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Multiple Myeloma Diagnosis- B12 Deficiency, MM?

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The aim is to investigate retrospectively the association between vitamin B12 levels at the time of diagnosis and the complications including hypercalcemia and fractures in multiple myeloma patients.

Hi David, I came across your site after doing a Google search ‘difference between B12 deficiency and a multiple myeloma diagnosis.

I wonder if you have any thoughts on the above please as I’m feeling that my symptoms are more down to a B12 deficiency than my Asymptomatic Myeloma (pre-multiple myeloma)  but whilst my haematologist is generally supportive, he doesn’t think a B12 deficiency is the problem.



  • I’m a 62 year old male living in Belfast, N.Ireland.
  • 30 years ago I had Non-Hodgkins Lymphoma. I had 19 sessions of chemo followed by an autologous bone marrow transplant and was in remission for the last 6 years.
  • Around 6 years ago my Paraprotein levels were showing a figure of 14 which is now elevated to 21 and I have been diagnosed with Multiple Myeloma but have not required treatment (wait and watch policy).
  • I have been vegan for around 3+ years.
  • My B12 blood checks were 248ng/l Sept 17, 185 Sept 18 (then started on 3 x 50mcg B12 tablets prescribed) and 469 Oct 18.
  • I have been constantly complaining to my GP and haematologist about fatigue for the past 2 – 3 years but they put it down to my Myeloma.
  • Around / just over a year ago I had vertigo, confusion, light headed, lethargic and dizzy spells. I also had heart palpitations which ECG showed were ok and was diagnosed with Essential Tremors in both hands.
  • My dizziness was put down to a possible ear infection and I was given antibiotics.
  • I have recently developed peripheral neuropathy which I’m told was from chemo nearly 30 years ago.

I have been pushing my haematologist to check for B12 deficiency and at my request he did a blood MMA test which he reports as:

  • “Yes it’s back and within normal range, so no B12 deficiency…”
    ” Homocysteine back this morning and measures 12 micromols per litre (i.e not significantly elevated)…”
  • “Your blood cells are normal sized…”
  • “You have not been checked for intrinsic factor as you would need to have biochemical evidence of B12 deficiency first and we don’t have that as yet…”

Re other causes of anaemia – there is no evidence of iron deficiency or haemolysis. I think myeloma is the most likely cause however your blood counts and paraprotein are showing slow progression at most. ‘

Last year I began taking Metformin not for diabetes, but as a repurposed drug for my cancer under a trial with Care Oncology Clinic.

A few months ago after receiving these readings / results I self medicated and am now taking 2 x 1500mcg / day tablets and more recently 1000 mcg Liposomal Hydroxyocobalamin.

I think I’m feeling a little better but the hand tremors are still there and I’m still a bit lethargic, lifeless and tired but the palpitations are gone.

Thanks in advance, Steve

Hi Steve-

I am sorry to read of your heath challenges. This may not help much but MM is a difficult cancer to diagnose. I will try to shed light on some issues below.

Several things. I will excerpt your comments below in order to address the issue-
1) B12 deficiency and MM- First and foremost, B12 deficiency is “associated” with multiple myeloma but, according to research, B12 deficiency is not a “cause” cause of MM. Deficient blood levels of Vitamin D3 is also associated with MM. My point here is that the research is not ideal for many diagnostic issues. Nerve damage is also a common side effect of MGUS (pre-MM) but pre-MM is supposed to be asymptotic, as you have pointed out.
2) Having said the above, please see the article linked and excerpted below that cites several “B12 deficiency”  risk factors that overlap some of your lifestyle- fatigue, neurologic symptoms, veganism, tremors…
The bottom line is that I think you are correct. B12 deficiency is the issue. However, I don’t know enough about your situation, your physicians, to know what tests to run, how to diagnose and treat your B12 deficiency.
I think the article below cites factors that overlap with your symptoms and lifestyle and should point you and your doctors in the right direction.
I hope this helps.
Thanks and hang in there,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Vitamin B12 Deficiency

“…Diagnosis of pernicious anemia is also relatively simple in the case of a patients presenting with fatigue due to anemia, neurologic symptoms (myelo-neuropathic, more rarely cerebral/autonomic), and glossitis. Pernicious anemia is also usually associated with family history of the disease in one-third of the patients and with other autoimmune diseases. However, the majority of cases do not present with this classic, full-blown symptomatology, and, in many cases, the classic manifestations may be absent…
In addition, much more common is subclinical B12 deficiency, with no clinical expression, but with the presence of abnormal biochemical markers. In these cases, gastrointestinal (GI) absorption is normal in the majority of cases, and small reductions in absorption can be demonstrated for food-bound B12 in one-third to one-half of the cases…
Strict vegetarians (veganism, avoidance of all animal products) and chronic alcoholics should also be considered at risk of developing B12 deficiency
Patients on chronic therapy with either metformin or omeprazole have been shown at increased risk of developing B12 deficiency….



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