Need for registration of FIR for conspiracy and attempts to cause grievous bodily injury leading to ultimate death by inducing severe vitamin B 12 deficiency in me in 2010, 2011 and 2012 - Seema Sapra, lawyer - WP Civil 1280/2012 a corruption whistle-blower petition in the Delhi High Court (Seema Sapra v General Electric Company and Others)

An FIR must be registered that there was a planned criminal conspiracy
to physically destroy me by deliberately inducing severe vitamin B 12
deficiency in me in 2010, 2011 and 2012 to prevent me from blowing the
whistle on General Electric Company's corruption in the Indian
Railways locomotive factory tenders.

I have complained that in July 2011, I smelled nitrous oxide inside my
house in Jangpura Extension.

This was obviously not the only time that nitrous oxide was released
into my accommodation. It was probably being released into my home in
2010 and all of 2011 as well.

Nitrous oxide exposure causes vitamin B 12 deficiency.

I had weakness, fatigue and difficulty with breathing in July/ August
2011. At that time, I had symptoms of numbness and tingling in my
hands and feet. I had anemia in July/ August 2011.

Earlier in Feb 2011, a gastroenterologist at Apollo was used to
misdiagnose nausea on account of poisoning as heartburn and prescribed
a stomach acid blocker. I took this for about 10 days in Feb 2011. I
was going to Apollo because of persistent coughing inside my house and
was consulting a pulmologist who sent me to the gastroenterologist. In
Feb 2011, it had not occurred to me that I was being poisoned.

Another doctor at Apollo again encouraged me to resume taking the
stomach acid blocker in June 2011 when I went to see him for a visibly
swollen lymph node in the front of my neck. This swelling was also on
account of ongoing poisoning. I have already complained that this
doctor deliberately prescribed me double dosage of sedating
anti-histamines which I did not take. I told this doctor that I did
not need a proton pump inhibitor.

Stomacd acid is required for the body to absorb vitamin B 12. A proton
pump inhibitor would have further aggravated vitamin B 12 deficiency.
The prescription for a proton pump inhibitor was part of this
conspiracy to further aggravate B 12 deficiency that was being induced
by release of nitrous oxide into my accommodation. This would have
prevented my body from absorbing B 12 from my diet.

In August, a doctor at the Defence Colony market told me to take oral
Vitamin B 12. I had gone to her only to get an opinion on lung Xrays,
because Max doctors were covering up lung congestion. This was in
August 2011 after I had made written complaints of poisoning to the
CJI, the police and to Max Healthcare. By then I had expressly
complained in writing that I had been exposed to nitrous oxide,
because I had identified the gas after I smelt it in Max Hospital
while waiting outside the ultrasound room. This doctor told me to take
vitamin B 12 after a telephone call which she took after asking me to
leave the room. My consultation with her could have given her no
indication that I needed vitamin B 12.

The test for B 12 at Max hospital was done in August 2011 more than 10
days after I had already started taking daily doses of vitamin B 12.

I reproduce below articles describing the severe health consequences
of vitamin B 12 deficiency.

Extracts from wikipedia

Vitamin B12 deficiency can potentially cause severe and irreversible
damage, especially to the brain and nervous system. At levels only
slightly lower than normal, a range of symptoms such as fatigue,
depression, and poor memory may be experienced.[2]

Vitamin B12 deficiency can also cause symptoms of mania and psychosis.[27][28]

...

▪ H2-receptor antagonists: include cimetidine (Tagamet), famotidine
(Pepcid), nizatidine (Axid), and ranitidine (Zantac). Reduced
secretion of gastric acid and pepsin produced by H2 blockers can
reduce absorption of protein-bound (dietary) vitamin B12, but not of
supplemental vitamin B12. Gastric acid is needed to release vitamin
B12 from protein for absorption. Clinically significant vitamin B12
deficiency and megaloblastic anemia are unlikely, unless H2 blocker
therapy is prolonged (2 years or more), or the person's diet is poor.
It is also more likely if the person is rendered achlorhydric(with
complete absence of gastric acid secretion), which occurs more
frequently with proton pump inhibitors than H2 blockers. Vitamin B12
levels should be monitored in people taking high doses of H2 blockers
for prolonged periods.

