That is the question!  It is common, for some people, to self diagnose after reading a short list of symptoms.  To those individuals, knowing that weakness, fatigue, constipation and loss of appetite were symptoms of B12 deficiency would have them consuming mass quantities of the supplement.  However, there are many causes for these symptoms of which B12 deficiency is only one.  We should look at symptoms as mere guideposts on the journey to an accurate diagnosis.  Other possible causes could be; hyperparathyroidism, hypopituitarism and Addison's disease.  The mere sound of these names may strike fear in the heart of the self diagnostician, therefore, one may be inclined to treat with B12 in the hope that a subsequent reduction in symptoms would preclude the more scary diagnosis.

So let's venture further down the symptom trail in an effort to support a diagnosis of B12 deficiency.  In addition to the above symptoms one would also expect to see, numbness in the hands and feet, loss of balance, memory issues, depression, confusion, and soreness of the oral cavity.  This list, for the most part, is just as subjective as the first, so anyone looking to convince themselves of a deficiency has a little more work to do.

To make an objective diagnosis we should look for more objective measures.  One tell tale sign of  later stage B12 deficiency is the development of megaloblastic enemia, a condition of enlarged red blood cells.  However, most individuals would like to know before it gets to that point.  Earlier detection can be determined by measuring for elevated homocysteine or methylmalonic acid in the blood which rise with  B12 deficiency.  This method is even more accurate than measuring blood B12 concentrations itself, due to the fact that intracellular B12 can be much higher than blood levels.

So let's now assume we have run the tests and we know for certain that B12 levels are low.  Does this mean that we can merely increase the intake though diet and supplementation.  In order for B12 to be absorbed into the body it must first be removed from the protein that caries it in our food.  This process is carried out by the hydrochloric acid in the stomach.  Then it must attach to a different protein, excreted from the stomach lining, called intrinsic factor which will facilitate it's absorption in the intestines.  If either of these steps is compromised then the amount of B12 absorption will be limited.

For individuals, who self medicate with antacids for digestive issues such as ulcers, heart burn or indigestion, there is a reduction in stomach acid that does not allow the initial protein to be removed so  the B12 is not available for binding to the intrinsic factor.  Additionally, people with pernicious anemia lack the ability to produce intrinsic factor  thereby eliminating the handle that facilitates  absorption.  Even with normal intrinsic factor production, there is a finite amount of it produced and therefore a natural limit to the amount of  B12 that may be absorbed.  It is for these reasons that if one is severely deficient in B12 the best course of treatment is intravenous B12 injections.

There has been some indicators that B12 can be absorbed through mucous membranes such as those located in the oral cavity.  To facilitate absorption it is said that placing a B12 tablet under the tongue until it dissolves will increase the amount absorbed. 

Ultimately, this is one case where verifying a need can save money in the long run.

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There are many causes of back pain.  It is sometimes tough to make the call of when to see a professional, remedy however, you should always err on the side of caution.  Here are a few red flags that should prompt you to seek the help of a chiropractor.

The pain may have came on within a short period of time after doing a highly strenuous activity.  This may have been lifting an object while bending over or may be from sitting, bending over, rotation of the trunk, or some combination of these activities.  These activities often result in significant increases in the pressure within the vertebral disc.  This often leads to tearing of the ligaments which contain the disc.  Proper care and treatment of such injuries will reduce the healing time and help prevent future injuries.

If the pain which begins in your low back starts to travel down one or both legs.  This indicates that the nerve supplying to that region of the leg is being irritated due to trauma and inflammation around the nerve.  This most commonly occurs at the nerves point of departure from the spinal canal, between the vertebrae of the spine.  While a herniated disc is often the culprit, there are many other tissues in this region that can cause similar symptoms.  It is important that a professional determines which tissue is involved and sets forth a treatment sequence that will effectively facilitate healing.

If ones low back pain is combined with significant changes in urination or defecation frequency, then there may be a more serious involvement.   On occasion the spinal canal can narrow due to injuries to either the disc or the ligaments surrounding and lining the spinal canal.  This narrowing can cause pressure on the spinal cord itself.  This situation is one that needs immediate attention and should not be ignored.

If ones low back pain is present while they sleep there is additional reason to be concerned.  Of course tossing and turning at night may cause one to use muscles and joints that are injured, thereby causing them to experience pain.  On the contrary pain that wakes one even in the absence of motion should be of concern.  When one has a bone tumor it can irritate the periosteum of the bone and cause this type of pain.  Chiropractors are trained to identify when this may be a possibility and determine if further studies or evaluation from an oncologist are in order.

Most first episodes of low back pain are self limiting, i.e. they will return to a pain free state with no treatment at all.  However, incomplete healing of the damaged tissues leaves the individual with a weakness that is much easier to reinjure in the future.  Professionals, such as chiropractors, will not only assist one in their recovery from injuries, but will also instruct their patients in proper management of the human frame.  

"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame." -Thomas Edison

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