of illness in cardiovascular system (Tests taken - ECG, Echo, Tread mill test, primary care physician concluded it was just too much of stress and some vitamin deficiency. I continued with the medication for another 3 months.

October 2011
------------------
I was given Flu vaccination by my employer (In the US, people are given flu vaccinations before the onset of winter). I fall sick within few hours of taking the Flu shot. I developed fever which subsided the same night. In the meantime, the work pressure and stress was tremendous. I kept working for 14 hours a day for almost 5 months continuously. I started feeling tired, burnt out every day. But thought it was just the work pressure as I felt great on Mondays after relaxing weekends. I develop insomnia and body/back pain. I took couple of days rest. The body/back pain went away but the sleep problems remained.


February 2012
-------------------
Hell broke loose into my life. I developed severe back pain, insomnia, severe indigestion. Within a week’s time I fall extremely sick:

i) I was barely able to walk

ii) The food I ate did not get digested. I completely lose my appetite.

iii) I am not able to sleep for days in a row (like 72 hours continuous)

iv) My mind becomes too foggy, I was not able to think clearly & make any decisions.

v) I develop severe pain in the spinal cord, knees, feet etc

My new primary care physician runs blood tests, urine tests. The results came up with the following abnormalities:

Vitamin D, 25-Hydroxy (Low) 11 ng/mL Reference Range 32 - 100

Vitamin B12 (In the Borderline) 236 pg/mL Reference Range 211-946.

Blood trace found in urine (Only RBCs, No WBCs, No Puss cells)

My doctor concluded that I have severe depression, vitamin D, Vitamin B12 deficiency and Urinary Tract Infection. She gave me a vitamin b12 shot, again starts me in 0000IU per week vitamin D2. Also, she gave me Bactrim Ds tablets for the UTI.

My doctor refers me to a orthopaedician for my back, knee pains. The orthopedician ran Xrays and concludes that my back pain was due to thoracic scoliosis and injected hydrocortisone steroid along my spine for pain management. The steroid did not alleviate pain. And later I find that the entire diagnosis was wrong.

I spent almost 3 weeks in bed. Unable to manage my health condition in the US, I returned to India in March 2012.

March 2012
---------------
I visit XXXXXXX Hirudayala, Bangalore and consult Oncologists, gastroenterologist, Orthopaedician, Urologist. The doctors rule out all types of Cancer & major diseases. They concluded I was under severe depression. They gastroenterologist diagnosed acid pepsis and gave me 3 weeks course for the digestion problem. All other doctors rule that my health will improve with time and I don’t need any medication other than good food & sleep. I take rest for another 4 months. Nothing improves.


November 2012
---------------------
My health condition kept deteriorating (Insomnia, Weakness, Indigestion, Bloating, Suicidal Thoughts).

I developed burning sensation, pins & needles in the back, numbness in the back, shooting pain in the feet & knees, extreme weakness.

I felt like it was better to die rather than living a life where I was not able to eat, digest & sleep.

I finally XXXXXXX a psychiatrist. She diagnosed depression and put me on anti-depressant for a month. Endoscopy was done by another gastroenterologist and it came back normal. A spine MRI was done for the back pain and everything came back normal.

My family doctor in India runs tests like ASO, Blood, Urine. The blood test comes out normal. Urine had blood trace and the doctor says it was because of heat.

The doctor gave me lot of enzymes and flushes the digestive system over a period of two days. Finally, I was able to eat and digest the food too. But still my appetite was almost lost.

My health seemed to improve a bit after the cleaning of my digestive tract.


February 2013
------------------
My health deteriorates further (severe back pain, tingling, numbness, insomnia, indigestion). This time, I consult a new orthopaedic surgeon in Chennai. The doctor runs spine MRI, blood, urine tests. He concluded it was all the vitamin B12 deficiency and depression. The new doctor concludes it was all Neuropathic pain due to vitamin B12 deficiency.

He immediately starts me on Vitamin B12 (Methycobal 500 mcg) per day, every day for a week, then 2 injections a week after that.

My health improved to a large extent (Burning in the back reduces, digestion improves, sleep patterns improves). But the health improvement reaches a saturation point in a months time and all the symptoms return in April 2013.


May 2013 (Right Now)
--------------------------

The burning sensation, pins-needles, foot pain, knee pain, back pain is between moderate and severe. Appetite has gone down. Sleep patterns are OK.

