One thing that makes us clinicians rather than therapists is a wider knowledge base and ability to diagnose.

You may have magic in your hands, the power to unlock the stiffest and twistiest of spines, but if the patient has something so serious it could kill or disable them, that power is going to be wasted.

One such example is patients turning up with bilateral neurological symptoms.

👇 actual patient of mine

This is very much a red flag for us to be doing a very good examination within the context of the patient’s history.

And digging into the symptoms and the patients’ health overall.

If we can exclude myelopathy from a physical source like a central disc bulge or degenerative change, what then?

One thing to always keep in mind is vitamin B12.

B12 as part of METHYLATION is how you make MYELIN.

And as myelin starts to go down, at the end stage of that process, you will get bilateral tingling, numbness, pins and needles and pain.

Usually this happens slowly and patients should be screened and diagnosed.

However, there are some cases where it can come on very quickly.

If your cellular B12 levels are heading down and then you suddenly have a big drop in levels, it might then suddenly create sudden onset of neurological symptoms.

One such way is via the use of NITROUS OXIDE (NO) aka laughing gas.

You see nitrous oxide destroys your B12 reserves, so if you are low-ish and getting low grade symptoms (some pain, depression/anxiety, fatigue, mouth ulcers etc), and then use nitrous oxide it can create a sudden onset of neurological symptoms.

Recently the tragic case Kerry-Anne Donaldson was highlighted.

She was a heavy user of nitrous oxide and sadly is now in a wheel chair.

This is not an isolated case.

And here is the scary bit:

Many of these patients will have NOMRAL B12 blood levels.

The reality is the serum/blood test can rule deficiency in BUT NOT OUT.

This is not my opinion, it is in the NHS guidance.

The B12 test is a reflection of the levels of B12 in the blood NOT the cell, where it is turning on METHYLATION and you make myelin.

Unfortunately, the technology for B12 testing is also confused by B12 analogues found in foods like spirilina.

Thus, we see case reports of myelopathy induced B12 deficiency with normal B12 serum levels.

If the attending GP/consultant knows the research, they will be using two functional or cellular markers called HOMOCYSTEINE (HCY) and METHYL-MALONIC ACID (MMA).

These are often very high, as B12 goes down, these build up indicating cellular/functional deficiency.

It is not my opinion it is in the NHS guidance.

And case studies show this.

So what are we to do then in clinic?

Here is the reality, there are thousands and thousands of patients walking around with sub-optimal B12 cellular levels.

When levels go so low and they get bilateral neurological symptoms the NHS will usually pick it up.

BUT, not always in time.

And, they do not always present with such obvious symptoms.

They might go from low grade depression/anxiety into psychosis.

Will they always be diagnosed then?

Will the attending doctors know to test homocysteine and MMA for cellular deficiency, in spite of normal B12 levels?

When B12 starts to drop, long before you get bilateral symptoms, they will have a lowered pain threshold.


Fatigue in the absence of anaemia is very common and due to B12’s unique role as a rate limiter in Krebs cycle.

Sadly, all this is simply not being done by the NHS despite the guidance being very clear that symptoms are the most important factor in assessing the significance of a B12 blood test.

That an intermediary grey zone of blood test value exists with no clear cut off point for defining deficiency.

In clinical practice, it has to be you that saves these patients.

How would you feel if it was your son/daughter with an acute psychotic episode, drugged in a secure facility and later it turned out they were low in B12 due to their new “healthy” vegan diet aka meat free ultra processed junk food diet?

If it was your mum or dad diagnosed with diabetic neuropathy, falling over and fracturing, when it was actually B12 deficiency secondary to the diabetes drug blocking B12 absorption?

It has to be you.

If in doubt, always give B12.

At IN Health supplements we have a series of short videos on B12, its role, blood levels, causes of deficiency and treatment.

3 videos: 2 mins, 3 mins and 8 mins and you will know more than 99% of GP’s.

Part 1: B12’s unique role in 2 key enzymes (2 mins)

Part 2: Key symptoms (3 mins)

Part 3: Blood levels & causes of deficiency (8 mins)

We have two amazing products that cut out any digestive issues and restores B12 levels quickly.

I am using the hydroxo liposomal form more and more and reserving the ACTIVE sublingual for those patients that don’t quite respond as I want.

B12 – The dose, the delivery mechanism, forms of B12, blood levels, which product when & safety (6 mins)

Note, patients with low B12 are often low-ish in folate and B6 both of which are needed for METHYLATION and iron.

I always give METHYL B HERO x1 daily in AM which is a combination of METHYLATION specific nutrients with B12 1000 mcg daily as a 2 week trial.

The only exception to this is patients with clinical anxiety.

They need a slower introduction of B12 and folate to methylate again. In those cases start with a few drops of B12 daily and slowly increase over 2 weeks to a full dose of 1000 mcg (1ml) daily.

If that resolves the issues, great, but often they need the folate and B6 etc in METHYL B HERO, so we add that too, once they are more stable.

We have a B12 infographic to help educate patients

See attached or if you want a free stand up strut board version email Natalie