What You Don’t Know About Vitamin B12 Can Hurt You

An interview with Dr. John Dommisse (November 2005)

Unfortunately I didn’t know about Dr. John Dommisse until I began preparing to attend the Weston A. Price Conference in November 2005. When I went to his website, JohnDommisseMD.com, what I found astonished me. Was it really possible that Alzheimer’s and other mental illnesses could really be a vitamin deficiency? Could chronic pain really be treated effectively? Was it actually possible to rebuild cartilage in arthritis sufferers? I wrote him asking for an interview, and he very kindly made time for me at the conference, on November 11, 2005. I took my grown son and daughter, Justin and Liberty, along with me and they got a little peeved with me for stopping so soon. They said they could have kept on listening all night. Truth to tell, I could have, too.

John Vlok Dommisse, MD, MBChB, FRCP(C) received his medical training at the University of Cape Town Medical School (home of the world's first human heart transplant). He completed specialty training in psychiatry at the University of Toronto's prestigious Clarke Institute of Psychiatry (where he became deputy chief resident) and other teaching hospitals. He has Canadian board certification in psychiatry, recognized in Arizona and other states. Dr. Dommisse spent one year on faculty at the University of Toronto, then 18 years in hospital and private practice in Portsmouth, Virginia. There he studied nutritional and metabolic medicine through literature searches of the medical journal databank of the National Library of Medicine. He now practices Nutritional and Metabolic TeleMedicine, as well as local, in-person medicine, in Tucson, Arizona. His address is 1840 East River Road, Suite 210, Tucson, Arizona  85718-5892. His phone number is (520) 577-1940 and fax is 520-577-1743.

Moneychanger: What caught my attention on your website were the amazing things that you had to say about Vitamin B12.  I had never heard that what is diagnosed as Alzheimer’s might be a B12 deficiency.

Dommisse: Yes.  Just this week I became aware of a new book because a patient of mine in the mid-west alerted me to it and I got it sent to me. [In the mid 1990s I helped her get on to B12, so she thought I should look at this new book called, Could It be B12?1 They are saying the same thing, that 25% of the American population is B12 deficient, and probably most of the Alzheimer’s and many other problems (depression, bipolar disorder, paranoid psychoses, hallucinatory psychoses and a lot of other things) are caused by that deficiency.

Moneychanger: Severe mental illness is nothing more than a B12 deficiency?

Dommisse: No, schizophrenia, if it’s really schizophrenia, is a separate condition.  That may be due to a B12 deficiency in the womb, but by the time the person is born and develops the schizophrenia, usually in their teens, it’s too late to turn it around with anything.  But it may have been a developmental thing ‘in utero’.  There are certain psychoses, like paranoia or hallucinatory psychoses, which could be a B12 deficiency, if they don’t have what’s is known in psychiatry as the “glass barrier”, which schizophrenics have. [Of course, B12 deficiency and schizophrenia are not the only causes of psychoses.]

Moneychanger: I assume that you treat people with B12, for instance, Alzheimer’s, and …

Dommisse: It becomes a matter of semantics.  Once they actually develop Alzheimer’s, it is irreversible.  But I catch them in their early stage, when they come to me and say, “I am really worried about my memory.  Both of my parents had Alzheimer’s and I am afraid I am going the same way.”  I have turned every one of them around.  Not one of them has gone into full blown Alzheimer’s.

Moneychanger: I’m wondering if I’m in that same case.  My father is dead, but my mother is in a nursing home.  My father’s father had what they called senile dementia, but he lived in the country and their diet was pretty much what Sally Fallon describes as a “primitive diet.”  How much is required to turn it around?

Dommisse: Well, most cases of B12 deficiency can be treated with very high doses in lozenges or pills by mouth.  But you have to use a very high dose.  The only people who have to get it by injection are the ones with Crohn’s Disease or those have had the terminal ileum (the last twelve inches of the 22-foot small bowel) cut out.  Why?  Because that is the only place where the B12 is finally absorbed, after it has been treated in the stomach with intrinsic factor, an enzyme which the stomach cells secrete to make it more absorbable lower down.  If you lack intrinsic factor or hydrochloric acid in the stomach (as many people do, from middle age on), you can’t get the B12.  Only 1% of it is absorbed and that’s not enough, unless you take very high doses.

