Vitamin B12 is the toughest thing to lecture on because there is no definitive way to rule it out as an issue.

Blood tests can rule it in, but not out.

The symptoms can be so varied from persistent vague pain, numbness, tingling to fatigue (usually in the absence of anaemia) to health issues and more.

So the clinical symptoms are KEY to diagnosis.

Even the NHS guidance recognises this:




As they also note, if you miss the diagnosis, neurological impairment can be permanent, so if in doubt, always give B12.


We went over a case study that really shows the power of what we teach can do.

By understanding that B12 holds a critical place in two key enzymes, we can use that to work out the key symptoms and then diagnose when others fail to do so.

B12 is critical for the process of METHYLATION, if you want more info on that please login to as a practitioner and go to education tab and check out B12 in clinical practice.



Short version, methylation is needed to make NEW CELLS, like collagen for your tendons, cartilage, bone, ligaments, and for your gut lining and oral mucosa.

Or red blood cells (RBC’s), hence the link between B12 and anaemia.

BUT, RBC’s and collagen are long lived, the former 4 months.

While your oral mucosa is 100% renewed after 3-5 days.

Thus issues in the mouth MIGHT mean an early warning sign of low methylation status.

For us, it is important to know, it also makes MYELIN – in the early stages, this LOWERS PAIN THRESHOLDS, and highlights regional neuro-mechanical issues that were previously LATENT aka asymptomatic now painful.

Then, as it progresses, yes it MIGHT give them bilateral tingling, numbness, p-n’s etc which is (hopefully) an easy sign to flag.

But it might just make them hurt all over, non-specific pain.

Back to the case study.


plus lots of mouth ulcers


So wide spread pain, very non-specific. But, not joint issue per se.


Blood tests show:


To confirm – he is NOT anaemic, cells are normal size, his inflammation markers are normal (CRP), his vitamin D is 60 and he is negative for the antibodies associated with auto-immunity associated with B12 deficiency aka pernicious anemia.

He was diagnosed with Behcets disease an autoimmune issue.



So he is living on pain killers/NSAID’s, trouble with that is these meds do reduce the pain somewhat REGARDLESS of the root cause.

So they can still bury their head in the sand, whilst burning a hole in their stomach and their liver is taking a pounding.

But he came back eventually 3 years later.

This time, as well as mouth ulcers he has a really sore tongue.


Luckily, someone knew their methyllation biochemistry and thought about checking for B12.


Note B12 in this measurement, anything under 200 is deficient (pg/mL is same as ng/L)


Homocysteine a highly inflammatory molecule and neuro-excitatory NT is also high secondary to low B12.

So they gave him:


And the result to his intractable body wide pain?


Complete remission of his pain in one month.

Oh and no new mouth ulcers or sore tongue either.

The only solution to the pain of a drawing pin in your foot, is drawing pin removal – that is living in reality. 

Your body will adapt to the pain in the foot, you change your gait, it hurts less, you adapt your lifestyle to irritate it less.

You might even take some NSAID’s or gabapentin for the diagnosis of   “hurty foot syndrome” or HFS as it is known in the NHS.

But it still hurts and then your back starts to hurt too, and your neck and your knee – your gait has slowly challenged your neuro-mechanical system and it has reached failure.

Yes you will find compensation all through the spine and limbs and you can call it what you want – subluxations, fixations, dysfunction, trigger points,  and on and on.

Now, you might be the best adjustor on the planet, do every seminar going, be the fastest and the most specific.

You have sold your patients on benefits of care, maybe even the overall health benefits, wellness for all.

But if the drawing pin is still in there, those compensations and pain from gait change, not to mention the sodding foot pain, are going to persist.

You will help the pain a bit, and they would be truly grateful.

You have, after all helped them more than anyone else.

But would it be more ethical just to remove the sodding drawing pin?

If you ONLY want to do your specialist technique techniques for a patient, ignoring other issues, then you are a therapist. 

But clinicians diagnose and treat or refer accordingly.

B12 deficiency leads to permanent neurological damage including dementia. 

How would you feel if you sent a loved one off to a DC/DO that was brilliant at manual therapy of many kinds, but ignored the root cause.

Then they sold them a theory and package of care and assumed if there was anything really to be done the GP/NHS would sort it.

And they ended up permanently damaged or dead?

Not good enough. 

Behaving like a therapist when you are a qualified clinician is like an adult behaving like a child. Unwilling to take any of the responsibility that comes with being an adult.

You may think you can refer out for nutrition, after all you are a true Chiropractor/Osteopath.



People are f****ed up, good luck with that hole in one adjustment now BJ.

Are you going to live in reality or theory? Maybe your theories are not quite as good as you sell them as?


The real issue is how would you know they needed referring out?


If you didn’t know glossitis and mouth ulcers are symptoms of B12 deficiency, you would know to refer out, would you?

If his blood levels of B12 were normal I still would have given him B12, because the clinical picture is the most important thing.

Oh and do I resolve all my patients’ issues, 100% of the time by ripping out the primary?

If only it were that easy.

Sometimes it is just not possible for a variety of reasons – mine and theirs.

But if I am treating compensation to relieve their suffering, I know I am doing it and so do they.