In the last post, I wrote about my personal experience with hyponatremia and its deleterious effects. What I did not talk about was the absolute stress and trauma that it can and does cause, especially with a sodium level as critically low as mine had been.
As mentioned in the last in the last post, I checked into the emergency room with a serum sodium level of 109 mEq/L, a very grave situation. That I was able to remain conscious let alone stand and hold a debate with paramedics at that sodium level was indeed a strange testament to the power of this lifestyle notwithstanding the pitfall that I had unwittingly stepped into.
By the end of the first 24 hours in the ICU on a sodium chloride solution IV, I was feeling pretty good and wanted to leave the hospital. I remember sitting up on the bed and practicing pranayama exercises as well as taking walks around the floor since the IV contraption had wheels. Despite the depleted sodium level, I was still myself. That night, I told one of the nurses that I wanted to check out. She suggested that I stay the night.
By the next day, I’d suspected that I would be released. Instead, I was told that I would need to stay another day. Another day? I had things to do! I had to go to work the next day. I had a dentist appointment in the afternoon!
I told the doctor I wanted out.
“I cannot release you with this sodium level.”
“Can’t I just eat a lot of celery and greens to get the level up?”
You have to understand that when you talk to the average doctor like that, they think that you are a deluded anorexic. He asked me if I ate salted nuts. I said that I didn’t eat that. “You need it,” he exclaimed! This was the same doctor who took it upon himself to order me fish on the last day, which I refused. I suppose he thought he’d put an end to all this vegan nonsense, but as I told the woman who brought me the meal, “It doesn’t work that way.”
At any rate, around noon on the second day, I signed the necessary papers and checked myself out.
By the time I got on the street, I started to realize that I’d probably made a mistake. I was disoriented. I wasn’t sure which way to go, was it left or right. By the time I’d walked the mile home I didn’t feel well and started eating salt.
The doctor was right. I called the hospital and asked if I could check back in. “This is not a hotel,” the woman said! “You have to go through the emergency room and go through the normal procedure!”
So that’s what I did.
You have to understand that when you are at a serum level of 109 mEq/L, you are literally at the door of death; in fact, you should probably already be dead. At 115 mEq/L the symptoms are coma and death. When I checked myself out of the hospital that day, my serum level was 125 mEq/L, which I did not realize at the time, is still severe. Having said that, when you are at a serum level of 125 mEq/L, you feel so much better than the absolutely critical and fatal level that I checked in with, especially when you are doing nothing but laying around on a hospital bed all day. I still hadn’t sunk to the low level which was to follow in the next two and a half years which I will get into in a moment. At that point, I was still feeling like my normal, active, industrious self, again despite the low sodium levels.
I checked myself back in that afternoon, cancelled my dentist appointment and that evening called and cancelled my students scheduled for the next day. That was a challenge I might add. It was very difficult to make the calls on the cell phone even though their numbers were saved in the phone, showing that I indeed was not yet fit to leave the hospital.
The next day the doctor ordered my release which I was very glad about. I remember still not feeling strong and a little light-headed but wanted to hurry out before someone noticed.
I did a bike ride a few days after getting out of the hospital and crashed the bike. I was heading up a hill on a very narrow street and had to get around a car but just didn’t have the physical wherewithal to pull it off. I was soon to find that the crash and the minor damage it did to the bike were to be the least of my troubles in that week.
A point to remember, especially from my experience, is that when one becomes that imbalanced in a particular nutrient, that balance does not immediately become reestablished. I was to find the hard way that it would take nearly a year before I was out of the woods with the sodium issue. Having said that, were it to happen again, I would take different measures than I did then.
As mentioned, even after two days in the ICU, I still didn’t feel that great and my sodium level still was not yet stable. This manifested the following week with episodes of prolonged insanity, by prolonged I mean perhaps a day or half of a day. I really don’t know what was more traumatic, the prospect of losing one’s life, or the prospect of losing one’s mind. To this day, those few days of insanity were by far the scariest days I have yet experienced, although, what was to follow was pretty scary as well although not quite as intense.
One night I truly thought that was it. I thought that the only option that I would have from that point would be to check myself into an asylum. I chuckle a bit at the thought of that, some people probably still think that for me, that would be a good option, but it was far from funny then.
