Nutrition doomsayers often warn against taking vitamins, especially in large doses. Are megavitamins dangerous? The truth of the matter is that vitamins are in a class by themselves when it comes to safety. They are safe, even at large doses, so long as the warning signs of toxicity are heeded. Even the fat soluble vitamins, A and D offer treatment benefits that far outweigh the adverse effects of overdose. But isn’t that what doctors are for, to help patients use medicines safely and effectively. It is just common sense that megavitamins should be used under medical supervision. Unfortunately the medical profession is just now recovering from "malnutrition." It is not easy to find an experienced and knowledgeable nutrition-physician.

Dr. Jonathan Wright began using megadoses of B12 for treating asthma 20 years ago. He found that wheezing disappeared in 8 out of 10 cases if the patients were not already dependent on cortisone. Dr. Wright tells of other physicians who have observed similar results,1 starting in 1949, when Dr. Wetzel found as little as 10 mcg of B12 daily for a week cleared a case of "intractable" wheezing in a child at summer camp. Later on, Dr. Simon reported similar results in 20 adult asthmatics treated with injections of 1000 mcg. One shot a week for a month was enough to do the trick in 18 out of his 20 patients. In Italy Dr. Caruselli used intravenous megadoses of 30,000 mcg. over a 2 to 3 week period in treating a dozen adult asthmatic patients. Ten of the twelve were completely relieved of their wheezing by this treatment.

In 1957 Dr. Crocket reported on 85 asthmatics, all treated with injections of 1000 mcg of the vitamin at intervals of one to four weeks. The benefits were related to age for about 80 percent of the children were relieved of wheezing but only half that number between 30 and 50 years of age and only 14 percent of those over age fifty were symptom-free. That suggests that the younger patients were responding to the adrenalin-like action of B12, whereas the older patients were at a later stage of bronchial fibrosis and not mere inflammation and spasm.

Dr. J. Domisse reports2 that almost all of his depressed and bipolar patients have had B12 levels in the lowest third of the normal range and "when those levels have been raised to the highest one third of that normal range every one of those patients has done and felt better." Don’t you think megadose vitamin B12 should be considered in every case of resistant mood depression, even before tricyclic anti-depressant drugs and serotonin re-uptake inhibitors, such as Prozac?

Megadose vitamin B12 can also be of great benefit in treating chronic fatigue syndrome (CFIDS). Dr. Paul Cheney, a physician and researcher in this field has observed significant relief when the vitamin is given by intramuscular injection two or three times a week at doses above 2500 mcg. After a few weeks, over half the patients treated at the Cheney Clinic reported sustained improvement in energy, mood and mental ability. These benefits were not seen after oral or nasal administration of the vitamin.3

Dr. H. L. Newbold reported dramatic effects of similar doses of B12 against sedative drug overdosage.4 One of his patients, a drug dealer, had learned to depend on vitamin B12 doses of 6000 mcg to revive people who were otherwise incapacitated by black-market Quaalude. As luck would have it, Dr. Newbold was called on to treat a woman in coma after such an overdose. Two minutes after the injection of 9000 mcg, the patient awoke and was able to talk. In another few minutes she was able to walk! An ambulance had been called--but the order was cancelled.

Drs. Alice Tang of Johns Hopkins School of Hygiene and Public Health studied the effect of B12 and folic acid, along with vitamin B6, in AIDS patients.5 The team found blood levels of B12 and B6, and to a lesser extent folic acid, were low in AIDS patients. But the importance of B12 stood out plainly: those with adequate blood levels remained free of disease for about 8 years; while those who were deficient in B12 developed clinical AIDS in only four years. What a testimony to the power of a vitamin.

Do we know any other factor that can yield a clear-cut doubling of symptom-free life in HIV positive individuals? Now the question is: will the medical profession use this information? Will doctors measure B12 and treat with oral supplementation and injections? Will they use B12 even in case of "borderline" deficiency? And, finally, will the patients accept vitamin treatment?

Here is a letter I wrote to one of my patients, a lovely lady who just plain disappeared from follow-up until I called her many months later. As you will no doubt agree: she was her own worst enemy. Unfortunately, her family and physicians seem to have let her down also.

"I have recently reviewed all my recent cases in which low levels of B12 were found. Yours is one of them. I know that my assistant called you on two occasions to remind you to follow-up on the finding of a very low B12 level (78 pg vs. laboratory normal of 150-800 pg/ml). Recent findings support a revised range of normal of at least 250 pg and some authorities recommend maintaining blood levels of 1000 pg in order to prevent memory loss and nerve problems.