Moneychanger: How high is high?

Dommisse: Have you heard anything about doses?

Moneychanger: I read what your articles on your website.  For instance, what is the US government’s recommended daily allowance (RDA)?

Dommisse: Six micrograms.  To give that a little perspective, most B12 shots given are 1,000 micrograms (mcg).  But now they have come out with 10 milligram shots, which equals 10,000 mcg. Methyl-B12, methylcobalamin shots are more powerful and flood the tissues with this very penetrating form of B12.  It goes through ‘the blood-brain-barrier’, the choroid plexus, into the cerebrospinal fluid without having to be processed in the liver.  Liver processing can be a problem in cases of a damaged liver, or alcoholism, or zinc deficiency, or copper excess.  All these prevent B12 conversion to methyl-B12.  By taking it as methylcobalamin (methyl-B12), it goes straight to the brain and you’ve got it.

Moneychanger: You take that by intramuscular injection or…?

Dommisse: Well, if the level is very low in the blood, even below the lab normal range.  First of all there is the U.S. lab normal range, and the Japanese.  The low end of the Japanese lab normal range is 2½ times higher than the American—and they have hardly any Alzheimer’s in Japan.  That should tell you something.

Moneychanger: What could be causing a deficiency so widespread?

Dommisse: Well, it’s not just a dietary deficiency. Vitamin B12 only comes in animal protein foods like meat, poultry, fish, seafood, eggs, and dairy.  That’s it.  But most people who are B12 deficient are not vegetarian.   Vegetarians, especially vegans,2 are at great risk for B12 deficiency if they don’t take B12 supplements.

Most cases of B12 deficiency are people who eat steak and eggs and everything, but have an absorption problem.  An autoimmune disease attacks the stomach lining cells, leaving them unable to produce the intrinsic factor which acts like a catalyst or enzyme to make B12 absorbable lower down in the intestines.  This is the commonest form of B12 deficiency. For this form you could do the shots in the beginning, maybe, if the level is really low and you want to flood the tissues fast, but, within two months of the high dose lozenges, there is no difference in the blood level or the effects of treatment.

Moneychanger: What would be a maintenance dose for these people?

Dommisse: That depends on how bad their deficiency is.  Let’s use the U.S. normal range.  Usually that’s 200 at the bottom end (180-230) and up to 900-1100 at the top end.  In Japan it’s 500-1300.  So anyone testing below the U.S. range is very, very bad. They had better get the 10 milligram shot, two or three times a week for several weeks, then once a week for a time, and then once a month.  The custom is that they get the 1000 mcg shot maybe three times a week for a few weeks, then once a week for one month, and then once a month forever—and that’s supposed to be the full treatment.  However,  in this neurological/ brain form of B12 deficiency, it is usually NOT enough, once again “proving” to the physician that B12 deficiency is not the cause of the patient’s dementia/Alzheimer’s!

B12 deficiency has a two-fold effect; haematological and neurological.  So, around 1850, when Addison first described “pernicious anaemia”, he was focusing on the anaemia.  But he also noted that this condition produces strange neurological and mental effects.  He didn’t know what the deficiency was, he just described the clinical condition of the patients.  Then, about 1920, Ripple and Menoe and another person discovered that if you gave a dog or a human a lot of liver to eat, especially raw liver, their pernicious anaemia was cured.  (One of them was a veterinarian and the other two were doctors.)  So it became known as the “liver factor,” or something like that.  Then in 1948 Castle isolated the actual vitamin in the tissues.  The reagent that he used to extract this vitamin from animal protein foods contained cyanide and it formed cyanocobalamin or cyano-B12 with the natural version of B12, hydroxycobalamin (hydroxy-B12).  Ever since then Americans have thought that cyanocobalamin is B12 but that’s a misnomer and it doesn’t occur in nature.  The natural form is hydroxocobalamin and the most active forms in the body are adenosylcobalamin (5-deoxyadenosylcobalamin) and methylcobalamin.  But methyl is the one that goes to the brain, the spinal cord, and the spinal fluid.