I got over this. Episodes of insanity after the first week passed, but at about three weeks after getting out of the hospital, I started to notice the first signs of a mental imbalance which was to go from bad to worse over the next two and a half years.
By September 2009, certain things had happened that I had increasing difficulty coping with. I started to become depressed. I had never really been depressed in my life. I had an episode with depression when I was 15, but that was nothing that the cessation of marijuana and starting a running program didn’t fix.
This depression became something that I couldn’t shake. Goals and projects that I began, I was unable to see to fruition.
As I mentioned, things went from bad to worse and in January 2010 I suffered hyponatremia for a second time. This, coupled with the depression together with other stresses I had been going through, made things almost unbearable. It was a great stress in itself that this was the second time that I’d gotten myself into the same mess. I’d started to become very anxious. Anyone who has suffered hyponatremia knows that thinking is impaired and simple decision making becomes difficult.
Unable to come to a simple decision and preoccupied with the indecision, I accidently made an illegal turn on red on the way home from Hollywood one night as my serum sodium level was obviously dropping and got a $500 ticket! Welcome to California.
I didn’t sleep that night or the next three nights. Knowing the feeling of hyponatremia, I knew that I was hyponatremic. Hyponatremia, together with insomnia, was really too much to bear.
Desperate to get my sodium level up to an appreciable level, I was consuming a sodium chloride solution (sea salt and water) and an electrolyte solution. I was also eating celery and drinking coconut water, both being significant sources of sodium. The celery and the coconut water seemed to have a better effect than the sea salt, which in retrospect, it is easy to see why. Table salt, sea salt is sodium chloride, an inorganic substance that the body tries to rid itself of. Sodium, however, derived from plants is usable by the body. This probably explains why the sodium chloride solution used for IV in the hospital does not retain well. It boosts the level up and saves one’s life, but that level soon dips down again in a day or two albeit not as low.
The salt that I was taking in was causing me to be bloated and retain water. But I was desperate. Had I to do it again, I would just consume as much celery juice as I could as well as celery juice possibly mixed with chard juice. I would also eat a lot of celery and chard and other greens except for lettuce.
The second time that I became hyponatremic, I had been eating mostly bananas and lettuce. Neither are a significant source of sodium. As well as this, as mentioned in the last post, six months prior to this, my serum sodium level was fatally low, so my level was more than likely not well established anyway leaving me more prone.
After the third sleepless night and obviously still hyponatremic, I checked myself into the hospital on the early morning of January 23, 2010. I was diagnosed with hyponatremia with a serum sodium level of 125 mEq/L which is severe. My efforts to get the level up may have had some effect, but not enough. Like I said, I would have probably been better focusing on celery juice to get the level up, but fear, desperation, anxiety and a very compromised condition clouds one’s judgment.
It is amazing that when one gets into the emergency room all they can do is hand you a list of psychiatric clinics for your mental issues.
“If you got that stressed out from a traffic ticket, you have some problems.”
“It was the hyponatremia.”
“What’s it got to do with hyponatremia?”
Anyone who has suffered with severe hyponatremia knows that it affects the mind as profoundly as it does the body. You would expect those trained in these matters to know this, but that is obviously not the case.
Having said that, I felt great that night after I got out of the hospital. However, that was not to be the case the next day or the following three weeks.
Another thing that amazes me is the pill pushing nature of the medical profession. I suppose it’s not so amazing really since the pharmaceutical industry wields great power and rules the AMA. When I mentioned that I had insomnia the previous three nights, I was written a prescription for “sleeping pills” at the drop of the hat. My serious mistake was to fill the prescription “just in case.”
The next day, as with the first time I became hyponatremic, my sodium level dipped again. I could feel this right away. This time, I was filled with anxiety about it. As a result, I couldn’t sleep that night. I took the first sleeping pill which I’d never done before. This started a vicious cycle of insomnia which was to last the next three weeks that sleeping pills did little to alleviate.
The following day, as a follow up, I went to a local doctor recommended by the hospital. I had another blood test which revealed that my serum sodium level was indeed low at 130 mEq/L and I certainly felt that. Actually, my level was probably lower the previous day because again, I took salt to try to get it back up.
When I was at her office, she noticed my state of agitation and mentioned that she could prescribe an anti-anxiety drug as she thought that it was anxiety that caused me not to sleep. I told her no. That I’d even taken one sleeping pill was almost unbelievable to me.