"I want to be sure that you let your local doctor know about the low B12 test result and that you get follow-up blood tests until the level is repeatedly over 500 and preferably over 1000 pg/ml. I have seen a few patients lose their memory function permanently because of B12 deficiency. The outcome is similar to Alzheimer’s although it can be preceded by depression, paranoia and other signs of mental illness, which you have had. Permanent nerve and spinal cord damage can also occur if B12 deficiency is not treated; therefore be sure to show this letter to your doctor."

This particular woman was seen on two occasions in June 1993. She gave a history of 3 psychotic episodes. The first occurred after her first child was born and was considered a "post-partum psychosis." After two weeks in a psychiatric ward she was maintained on Haldol therapy for six months, during which time she nursed her son. Three years later she gave birth to a daughter and again had post-partum symptoms of insomnia and anxiety but without mania or psychosis. She had been vegetarian since 1982 and returned to a B12-deficient vegan diet each time after weaning.

She functioned well until 1993 when she developed insomnia, which after a week led to mania and confusion. She settled down after treatment with Stelazine and consulted me 3 months later, no longer on medication. Her diet was devoid of flesh foods and milk except 3 cups of sweetened yogurt and 3 eggs a week. She drank bottled water and no soft drinks or refined sugar, other than in the flavored yogurt. Her diet was low in methionine and vitamin B12. At the same time it was high in brassica vegetables, of the cabbage and mustard families, which are cyanogens, similar to cassava, which was recently implicated as a cause of blindness and nerve damage in a serious epidemic in Cuba. Economic hardship deprived Cubans of milk and meat and forced them to eat cassava when they ran out of grain.

The cyanogens in foods are of special importance given her additional history of migraine and visual loss twice a year since 1980. She may have been having eye damage similar to that in Cuba, but milder because of protection by protein intake from grains and yogurt. Mother Nature provides sulfur from the amino acid, methionine, to conver cyanide to inactive thiocyanate. Though methionine is low in her vegetarian diet, conservation of methionine from homocystine is possible, though it uses up precious B12, folic acid, and B6 and she was low in all these nutrients. I suspect a genetic factor in her illness also, for her father was alcoholic and committed suicide, a tragedy that often reflects familial B6 defects. In fact, her own B6 activity was tested and found to be deficient along with her B12 deficiency!

Yeast infections were diagnosed two years earlier, before the onset of her migraine headaches, and she was treated with antifungal drugs. It is not widely known that these drugs also destroy B12. Luckily she also was in the habit of eating spirulina, blue green algae, which is one of the few vegetable sources of vitamin B12, and she improved as a result. Spirulina was an especially lucky choice because her lifestyle also exposed her to the combustion products of a wood-burning stove, which releases PCP (pentachlorophenol), a wood preservative. This chemical is another one that destroys B12; and since it is inhaled in the fumes, it travels directly from lungs to the brain to do its damage.

The fact that she reported serious memory loss, inability to recall names, dates and phone numbers, since her third psychotic episode, is ominous. The fact of her lack of follow-through is a further omen. The failure of her family to insist on additional medical care also bodes a gloomy prognosis for this young wife and mother. When a patient with a brain-threatening disease is evasive about follow-up, it is wise to assume that she is lacking insight or is in denial to a psychotic extent. The only way to verify the extent of the loss of mental capacity is by means of formal testing; because it is usual for such people to cover-up their memory gaps and fool even their families and doctors until they reach a crisis and deteriorate, possibly beyond the point of full recovery.

A doctor has no power to intervene against the wishes of the patient and family when and if they decline treatment as in this case. I made two telephone calls and wrote a note to the patient defining the terrible consequences of inadequate treatment. I had expected this also to inform the primary care physician but when I called a year later no follow-up treatment had been done and no follow-up vitamin B12 measurements had been made. Luckily this woman has not had a relapse into dementia, presumably because her body absorbed enough B12 from my treatments to maintain her; but she is on borrowed time.

In the space of 10 years and 3 hospitalizations for psychosis, under the care of at least three different physicians, including a psychiatrist who has followed this case for the entire time, no test for B12 was ordered for this patient before she consulted me. The psychiatrists treated her only with anti-psychotic drugs and she recovered reasonably well each time, so they let it go at that.

An orthomolecular psychiatrist puts nutrition first, tests for nutrient-related disorders, and often finds the cause behind the disease. Until orthomolecular thinking becomes part of orthodox medical education, American physicians will too often miss-out on vitamin B12 and other nutrient deficiencies. Of course it is important to prevent any damage from vitamin overdoses, but it is a lot more likely and even more important to prevent neurological damage from B12 deficiency. The fact that vitamin deficiency horror stories are still occurring at all these days is testimony to a major failure of American medical education and practice, the failure to "put nutrition first."

©2000 Richard A. Kunin, M.D.