Before you develop the anaemia and the enlargement of the red blood cells (called macrocytic anaemia) B12 deficiency can give you the mental and  neurological effects.  That was described in 1905 by J.W. Langdon in the Journal of the American Medical Association. Yet to this day in the year 2005, most physicians in the U.S. think that to have the B12 deficiency you have to be anaemic and you have to have enlarged red blood cells.

Moneychanger: Although the onset of the neurological damage, or the B12 deficiency, may be evidenced before the anaemia ever shows up?

Dommisse: Right, and since the American lab normal range is set low, by the time the level goes under 200 and by the time the patient reaches the large blood cells of macrocytic/‘pernicious’ anaemia, he is gone.  Then they are full blown Alzheimer’s, and that’s an irreversible condition.  Once they have totally lost their memory, and their personalities change and they can’t even care for themselves, then it’s irreversible.

Moneychanger: I have a friend with Alzheimer’s who lost her sight.

Dommisse: That can be a symptom of B12 deficiency too!

Moneychanger: It wouldn’t help her now, would it?

Dommisse: Well, how long has she been that way?

Moneychanger: Well, two years, I think.

Dommisse: It’s too late.  You must catch it in the first 6-12 months and you can turn it around.  Again, it is a matter of degree.  If it’s not that severe, maybe up to two years, max.  But three to four years, it’s too late.  But I would still give B12 to her if she is low (below 1000 pg/ml in the serum).  There could still be improvement in some aspects of the condition, such as social behavior, etc.

Moneychanger: If someone thought they might have B12 deficiency, what sort of test would he ask his doctor to perform?

Dommisse: Serum B12 level, but you have to interpret the test according to the Japanese standards.  Mature adults ought to have a level of at least 600 to 2000, in my opinion.  In young people I use a level of 1000 to 2000.

Moneychanger: What is the measuring unit?

Dommisse: Picograms per milliliter (pg/ml).  Another unit sometimes used is picomoles per liter.  1.3 picograms per milliliter equals one picomole per liter, in the case of B12.  In some countries they use picomoles so you have to be prepared for that.  Another measure, used in San Francisco, is nanograms per microliter (or per liter, I’m not sure, but the units are the same size as the pg/ml units).

Moneychanger: You have published a professional paper about this, have you not?

Dommisse: Yes;  it is available on my website for $1.75.

Moneychanger: Does B12 help in chronic pain?

Dommisse: Yes.  You can have strange back pain, pain in the limbs, unexplained.  You can even have electric shock-like sensations (described by the German psychiatrist Lehrmitte) which are linked to B12 deficiency.  In fact my bookkeeper told me she was having electric shock feelings, and I told here she had a B12 deficiency.  She just took it without even having any lab work done.  But she did lose the electric shocks!  [This is a very bad idea: You should always get the lab work done first.   It’s relatively inexpensive (I get it for my patients thru the lab for about $20) and then you know whether you have the deficiency or not - using the higher range, as I have explained.]

Remember that all mammals—sheep, dogs, horses, humans,  all mammals—are born with a 2000 micrograms level, which is the ideal level.  That’s what God made you with.  Then it slides down through life, depending on toxicity, deficiencies, diet, autoimmune disease, poor absorption, bowel resection, alcoholism, and Crohn’s disease, among other causes.

Moneychanger: You are primarily a psychiatrist?

Dommisse: Primarily in the sense that that is where I started, but not in the sense of how I spend most of my day now.  Most of it is spent in nutrition and metabolism, and only about 10-15% in psychiatry.  But boy! do I help those psychiatric patients, and without medication, often!

Moneychanger: That was one of the things that startled me about your website.  When I hear “psychiatrist” I bristle at once because I expect to hear about the need for psychotropic drugs, and I don’t like them at all.  They are prescribed like candy for everything.

Dommisse: Kids are being put on drugs also, especially for AD(H)D, Attention-Deficit (Hyperactivity) Disorder, another condition that can often be corrected with nutritional or anti-toxicity approaches.