Later that week, the insomnia continued and I became psychologically reliant on the pills although they did little good as I’d gained a tolerance to them after three days and I certainly wasn’t going to increase the dose as I’d already been taking the maximum recommended daily dosage.
I became desperate and called the doctor for the anti-anxiety pill she recommended called Ativan. So there I was, switching back and forth between Ambien, the sleeping pill, and Ativan, the anti-anxiety drug, as either became ineffective after three days of use. I could barely sleep at all and the sleep on Ambien was like no sleep at all. Coupled with this, I could feel the sodium level dipping back down again.
After three weeks of this nightmare, most certainly the worst three weeks of my life, I began to sleep again and haven’t touched those drugs since. They were vile. I remember eating a lot of greens at the time and felt that they somehow helped to bring me back down to Earth, probably the minerals including the sodium were therapeutic and essential at the time.
However, my sleep still wasn’t good as it had been prior to this. Actually, my sleep hadn’t been good after the depression set in a couple months after the first incident of hyponatremia, which prior to that had been perfect for most of my life.
But now the depression had gotten even worse and became severe, almost suicidal at times. I didn’t commit suicide obviously, even though at times I wanted to, but the thought of my parents and my knowledge of the afterlife kept me from doing so along with others reasons as well. I also didn’t want to let down my friends in such a drastic way.
This, I was to endure for the next two and a half years, the depression being unbearable and incapacitating at times. I managed to keep fairly regular bike rides for this period but sometimes it was a struggle to get out of bed let alone get on the bike and push it for 25 miles.
A friend of mine suggested I get help. By “help” he meant drug intervention, which was completely out of the question. I’d gotten myself into this and I was going to figure how to get myself out and wasn’t going to repeat another “drug experiment” like I did in those three weeks mentioned previously, although most of the time the prospect of getting myself out of it seemed grim.
I kept thinking that it had all started after the first case of hyponatremia at the end of July 2009. I thought that it must have done something to the system that at the time I was unable to decipher. I’d feared that my serum sodium level in July 2009 was so critically low that it may have done permanent damage.
Oddly enough, the same friend who suggested I get “help” suggested that I mention to Harley, aka Durianrider that I’d been depressed and see what he said. At the time, I didn’t. After all, what was Harley going to tell me? Having said that, I am of the firm belief that when certain karma has been spent, God speaks, and that can manifest in any of thousands of different ways.
At some point, for reasons I don’t remember, I did mention to Harley in an email that I’d been struggling with depression for the previous two years.
“When’s the last time you had a B12 shot?”
Bingo! B12! Maybe that was it. I’d experienced feeling relief from the horrid hell before when I supplemented B12 but wrote it off feeling that it couldn’t be that significant, couldn’t be that simple. It must have been the way I’d been living my life and the result of bad choices that I’d made and that this was just the resultant hole that I’d dug.
Could it really be B12? So simple and straightforward was Harley’s response. I’d received “advice” from others about what I “needed” to do and how depression was a result of this or that or some other convoluted opinion. But B12? So simple. God indeed must have spoken.
I decided to take this advice seriously. I started immediately on an oral methylcobalamin spray with the intent on getting a prescription for B12 shots.
After a week, I started to feel better. This was before Christmas and I was actually feeling a bit festive for the first time in three years. This was the first Christmas in that time period that I actually wanted to celebrate which was not like me; I had always looked forward to Christmas. I still had some days of deep despair, however, and at those times, started to doubt the effectiveness of the B12 therapy. But overall, I felt quite good and those days of despair passed. Keep in mind that I wasn’t on shots yet and while the oral spray supplement is more effective than pills, it still generally isn’t as effective as shots.
I returned home to the east coast to visit my parents on December 18, 2011 feeling great. I’d begun to think that I’d had the depression kicked. I was enthusiastic, I was upbeat, I felt like seeing friends for first time in a few years. This was great.
Fast forward two weeks to New Year’s Day. I awoke and the black cloud had returned. The depression returned with a force and hit me like a ton of bricks. It was an effort to get off the couch that day and the following days. If you’ve not suffered with severe depression, you have no idea of the horror that it brings when it returns after a reprieve.
