Dr Joseph Chandy, a 74-year-old general practitioner in County Durham in the UK, is convinced he has discovered a cure for many cases of depression, but to the medical authorities, his treatment is dangerous and unproven.
For years he’s had to pay for supplies out of his own pocket when he couldn’t get National Health Service reimbursement for the treatment. In 2006, his local health authority banned him from using his treatment on his patients. After many months of deliberation, they finally lifted the ban, only to have it slapped on him again by the General Medical Council in June 2014.
Despite the testimonials of hundreds of grateful patients, who have even formed a patient group to champion his work, the GMC order also effectively bans him from using the treatment in any private work outside of the NHS and from practicing outside his practice, the Shinwell Medical Group, in Horden.
What is Chandy’s dangerous and unproven contraband worthy of GMC reprimands, including a court order?
Injections of vitamin B12.
“This is what happens when you challenge the Establishment,” he said. “It is a witchhunt. They know I am right, but I am challenging the old thinking, the antiquated thinking.”
The Chandy case highlights yet more evidence that the condition we call ‘depression,’ which afflicts so many of us at one time or another over the course of our lives—is something other than a case of inherent chemical imbalance. According to the standard view of modern medicine, depression is the result of an imbalance in the brain chemical serotonin—a theory that’s never been proven—and the standard approach is to use drugs like SSRIs (selective serotonin reuptake inhibitors) to slow the process of serotonin being taken up by the body.
But new evidence increasingly points to the fact that any imbalance in the body may have more to do with a simple deficiency of one or more trace elements that are vital for maintaining mood, or may be part of a larger picture of a metabolic disorder related to other degenerative diseases stemming from dietary causes.
Although Chandy treats all sorts of cases of ‘puzzling’ illness with vitamin B12, including patients with severe chronic fatigue and multiple sclerosis (see box, right), his casebook also includes a number of patients with debilitating depression that turned out to be a simple vitamin deficiency.
Jeanette Chapman, age 42, for instance, was featured in a BBC documentary about Chandy’s work. In it she described how B12 injections helped her recover from severe depression, allowing her to stop taking antidepressants. Chandy has even gone on record to say that many cases of depression may be nothing more than a serious deficiency of vitamin B12 and that a low mood often goes hand in hand with B12 deficiency. As a doctor practicing in the same district for 33 years, he has cared for a number of generations, and as a consequence, has discovered that this deficiency can even run in families. Over the years, he has personally funded its successful use to treat hundreds of patients with depression.
One such patient, a woman in her mid-30s, was visiting her mother in Horden from York. She had been diagnosed with extreme endogenous depression and was on a cocktail of drugs. Although college educated, she’d been unable to work. After Chandy took a blood sample, results showed a severe B12 deficiency. He began to give her regular B12 injections.
“Within weeks she started to feel better, and within a month I was able to take her off all drugs,” he says. “She ended up getting another degree and now has an important job with the government.”
A simple lack
The B vitamins play a central role in regulating levels of important neurotransmitters like serotonin and dopamine, which are involved in feeling happy. B12 is vital for the formation of red blood cells, and its deficiency can lead to what is termed ‘pernicious anemia,’ characterized by mood swings, depression and other conditions often mislabeled as psychiatric problems.
New scientific evidence is emerging to show how important B vitamins like B12 are to a buoyant mood. A Finnish study, carried out at 20 different medical centers across Finland and involving more than 400 patients with depressive symptoms, was one of the first to discover that levels of vitamin B12 corresponded to the level of depressive symptoms: those with the highest levels of B12 [331 ± 176 pmol/L (picomoles per liter)] suffered no symptoms of melancholy, while those with general depressive symptoms had average levels of 324 ± 135 pmol/L and those with the worst symptoms—or ‘melancholic depression’—had the lowest levels of B12 (292 ± 112 pmol/L).1
A US study of women aged 65 and over found that those who were deficient in B12 were twice as likely to be depressed as those with adequate levels,2 while a population study of nearly 4,000 elderly men and women with depressive illness discovered that those with poor B12 status were 70 percent more likely to be depressed.3
While it isn’t clear why exactly B12 is so central to depression, several theories based on animal models suggest that it has to do with the interaction of B12 and S-adenosylmethionine (SAMe). Found naturally in nearly every cell of the body, SAMe is involved in, among other things, the production and breakdown of brain chemicals like serotonin, melatonin and dopamine—the neurotransmitters involved in regulating mood—and not having enough B12 or folate can reduce levels of SAMe. This is supported by the fact that a few clinical trials have shown that doses of 200–1,600 mg/day of SAMe were better than a placebo and worked as well as tricyclic antidepressants in easing depression.4
The important role that micronutrients like B12 play in staving off depression can be seen in the complex and interesting link between depression and an unhealthy diet. There’s also evidence linking depression to the same metabolic syndrome—including inflammation, insulin resistance and mitochondrial dysfunction—that underlies many degenerative conditions like heart disease and diabetes.