Moneychanger: Right, and that was another reason I was very interested.

Dommisse: Now, you said that your situation was very similar.  Were you worried about your parents or were you referring to yourself starting to be worried about your memory?

Moneychanger: I am starting to worry about it.  My short-term memory is a problem.

Dommisse: Well that’s what it affects, the short term memory.  You can remember things from 20-30 years ago, but yesterday, no. Right?  So now is the time to do something about it, before it gets worse.  Because once it gets worse, it’s harder to do.  I have a patient now, one of the day-trader guys hooked up to a computer with a satellite, and he has never had a health concern in his life.  But now all of a sudden he is losing his short term memory and he has moved to Tucson so I can treat him.  I am going to have him psychologically tested in order to document the exact areas of deficiency he has right now so that we can document the reversal or the non-reversal if we are too late  I don’t know if he can find the psychologist’s office because he struggled to find mine and was about half an hour late!

Moneychanger: Well, my short term memory is not that bad - yet.  Is there an average age where the B12 deficiency manifests?

Dommisse: Well, it‘s more common from middle age onward, but it can happen even in a newborn child.  It can happen to a baby in the womb and by the time it’s born it already has developmental problems.  Those are usually missed.  Pediatricians are not much into it.  I have a woman in Tasmania who emails me about the horror story of her child who is now twelve and is actually improving some on high-dose continuous B12 supplementation.  She had to diagnose it herself on the Internet, not the doctors.

Moneychanger: Let me shift gears and talk about chronic pain because you seem to offer some hope for people with chronic pain.
I have a friend who is basically out of business.  He is in good physical shape, nearly 60 years old, and suffers from chronic pain in his neck that they think resulted from whiplash years ago.  But only in the last five years has it affected him this way.  He is on the maximum morphine patch.

Dommisse: I’ve got about eight natural things that I do for arthritis and it’s virtually sure that you are going to get out of it.

Moneychanger: You mean the pain of arthritis?

Dommisse: Yes, and the whole condition.  You are going to build new cartilage.

Moneychanger: That was the thing that amazed me in one of your articles.  You said you knew  a 63 year old man who had bone-on-bone knees ...

Dommisse: They were going to put new (prosthetic) knees in.

Moneychanger: Which is another big industry, joint replacement—and his chiropractor put him on four 500 mg Glucosamine Sulfate capsules and 8 omega-3 1000 mg capsules daily, in divided doses …

Dommisse: Yes, within three months he had no pain.  By the time I saw him, five years later, he was playing tennis (on his own, original knees)!

Moneychanger: But I thought cartilage would not regenerate.

Dommisse: But it does.  See, the orthopedists don’t know anything about this—except those who are injecting hyaluronic acid into joints to build the cartilage.  There are some of them now that are starting to inject hyaluronic acid, which is one of these natural things, into the joint because it’s dramatic and they can do their procedure and they are helping some people.  They don’t believe in glucosamine.  However, some of them are actually starting to realize its benefits, and the omega 3 oils.  Then you can also add cetylmyristoleate, which is a fatty acid.  Dr. Diehl, in the 1970s, discovered that it is the substance that mice have a lot of in their bodies—keeps mice from ever getting arthritis!  They are high in this fatty acid.  So he started to manufacture it and now there is a Dr. Cochran who is continuing his process.  Now there are a couple of companies selling it.  It is wonderful.

If they are mild, I usually start people on the glucosamine sulfate, but it has to be four capsules, not three, at 500 milligrams each, two in the morning and two in the evening.  Two of the 1000 mg fish oil capsules twice a day, 1000 of borage oil twice a day, and 1000 of flax oil, twice a day.  This is if they are mild.  I start them just on these things, oils and glucosamine.  In three months, if they are not pain free, I then add the cetylmyrostoleate.  Give them another month or two and if that hasn’t done it, I add the hyaluronic acid, then I add the inflammatory enzymes.  I’ve got a protocol of seven things that I use—guaranteed, if you are not cured using some or all of these seven things, you are a freak!

Moneychanger: You are talking about people with bone-on-bone pain?