Just prior, I was feeling quite well and thought that I was turning my life back around because I was then making certain definite decisions. But what I’d realized was that I still wasn’t taking the B12 thing seriously. I hadn’t supplemented during the previous two weeks while away. Perhaps the serum B12 level had dropped again. With all that I’d experienced previously, I had to go with that. The next day, I immediately started on supplemental B12 again. My parents had some time release B12 tablets and I started on those. This wouldn’t be as effective as the oral spray I’d thought, but it would certainly be better than nothing.
That was on Monday, January 2, 2012 that I resumed supplementation and by the time I’d returned to Los Angeles on the evening of January 6, 2012, I started to feel normal.
In the interim, on Wednesday, January 4, 2012, I’d gotten a call from the doctor with the results of the serum B12 test that I asked her to administer the last time that I saw her for other reasons on December 14, 2011. My level at that time was 230 pg/ml. That was after a full month of oral methylcobalamin supplements and my level was still only 230 pg/ml! I was feeling pretty good at 230 pg/ml but that level is borderline. What must my level have been before the solid month of B12 supplement when I was severely depressed? I don’t have the clinical lab reports to prove it, but I would speculate that I was falling below 200 pg/ml at those times. It would have been interesting to have clinically documented this.
I’d gotten a so-called “full range” of blood work a year and a half before to see if I could find some physical reason why I’d been suffering mentally. Believe it or not, they didn’t test for B12! I have since found that is not unusual. The medical profession in general doesn’t take B12 levels seriously and they almost never check for deficiency even though a deficiency manifests in dozens of different ways, depression being one of them. The problem here though is that symptoms of B12 deficiency often mimic other disorders such as MS, Parkinson’s, dementia to name a few, so it often goes unnoticed. I recently told my father to have his serum B12 level checked and he told me that the doctor told him that they usually don’t check for it because “the insurance companies don’t like it.” Don’t like it?
When one examines the nature of the industry, what I like to call the disease industry, one finds that no one is making any money offering cures. B12 therapy is an inexpensive, safe and easy method, and as thus, makes the industry little money.
My doctor, when the results were in, suggested that I not resort to injections. With all credit due, this is foolish advice! With a level of 230 pg/ml after an entire month of supplementation with a recent history of depression, I needed to be on shots!
After returning to Los Angeles, I’d run out of oral B12 spray and was relying on tablets. My depression returned on January 20, 2012 with a serious vengeance. By January 24, 2012, I had been too depressed to go to work. That day, I started on the oral spray again, an order that I’d just received a few days before. I must have sprayed nearly 10 g of the liquid into my mouth that day, a serious mega dose, but by that time, I was fairly convinced that my depression was a result of a low serum B12 and I had the clinical evidence now to prove it.
The next day, January 25, 2012, I’d actually started to feel better. I returned to the doctor and requested a prescription for B12 injections. This time she gave it to me. I went to YouTube and watched a few tutorials on how to inject oneself and that night administered the first B12 shot.
By January 26, 2012, after the second B12 injection, I felt amazing, that my life and attitude had turned completely back around, and that was with using cyanocobalamin which is actually a lot less effective as compared with the more effective methylcobalamin. I had requested methylcobalamin, both from the doctor and pharmacy. Unfortunately, most doctors inject cyanocobalamin and that is also what most pharmacies carry.
It is unfortunate how backward in certain respects America is. Cyanocobalamin is less expensive than methylcobalamin and that, I am sure, is the deciding factor, in America anyway. In Japan, methylcobalamin is the B12 of choice. As well as this, only serum B12 levels above 550 pg/ml are considered adequate in Japan, this compared with the level of 211 pg/ml and above considered adequate in America, which is far too low. For this reason, as mentioned previously, coupled with the fact that B12 deficiency mimics many other disorders, many cases of B12 deficiency go undiagnosed with sometimes tragic results. It’s tragic as well as criminal!
So what is the point of all this? Firstly, we have to consider what B12 is. It is a stress vitamin or at least one whose stores can be depleted through stress, through physical activity, through pollution, through our poisoned and sterilized way of life.
As for my situation, my theory, it’s a little more than a theory at this point but I don’t have complete clinical evidence to support it, is that after the trauma of coming so close to death in July 2009 and then the absolute stress of temporarily losing my mind the following week and all that was to follow, depleted my B12 reserves because, as mentioned earlier, that is when I started to notice the ill effects.
