Coffee is more than merely a drink; in Jordan it is surrounded with custom and treated with reverence. It is not only a symbol of hospitality and trust, it is a traditional sign of respect and a way to bring people together. Black, cardomom flavored Arabic coffee, also known as "Qahwa Saada", is deeply ingrained in the Jordanian culture.
Usually having a bitter taste, beautiful aroma, and served in small portions into handle-less cups. It is closely associated with the Dallah - an iconic coffee pot of Arab culture. Serving coffee to guests is a large part of the culture's warm hospitality. (source)
Please feel free to contribute your feedback to ysmousa@yahoo.com
The problem mostly lies in absorbing B12. That's why a higher intake of food that is rich in B12 will not make much difference.
ReplyDeleteWhat is even more confusing is that people may have a B12 value that is closer to normal ( on the lower end) and still show deficiency symptoms. Normal B12 values are thought to be between 200-600 pictogram/milliliter. You may have a below normal value and show no symptoms at all. On the other hand, it could be hugely threatening to your nervous system if you have a value of 250 pictogram/milliliter which is considered normal but not adequate for some people. It just varies between one person to another.
This is where the doctor part kicks in. From my experience though, most doctors in Jordan fail at these stuff, even the most able!
B12 is relatively cheap. Whether you got a low normal or a below normal value, take the shots.
Thank you Yanal for the valuable information.
ReplyDeleteAfter a bit of wikipedia research, it seems, as you said, the most reliable way of boosting B12 levels is by injections.
Wikipedia states: "Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach. It is necessary for the absorption of vitamin B12 later on in the terminal ileum."
"Treatment
Patients experiencing an insufficiency in their intrinsic factor levels cannot benefit from a low dose oral vitamin B-12 supplement, because it will not absorb through the wall of the small intestine. Historically, the disease was thought untreatable before the discovery that it could be managed with regular injections of vitamin B-12, thus bypassing the digestive tract. More recently, Swedish researchers discovered that sufficiently large doses of B-12 can also be absorbed sublingually (through the blood), and it may be possible to avoid injectable B-12. However, as of yet, no standards have been set for treatment by the sublingual route and injections of B-12 are the only reliable method of treatment."
http://en.wikipedia.org/wiki/Intrinsic_factor
Well to start with, it is a nice article!! But don't depend on wikipedia alone because it is not scientific in everything!!
ReplyDeleteYanal: Thank you for the comment, but please don't get into details you don't know very much, concerning Jordanian Drs failure in these stuff!!
Now to talk about Vit B12:
Well it is not mostly an absorption problem!! you can say it is multifactorial! HOW??
1) It could be absorption problem as you said, and this is what everybody rely on to just run away from the answer! However, it is not the major problem.
2)Malnutrition is a big problem! You think everybody who eats BK and Mc and all that junk outside is well nourished?? Why?? Do you even think that there is any BEEF in this junk?? It is not even food, somehow!! except for the bread and lettace!!
3) Why i said multifactorial?? because we should highly consider the geographical distribution of the Vit B12 def! How?
It is well known that Vit B12 def is prevalent around the Meditterranean, in countries mainly on the east coast of meditteranean! In these countries, you may find levels as low as 150 and it is still normal!
By the way the range can be considered to be normal between 150 and up to 950!!
So it is not necessary to have symptoms with a level of 150! Also you can't say the neurologic sypmtoms are defenitly due to B12!! there are many many other causes to consider.
Also you can't get neurologic symptoms due to B12 def before getting anemia! and if you go check the CBC of those patients who think they have B12 Def, u'll find that it is normal, so the symptoms of fatigue and decreased conc as well as muscle weakness are not due to B12 def even though the blood levels are LOW or even LOW NORMAL!!!
Her you should definitely keep in mind the more common psyciatric illnesses that are very common and share similar symptoms including deppression! Nobody can deny depression as a cause of fatigue, decrease conc and muscle weakness! Emotions are critical issues in our lives!!
Ill be glad to hear your opinion back.
Dr. Omar
Thank you Dr. for this very informative post...it is well appreciated.
ReplyDeleteSo then we must come to the conclusion that B12 deficiency does not have to relate to an absorption problem
For analysis of why B12 levels are deficient, The Schilling test must be performed.
For more information about the Schilling Test:
http://en.wikipedia.org/wiki/Schilling_test
...and thank you again Dr. Omar for your comment.
Well Doc, after going to around 3-4 doctors(2 of whom are considered to be the top 2 neurologists in Jordan), and having been told that I got absolutely nothing, I can conclude that most Doctors here in Amman have below average skills in B12 related matters. If you had visited the best of the best doctors in Amman(All specialized in Neurology abroad and have 20+ years of experience) , then you could tell me that I don't know much about them.
ReplyDeleteI had tests run for everything, MRIs for lesions and a full blood count. They all concluded that the neurological symptoms I had were just "in my head" and mainly related to stress.
After googling for some time, I found out that B12 deficiency can cause neruo symptoms like numbness and weakness. I am taking the shots regularly and happy to report that I have improved very much!
Btw, I had a borderline normal B12 value...
If I listened to our top Doctors here in Amman, I would have been paralyzed by now because of their huge failure at these stuff!
Btw, I had numbness in hands and legs. My hands used to shake badly when I move them.
ReplyDeleteWeakness in about all my muscles. Vision problems and hearing problems in one ear as well. Depression too. All of which Doctors ignored because my symptoms weren't that clear. They were mild as you guys say..
A doctor can't feel your weakness or numbness. They just make you do some stupid physical movements which do not show anything wrong except in SEVERE cases.
They think if someone has weakness in his legs then he cannot walk.. Or in his arms, then he supposedly can't push hard which I could infact... I used to go to a gym at that time!
I really stopped going to doctors after the many stupid encounters I had with them..
Thank god I am symptom free now which only happened when I started to self diagnose my problem and found out that I am deficient even with a borderline value!
I'm sorry to hear this news Yanal, one's point of experience is certainly something that should be highly taken into consideration.
ReplyDeleteWell I agree 100% that a doctor can't "feel your weakness or numbness", well said.
But as a matter of opinion (even though im hardly qualified to talk about medical matters yet), everyone makes mistakes; its just the way we are.
It is a great dispair to read about the misfortunate encounters you have experienced with these doctors and I hope you go through better encounters in the future to come.
I'm very glad to hear that you are currently symptom free and have been relieved from your problem, wish you all the best.
Thank you for your point of view.
Salamtak yanal...
ReplyDeleteDr Omar