A history of depression is often a marker of future heart disease, which we now know invariably results from inflammation. In one study of nearly 900 people, those who suffered bouts of major depression and mood swings were twice as likely to have a heart attack as those who were not depressed.5
Women with a history of depression are three times more likely to die of a cardiovascular disease and 14 times more likely to die from a heart attack, with men 2.4 times and 3.5 times more likely to die, respectively. According to the authors, one ofthe culprits included increased serotonin binding in the brain due to persistent stress.6
Depression is also related to high levels of C-reactive protein (CRP), an indicator in the blood that inflammation is present somewhere in the body, although the jury is still out as to whether inflammation causes depression or depression causes the rise in CRP.7
Additionally, depression has been linked to raised levels of homocysteine,3 and it’s known that a vitamin B12 deficiency allows the buildup of homocysteine. A byproduct of the normal breakdown of protein in the body, this amino acid is a predictor of arterial disease and heart attack, and high levels significantly increase the risks when cholesterol is normal or even low.8
Indeed, high levels of homocysteine can quadruple the risk of cardiovascular disease.9 The biggest ever heart-health investigation, the US Framingham Heart Study, revealed that the higher the levels of blood homocysteine, the greater the extent of narrowing (stenosis) of the carotid arteries, while the higher the levels of folate and vitamin B6, the less carotid stenosis.10
What’s more, new data shows that a number of nutrients like B12 affect the mitochondria within cells, the ‘powerhouses’ responsible for each cell’s energy production, which also play a vital role in neurotransmitter signaling in the circuits that help to regulate mood.
Researchers from Yunnan University in China at the forefront of research into the role of stress and high levels of cortisol on mitrochondrial function have discovered that high levels of cortisol (our flight-or-fight hormone) can cause oxidative damage to mitochondria, in turn also affecting neurotransmitter signaling. Nutrients that protect against such oxidative damage include vitamin B12 and folate, omega-3 fatty acids, vitamin C, zinc and magnesium.11
This new Chinese evidence suggests that a lack of B12 may be only part of a complex picture of deficiencies in a number of nutrients.
B vitamins like folate, B6 and niacin play a role in the synthesis of the neurotransmitters involved in mood, and new evidence has discovered a relationship between depression and low levels of folate.12 According to animal research, B6 levels may also affect rates of serotonin synthesis by 20 to 60 percent.13
Besides the B vitamins, there’s evidence that vitamin C plays a role in depression. Dr Hugh Riordan, an American doctor of orthomolecular medicine, describes a patient of his who had been so profoundly depressed with severe fatigue that she’d barely been able to hold down her job as a teacher. Three years of psychotherapy had made no impact on her condition.
After testing her levels of various nutrients, Dr Riordan discovered she had a vitamin C deficiency. He prescribed 500 mg/day of vitamin C, an extremely modest supplementary level by his usual standards. A few weeks later, she returned to his office, claiming a miracle had happened: her mood had entirely lifted. Other patients in his case files have been helped by zinc, another antioxidant.
People who suffer from depression may also lack the proper balance between omega-3 and -6 fatty acids. One review of the literature on essential fatty acids (EFAs) showed that such imbalances, particularly as we age, can impede the communication between neurons and not only impair cognitive function, but also affect mood, causing depression.14
There’s also evidence that omega-3 fats are natural anti-inflammatories that can counteract depression. In a study of 432 adults with major depression, those who took a fish-oil supplement for eight weeks reported significant improvement in their condition compared with those given a placebo.15
Women in the last stage of pregnancy experience a sudden increase in inflammation, which one researcher at the University of New Hampshire says is a major contributor to postnatal depression after giving birth. Breastfeeding the newborn will lower the possibility of triggering the body’s inflammatory response—as will supplementing with omega-3 fatty acids, according to the author.16
Deficiencies of vitamin D, which are widespread in northern climates, including much of the US and Northern Europe, have also been linked to general depression by affecting neurotransmitters, inflammatory markers and other factors related to depression.
D is for dietary imbalance
By isolating B12 as a treatment for so many diseases, Dr Chandy may have inadvertently stumbled upon a new way to view depression: as not so much a case of inherent brain imbalance as dietary imbalance, the result of our increasingly nutrient-deficient, overly processed Western diet.