Dommisse: Bone-on-bone!  That crunching sound!  The story I told you is a true story, personally witnessed by me, including the original bone-on-bone original x-rays, and one-quarter-inch of cartilage between those bones in the follow-up x-ray!

Moneychanger: All of this is for arthritis pain?

Dommisse: It ultimately helps the pain, but it helps it by getting to the root of the pain, not covering it up and making the root cause worse.  It builds new cartilage.  All these things build new cartilage.

Moneychanger: I had no idea that vitamin B12 could do so much.

Dommisse: Most natural practitioners are out west.  A lot of my patients are from the South and there is hardly anyone in that region doing this therapy.

Moneychanger: If they are doing it, they are always looking over their shoulder because they are afraid that someone from the government is going to shut them down.

Dommisse: Right, and I’ve had to do that and the government has come after me.  It has cost me $250,000 just to stay in practice.  $250,000 just in legal fees, and finally they seem to understand what’s going on—that, yes, I am practicing outside of their box (although not outside of the box within which nutritional practitioners practice)—and I am getting results that they don’t even fully believe!

I understand what the issue is.  The people who drew up the charges knew nothing about nutritional medicine, but first, nutritional medicine is allowed by the Allopathic Board in Arizona.  Secondly they have a rule that, if they are going to  review or censure him or use an expert witness against him in court, the physician doing the reviewing doesn’t have to be the same speciality in nutritional medicine, but he does have to have a working knowledge of that practice area.  I have exposed them because they persecuted me with no peer review whatsoever.  They can’t do that.  So now they are backing off.  They must get a nutritional guy to tell me I am doing wrong.  These people who are coming after me can’t even imagine the results that I get.  They can’t even imagine that it could be true.  They are that far behind, yet they have the nerve to say that I am ‘outside the box’ and need to be censured, or possibly, eventually, even put out of practice.

Moneychanger: It is criminal that they refuse to accept the results.  Even if I didn’t know what you were doing, based on my own knowledge, I would still be forced to say, “It looks crazy to me, but it works, so how can I argue with it?”  It apparently doesn’t hurt anyone.  What’s the overdose on vitamin B12?

Dommisse: The only side effect that some people get—now, mind you, this is from massive doses—is that it can exacerbate acne. That’s it.

Moneychanger: The heartbreak of acne?

Dommisse: Right, and that’s only in some people.  If you use the right kind of vitamin E, the gamma-tocopherol fraction of it, and you correct any zinc deficiency they might have, the acne would probably go away.

Moneychanger: You mentioned glucosamine sulfate.  That’s available without a prescription, isn’t it?

Dommisse: Yes, it is, and all the cetylmyrostoliate, borage, inflammatory enzymes and hyaluronic acid is now available by mouth, the last-mentioned one by Pure Encapsulations, the company that has patented the orally-absorbable version.  All of these are over-the-counter.

Moneychanger: That may be part of the reason they have been persecuting you.  I truly appreciate your time.

Dommisse: Yes, I believe the pharmaceutical industry is behind much of the persecution of nutritional and other naturally-practicing physicians—if we flourish and cure more and more illnesses, where will that leave the profits of the pharmaceutical companies?!

1 Pascholok, Sally M., R.N. and Stuart, Jeffrey J., D.O. Could it be B12? An Epidemic of Misdiagnoses, Quill Driver Books, $14.95

2 “Vegans” are vegetarians who neither eat nor use anything that comes from an animal, including eggs, dairy, and honey. They won’t even wear leather. Like vegetarians, vegans risk severe nutritional deficiencies.

PUBLISHER’S WARNING & DISCLAIMER: By publishing this material, neither The Moneychanger nor the author/interviewee recommends or endorses any specific treatment or therapy for any physical condition or disease. Neither The Moneychanger nor the author/interviewee guarantees or warrants any results from any treatment discussed, nor assumes any express or implied liability for any use to which the reader puts this information. By this interview, the interviewee does not prescribe any treatment whatsoever for anyone who is not his patient. All the information here is offered for information purposes only, subject to the reader’s own research, prudence, and judgment.

Originally published November 2005