To add to this, I live in one of the most polluted cities in America, Los Angeles, I am an avid cyclist and I follow a vegan diet, which probably did not provide enough B12 to boost my level once it became low. I have no clinical evidence for this as mentioned, because low B12 levels were never brought to my attention prior to my requesting a blood test on December 14, 2011, which is not really the best way to detect a B12 deficiency anyway. An MMA test and homocysteine levels are a better indicator of B12 deficiency or at least should be administered along with the serum test. Having said that, depression had never been a problem whatsoever prior to becoming hyponatremic in July 2009. As I mentioned previously, I started to notice the first signs of what was to come about three weeks after that.
So I blame the low serum B12 particularly on trauma and undue stress that resulted from the very difficult experience with hyponatremia. However, the research does show that vegetarians, particularly vegans, are notoriously low in B12 which is not really a surprise, not that their “omnivorous” counter parts are generally very much higher either. A study done by Tufts University showed that those following an omnivorous diet averaged a serum B12 level of 311 pg/ml and that 40% of the American population is B12 deficient! Vegans, however, were on average even lower than omnivores in the study with an average serum B12 level of 193pg/ml. Both are rather low. So it could have been that I was on the lower end of the scale before the trauma happened, but not low enough to cause any noticeable problems, however, that projection is purely speculative and I have no clinical evidence to support that.
Of course, vegans would have to rely on their B12 source strictly from B12 producing microbes and in the world as it is, much of those microbes are being washed off, sterilized and otherwise destroyed. Even in our own bodies, most vegans are damaging their B12 producing bacteria through the regular ingestion of salt, garlic, spices, chilies and glutenous grains. Smoking, alcohol, pollution, pesticides, recreational and prescription drugs, especially antibiotics, would also do damage to this vital bacteria.
It would seem, and the research does seem to confirm, that in our modern day society, B12 deficiency is epidemic.
What is the solution to this dilemma? Would it be wise to include animal products in our regime? That might raise B12 levels of those following a strictly plant-based diet, but animal products have side effects and vegans are not the only people who are low or B12 deficient.
If all conditions were right, as they would be in nature, would vegans, following a strict frugivorous/herbivorous diet without the inclusion of excitotoxins such as salt, garlic, spices, etc. which damage delicate B12 producing microbes , be able to maintain a proper level of B12? Even our cousins, the primates in the wild, include some animal products in their diet, however, are they actually eating enough animal products to cover their B12 needs or are they deriving a sufficient amount of B12 from B12 producing microbes in the bowel and elsewhere? Of course, we also have the herbivores that eat only plants. I am sure that they are deriving sufficient B12 from bacteria in the gut, and the plants that they eat are replete with B12 producing bacteria since they have not been washed or sterilized with deadly pesticides. All this is something to think about.
For me, I will be not abandoning an exclusively plant-based diet just yet and probably nor will I any time in the future. In this washed, sterilized and polluted world, I will rely on supplementation.
I have been injecting the cyanocobalamin form of B12 with quite good results. However, I will be switching to methylcobalamin injections despite the several fold increase in expense. Methylcobalamin is more effective than cyanocobalamin. The body can more readily use methylcobalamin and over the first 24 hour period, retains 75% as opposed to cyanocobalamin which is a synthetic form that the body needs to first convert to methylcobalamin and retains only 20% over the first 24 hour period making methylcobalamin nearly four times as effective as cyanocobalamin in that respect.
I recommend that everyone have their MMA, homocysteine and serum B12 levels checked. If your serum B12 level is below 500 pg/ml get on supplements preferably methylcobalamin injections. If you don’t use injections, then an oral methylcobalamin spray or sublingual would be preferable to tablets.
B12 is a serious issue not to be taken lightly. Better to take precaution rather than learn the lesson through pain and suffering as I did.
I am very happy to say that since starting the B12 shots, I am completely depression free. In fact, what I experience on a regular basis is so much the opposite of depression that I may need to write another blog post on that!
Thanks again to Harley for such straightforward and effective advice!
To your health and much love,
Could It Be B12? by Sally M. Pacholok, R.N., B.S.N. and Jeffery J. Stuart, D.O.
B12 Exposed by David Rainoshek
FAQ with Durianrider: b12 & zinc. #262 by Harley Johnstone
B12 deficiency case history: raw radiant health with Natasha St Michael #279 by Harley Johnstone