Although increasingly the scientific literature supports Chandy’s clinical findings, the Medical Establishment, which remains far more trusting of dangerous drugs like SSRIs than of food or vitamins, has chosen to willfully ignore this evidence and has employed a Gestapo-like tactic in an attempt to crush an inexpensive and promising answer to depression and a doctor dedicated to a non-drug approach— despite the fact that B12 is one of the only nutritional supplements found to be safe at any level, according to a 2004 European Union Report on Nutritional Supplements. Although any nurse in the UK can administer the vitamin to a patient, Chandy is no longer allowed to diagnose or treat any condition with B12.
In response, Chandy’s patients have set up an online petition to make B12 injections available over the counter (to sign it, see www.change.org/p/ian-hudson-please-make-our-life-saving-injectable-vitamin-b12-hydroxocobalamin-available-over-the-counter). Some of his patients even plan to go to Parliament to campaign for the ban to be lifted, and Graham Morris, the local Labour MP and a member of the Health Select Committee, has approached the GMC on Chandy’s behalf.
Chandy says he is “taking it on the chin right now,” but he’s also writing up his findings behind the scenes. “Everyone knows I speak the truth. In India, my work is spreading and there are no such idiotic restrictions there.”
Depression can be a multifactoral problem, arising from a mix of diet, lifestyle, life events and even hormonal imbalance. But before embarking on expensive talking cures or taking powerful drugs with potentially damaging side effects, it may make sense to check whether your low moods result from a simple vitamin deficiency like B12. This may be one instance where there is such a thing as a magic bullet.
Dr Joseph Chandy had his ah-ha moment more than 40 years ago as a young doctor in India, when he wondered whether there was any connection between the general fatigue and malaise of many of his pale-looking Brahmin patients and their diet. He also noticed that patients improved after a senior doctor at the Thiruvananthapuram Medical College, where he was practicing, prescribed them a liver extract.
All the Hindus residing in his area were vegetarian and, as the most readily usable form of B12 is found in meat, fish, milk and eggs, vitamin B12 deficiency is particularly widespread among vegans or vegetarians.
Dr Chandy began experimenting with B12 in India and, after moving to the UK and setting up a practice in the former mining village of Peterlee in County Durham in 1970, he continued to research B12 and its importance to health.
Ten years later, he began treating his UK patients with the vitamin after delivering the baby of Glenise Mason, then 26, who complained of pins and needles sensations in her lower limbs and constant tiredness. He ordered a test and discovered she was severely deficient in B12; shots of B12 promptly ended her problems.
To date, Chandy has treated hundreds of patients suffering from multiple sclerosis (MS) and unexplained fatigue, as well as other unexplained conditions like depression.
His work has been applauded in his native India (he was awarded the Glory of India award), and he even met with Prime Minister David Cameron to discuss his findings. A BBC documentary about him and his work was made in 2006, and featured many patients claiming to have had their lives turned around by the B12 treatment, including MS sufferers who got out of their wheelchairs after undergoing the treatment.
His devoted patients have even formed a patient group—the B12 deficiency Support Group (www.b12d.org). Last year, he was not only ordered to stop prescribing the treatment, but also told he must not treat the condition at all by the Interim Orders Panel of the Medical Practitioners Tribunal Service.
Symptoms of B12 deficiency
• Constant tiredness
• Pins and needles sensations
• Hair loss
• Numbness in hands or feet
• Palpitations, recurrent headache or dizziness
• Tremors or palsies of any sort.
Testing for B12 deficiency
If you think you may be B12-deficient, the B12 deficiency Support Group (a registered charity, see www.b12d.org) suggests the following checklist.
1 Look at your symptoms. Check out their 1-Minute Signs & Symptoms Health Check.
2 Order blood results and compare with reference ranges. These tests measure your full blood count (FBC), serum vitamin B12, folic acid, thyroid-stimulating hormone (TSH), urea and electrolytes, liver function test (LFT), serum ferritin, glucose, 8–9 a.m. cortisol and vitamin D, all of which will exclude the most common conditions with B12 deficiency.
3 Anything lower than 350 ng/L blood serum of B12 indicates ‘subtle’ subnormal B12, while levels under 200 ng/L mean severe deficiency.
4 Follow the appropriate treatment schedule. If you are severely deficient, you’ll need to have intramuscular injections of cyanocobalamin B12 (1 mg), the only product licensed in the US for injection.