Doctor,
Do you think there could be something else than the vitamin B12 deficiency?
How long will it take to recover from vitamin b12 deficiency?

Is there any other test I should be taking to diagnose the problem further?

Is there any other specialist doctor I should be consulting with regarding this health condition?

What is the best course of treatment to get out of vitamin B12 deficiency?

What could be the root cause of this vitamin B12 deficiency? I am a non-vegetarian. I regularly eat eggs, milk etc.

Do you think something could be broken in my B12 absorption or metabolism mechanism? How to test and diagnose any such conditions?

Currently I am on Neurobion Forte (1000mcg mecobalamin) thrice a week.

I look forward to your reply.

Best Regards,

Miserable Guy.
doctor
Answered by Dr. Pavan Kumar Gupta 4 hours later
Hello,
Thanks for the query.
I really feel very sorry for the problems you have suffered and the way they are troubling you.
Since you have been seen by various doctors belonging to different specialities,the most likely explanation seems to be VIT B 12 deficiency as it not only causes various physical symptom but also the depression.
VIT B12 deficiency coupled with VIT D deficiency and depression seems to be troubling you most.
It is being said that lower level of B12 should be above 500 .In japan the minimum level of VIT B 12 is taken as 550.
With prompt treatment,VIT B 12 deficiency can be compensated in 4 to 6 months time.
Remember one thing,VIT B 12 deficiency can not  be cured completely and one has to take VIT B 12 supplement through out his life.
It said that 20 injections of VIT B 12 can completely replete the stores in your liver and then a monthly injection can take care for rest of your life.
Although dietary reasons are said to be responsible for B12 deficiency but it is mostly the result of poor absorption.
Poor absorption may be due to the lack of intrinsic factor in the stomach acids ,which is responsible  for absorption of B  12 from the food.
Or it can be due to 
Regular consumption of alcohol.
Use of anti diabetic drug like METFORMIN 
Excessive use of acid lowering medicines like OMEPROZOE or RANITIN Etc.

You may look for lack of intrinsic factor by testing for antibodies to intrinsic factor.

My advise to you is..
Get the cause diagnosed an endocrinologist.
Take injectable B 12 instead of oral tablet 
Do regular exercises.
Do regular yoga and deep breathing  exercise for mental calmness.
Take regular VIT D along with calcium.
Do regular aerobic exercises for 45 minutes a day.
Stop taking antacids and moderate your alcohol intake.
I hope you should be all right in next 4 to 6 months.
I hope it helps however you may revert to me for any further query.
Best of luck
Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pavan Kumar Gupta 47 hours later
Hello Doctor,

Thank you so much for your detailed reply.

1) I used to drink coffee/tea excessively while I was in the US. Do you think coffee/tea intake can either reduce intrinsic factor or play a role in vitamin b12 absorption and could have played a role in my vitamin b12 deficiency? Do you think I should stop drinking coffee/tea?

2) I was given an anti-depressant (Typlin OD) to be taken in the nights to get good sleep. I took it for like a month, but stopped as I thought I was getting to a point where I was not able to sleep without the pill. Do you think anti-depressants can have any effect on the production of intrinsic factor or the absorption of B12 and its metabolism?

3) Currently I am on vitamin b12 injections (Neurobion Forte - 1000 mcg) thrice a week. Do I need to stop the vitamin b12 injections before I go for further intrinsic factor testing and vitamin b12 tests (MMA, Vitamin B12 Serum, Homocystine)?

If so, how long should I wait after stopping the injections before I take the tests?

4) You have said that I need to test for antibodies for the intrinsic factor. Is this the only test required? Or do you suggest any other tests in addition to check for Vitamin B12 malabsorption / metabolism issues?

Thank you.

Best Regards,
XXXXXX
doctor
Answered by Dr. Pavan Kumar Gupta 2 hours later
Hello,
Consumption of tea or coffee and antidepressants have not been associated with faulty absorption of VIT B 12 however high consumtion of tea and coffee can cause insomnia and anxiety because of presence of caffeine in them.
You can take the test for antibodies for intrinsic factor any time.
There is no need for any other test.
Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pavan Kumar Gupta 25 minutes later
Thank you doctor. Your answers gave me lot of clarity and much needed information. You have been really helpful. Thank you.
doctor
Answered by Dr. Pavan Kumar Gupta 3 minutes later
Hello,
You are most welcome to ask any query any time.
Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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