About farming: if all farmers were to go back to the old methods of farming, using only organic methods, it seems unlikely that the production of food would be adequate to feed out 7 billion people on this planet. I don't like artificial stuff in my food. I also want to eat every day. Fertilizers, herbicides, and pesticides have greatly increased production and I am afraid that as a species, we have outgrown the planet's carrying capacity if food is grown without them.

Perhaps it is as simple as the new natural selection process?

Steph and Celeste, I have a visual reply to that below. When man does this to us, it's not a "natural" anything.

My family farm, and those of my other relatives, are huge. And creating organic food is not as hard as you might think. Sure, we have more people on this planet than is sustainable but there are also resources that are not being utilized, such as freeze drying and dehydrating food to make it last for 25 to 30 years. A lot of food - and water - is being wasted.

Alice, I don't have to guess at why my internist missed my deficiency. We discussed it. She pooh-poohed me over and over again. At one point, she asked, "Do you laugh . . . you know those big, guttural laughs?" Well, that's silly, of course I do and always have. But laughing is not a cure for the inability to digest and absorb vitamin B12.

I was young, attractive, working and "looked" healthy, so how could I possibly be sick? My symptoms were dismissed due to prejudice, pooh-poohs and labels that have nothing to do with a scientific conclusion.

I've encountered that same set of dismissive "protocols" over and over again. Don't doctors want to do their jobs?

If someone asked me to design a logo for them, would I say, "You don't really want a logo, do you?"

Thanks for the feedback, Alice. You know I honestly do appreciate it. Steph and Celeste too.

Annie

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Annie

I didnt know you, your posts from before but having read your recent posts i wanted to say i am very very happy you have joined the dialogue now as your insight and experience has been very helpful for me. Thanks.
Steph

Ok i confess i didnt know, i had to lookup monsanto...when i saw what it was i had to share a recent thought i had that it is sort of crazy that while big corporations continue to make huge profits, we have to have fundraisers to find cures for the illnesses that are in all likelihood the by product of big corporate activities. Seems only "fair" they should pay huh?

Steph, Thanks. A lot of people find my passion for medical issues annoying. I'm glad you can appreciate it. I've had great medical experiences but some of the ones I've had - and people I've known have had - are jaw droppingly horrid.

I'm grateful to know you too. This is such a great group and I'm always interested in everyone's unique point of view.

Yeah, I agree, it's the least corporations can do. Though I do suspect that they could care less if we're healthy, as long as they're making a profit.

I also suspect that the organophosphates are giving more people MG than ever before. There's no "proof" of that, however.

Thanks Steph. that was one of the points I was trying to make.
I wasn't referring to all farmers, but to those who use "round-up ready seeds" because it is much more convenient.

I have another possible reason- In pernicious anemia you expect to have macrocytic anemia. I assume you didn't have anemia.
One of my concerns when they started fortifying food with folic acid was that we will be seeing more and more patients with atypical presentations of B12 deficiency. I knew that every first year intern will put B12 deficiency on his differential diagnosis in a patient with anemia or even just macrocytosis, but without those findings it is quite likely that more vague neurological symptoms could easily be missed.

Physicians are trained very well to recognize and properly treat 80% of the patients-those that have typical presentations of diseases and respond well to commonly used treatment.

They are very poorly trained to recognize atypical presentations, rare disease not to speak of rare presentations of rare diseases. In fact they are trained to rule out those diagnoses that don't fit their paradigm.

Excellent physicians are capable of thinking- what's common is common, but at the same time being aware that zebras and even rare zebras do exist and start thinking about them when things don't quite fit.
Some physicians only consider zebras (which means they are going to ignore about 80% of those common and "boring" patients) and most physicians do very well with horses (and therefore do a good job with most of their patients) but totally fail when encountering a zebra.

But, even excellent physicians who work under the daily stress of modern medicine can fail to detect zebras.

Another problem is that physicians are not trained to think about nutrition (or nutritional deficiencies) unless there is an overt clinical picture. Nor are they trained to think about environmental exposure. I don't think you will find many physicians who will go like Dr. house to see what a patient is exposed to in his/her house. Most will not even ask pertinent questions beyond-smoking history or occupation.

Also, many physicians do not realize that you can't do away with the subjective experience of the patient, even if you have very sophisticated technological devices and very accurate tests.

As was written in an excellent editorial in the NEJM (following a study on asthma patients)- patients don't come to their physician complaining of a decreased peak flow, they come because they have difficulty breathing and they want relief for it.

Alice, I appreciate that you want to let my physician off the hook but she knew about B12 deficiencies. I was, in fact, anemic. My MCV, however, was in the normal range. We discussed that too. Since a B12 deficiency usually shows a high MCV and an iron deficiency a low one, they sort of cancelled each other out. Which is why she also ordered a peripheral blood smear.

Like my MG, I had a classic presentation of symptoms of a B12 deficiency. And my doctor was trained at the Mayo Clinic. She is also brilliant and listens to patients. She literally had no "excuse" for dismissing my concerns and she knew it!!

A B12 deficiency is actually very common. I personally do not believe it is a zebra. Pernicious anemia, maybe, but not a B12 deficiency. With all of the people taking antacids and acid blockers, I'll bet there are an increasing number of them with B12, iron, calcium and protein deficiencies.

I had three members of my family who were tested after I was and they were below 400. With symptoms. Of course, achlorhydria runs in my family.

I wish I could remember the name of the woman who did a study on food years ago that showed we are not getting the nutrients we think we are from it. B12 was not showing up in beef, for example.

I think it might be hard for physicians to admit that they have a boat load of prejudice when it comes to patients. Like my former pulmonologist, who admitted that she thought allergies were not a valid condition for adults - only for children. Once she had gained more knowledge of that, she obviously changed her mind.

The mistakes start in medical school. It just gets worse from there. There is no emphasis on creative/critical thinking; only on cramming two dimensional facts into a brain. There is such pressure to be "perfect" that no one can learn from failure. And fear of lawsuits might as well be tattooed on their foreheads.

I don't have all of the answers. Probably only a few. But when doctors keep failing over and over again, something is most definitely wrong. Massive rationalizations help no one. When I asked Dr. Weil in 2000 about this lack of critical thinking and no time for pathophysiology in medical school, he got really serious. He was quite concerned about what medical students are not being taught and that what they are churning out are not "thinkers."

Can you imagine how much better doctoring would be if doctors really thought of patients as part of their "team?" How refreshing would that be?

I have noticed that most of the B vitamin supplements have HUGE dosages of vitamins. Alice, can you clarify the folic acid statement you made? Does excess folic acid cause MG symptoms?

I am pretty sure that my B 12 levels were checked.

About a year ago I had started taking multiple different b vitamin supplements (bottles say hi energy blend, etc) as self treatment trying to have more energy, stamina, etc. i have always thought that any excess B vitamins were simply passed so if too much no big deal, just eliminated anyway but noticed recent blood tests have shown very high levels of B12. No dr as ever commented on it but i asked endocrinologist about high B12 on blood and if i should stop taking the supplements and she said didnt really matter, that basically would just be eliminated. Afterwards, i thought if just eliminated (i assume through urine?) then why would blood test have high level? I decided on my own to cut back the b12 pill to every other day. Any thoughts from the educated greAtly appreciated as this really really is not in my wheelhouse!