Ditch dairy and wheat
If your vitamin levels check out but you are still depressed, think twice about dairy and wheat. Nutritionists have discovered morphine-like substances called ‘exorphins’—derived from the incomplete digestion of proteins in cereal grains and dairy products—which may be a possible cause of depression. The evidence reveals five distinct exorphins in the pepsin digests of gluten, and eight other exorphins in the pepsin digests of milk.1 These foods can also inhibit the uptake of nutrients like B12.
Exorphins act like depressants, and it’s now thought that the immune reactions that arise from eating these foods include a number of psychiatric symptoms, even simple ‘brain fog.’
Depression has also been linked to allergies and celiac disease, where the inner lining of the small intestine (the mucosa) is damaged after eating gluten-containing grains like wheat, rye, oats and barley.2
According to a recent review, as many as one-third of adult celiacs suffers from various vitamin deficiencies and neurological changes, including depression.3
Are drugs behind your deficiency?
Recent research has revealed that proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs), two classes of drugs widely used to suppress stomach acid production, can cause major vitamin B12 deficiency.
In the study, patients taking more than one and a half PPI pills a day were nearly twice as likely to be B12-deficient. Even patients who’d used these kinds of drugs previously, but had stopped taking them, were more likely to have a B12 deficiency.1
Other drugs known to affect levels of B12 include birth control pills and nitric oxide (laughing gas).
A diet to beat the blues
• Consume a varied wholefood Mediterranean diet, which has been shown to help manage depression.1 This should include liberal quantities of vegetables and fruit, fish, legumes, whole grains and olive oil. Don’t cook with or use polyunsaturated oils.
• Eat four to six small meals a day if you’re hypoglycemic (low blood sugar).
• Cut out processed foods, as they contain trans fats and omega-6 fatty acids, which can be inflammatory.
• Limit sugar, which could be causing oxidative stress and insulin resistance.
• Consider supplementing with hydrochloric acid (HCl) if tests show you’re low in stomach acid and not digesting your food properly, as this has been linked with B12 deficiency.
Suggested daily dosage: 1 or 2 HCl capsules plus pepsin at the start of
• Get your B12 status checked (see box, page 46).
• Take the entire B complex.
Suggested daily dosages: 300 mcg biotin, 100 mg B6 (if over 100 mg, get medical supervision), at least 1,000–8,000 mcg B12 as methylcobalamin (better uptake in the body than cyanocobalamin), 400–800 mcg methylfolate (better absorbed than folic acid), 50 mg B1, 50 mg B2, 500 mg pantothenic acid
Don’t forget other nutrients, such as:
• Vitamin C.
Suggested daily dosage: at least 1–2 g
• Vitamin D.
Suggested daily dosage: 1,000–8,000 mg
Suggested daily dosage: 400–2,000 mg
Suggested daily dosage: 30 mg
• Omega-3 fatty acids, to maintain an ideal ratio of less than 4:1 omega-3s to omega-6s.
Suggested daily dosage: at least
• Coenzyme Q10.
Suggested daily dosage: 100–200 mg
Suggested daily dosage: 1,000 mg
• Multivitamin/mineral supplement, one that includes calcium, iron, copper, selenium, chromium and potassium.
Natural mood regulators
If this diet and supplement program doesn’t work for you, try the following natural antidepressants, but with the supervision of a trained professional, who can try each one on a trial-and-error basis.
• SAMe, which has evidence showing that patients taking SSRIs and S-adenosylmethionine did better than those just taking the drugs alone.2
Suggested daily dosage: 400–1,200 mg
• Rubidium chloride, an alkali metal resembling potassium, may be as effective as an antidepressant.3
Suggested daily dosage: 180 mg three times a day, but be sure to also take 5 g of sodium and 60–80 mmol of potassium to maintain electrolyte balance
Suggested daily dosage: 6 g or less (no more than 4 g if taken with niacinamide)
• l-5-hydroxytryptophan (5-HTP).
Suggested daily dosage: 25 mg with food, and increasing over 10–14 days to 75 mg, three times a day
• St John’s wort (Hypericum perforatum), shown in a review of 23 studies to be as effective as most antidepressants, but with far fewer side-effects.4
• Siberian ginseng (Eleutherococcus senticosus) and forskolin (derived from the roots of Coleus forskohlii), herbs that have scientifically demonstrated benefits.
Suggested daily dosage: 100–400 mg
Suggested daily dosage: 150–200 mg for one month as a trial
Suggested daily dosage: 500 mg, increasing as needed to 3–4 g over two to six months as a trial
Suggested daily dosage: 2 g three times daily as a two-week trial
• Regular exercise, shown to lower depression as well as improve health and wellbeing in general.5