...

▪ Nitrous oxide: Nitrous oxide inactivates the cobalamin form of
vitamin B12 by oxidation. Symptoms of vitamin B12 deficiency,
including sensory neuropathy, myelopathy, and encephalopathy, can
occur within days or weeks of exposure to nitrous oxide anesthesia in
people with subclinical vitamin B12 deficiency. Symptoms are treated
with high doses of vitamin B12, but recovery can be slow and
incomplete. People with normal vitamin B12 levels have sufficient
vitamin B12 stores to make the effects of nitrous oxide insignificant,
unless exposure is repeated and prolonged (such as recreational use).
Vitamin B12 levels should be checked in people with risk factors for
vitamin B12 deficiency prior to using nitrous oxide anesthesia.
Chronic nitrous oxide B12 poisoning (usually from use of nitrous oxide
as a recreational drug), however, may result in B12 functional
deficiency even with normal measured blood levels of B12.[37]

...

 Proton pump inhibitors (PPIs): The PPIs include omeprazole (Prilosec,
Losec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole
(Protonix, Pantoloc), and esomeprazole (Nexium). The reduced secretion
of gastric acid and pepsin produced by PPIs can reduce absorption of
protein-bound (dietary) vitamin B12, but not supplemental vitamin B12.
Gastric acid is needed to release vitamin B12 from protein for
absorption. Reduced vitamin B12 levels may be more common with PPIs
than with H2-blockers, because they are more likely to produce
achlorhydria (complete absence of gastric acid secretion). However,
clinically significant vitamin B12 deficiency is unlikely, unless PPI
therapy is prolonged (2 years or more) or dietary vitamin intake is
low. Vitamin B12 levels should be monitored in people taking high
doses of PPIs for prolonged periods.

...
Vitamin B12 (cobalamins), with folate, is necessary for the formation
and maturation of red blood cells and the synthesis of DNA
(deoxyribonucleic acid), which is the genetic material of cells.
Vitamin B12 is also necessary for normal nerve function. Unlike most
other vitamins, B12 is stored in substantial amounts, mainly in the
liver, until it is needed by the body. If a person stops consuming the
vitamin, the body's stores of this vitamin usually take about 3 to 5
years to exhaust.

People should not take high doses of vitamin B12 as a cure-all, but
otherwise the vitamin does not appear to be toxic.

Vitamin B12 Deficiency

Anemia develops, causing paleness, weakness, fatigue, and, if severe,
shortness of breath and dizziness.

A severe deficiency may damage nerves, causing tingling or loss of
sensation in the hands and feet, muscle weakness, loss of reflexes,
difficulty walking, confusion, and dementia.

The diagnosis is based on blood tests.

When high doses of vitamin B12 supplements are taken, symptoms due to
anemia tend to resolve.

Symptoms due to nerve damage, such as dementia in older people, may persist.

Vitamin B12 occurs in foods that come from animals. Normally, vitamin
B12 is readily absorbed in the last part of the small intestine
(ileum), which leads to the large intestine. However, to be absorbed,
the vitamin must combine with intrinsic factor, a protein produced in
the stomach. Without intrinsic factor, vitamin B12 moves through the
intestine and is excreted in stool.

Because vitamin B12 is necessary for the formation of mature blood
cells, deficiency of this vitamin can result in anemia. The anemia is
characterized by abnormally large red blood cells (macrocytes) and
white blood cells with abnormal nuclei. Anemia may not develop until 3
to 5 years after the deficiency begins because a large amount of
vitamin B12 is stored in the liver.

Vitamin B12 deficiency can cause nerve damage (neuropathy) even when
no anemia develops, particularly in people older than 60.

Causes

Vitamin B12 deficiency can result when people do not consume enough
vitamin B12 or when the body does not absorb or store enough of the
vitamin.

Inadequate consumption:

Vitamin B12 deficiency develops in people who do not consume any
animal products (vegans) unless they take supplements. If a vegan
mother breastfeeds her infant, the infant is at risk of vitamin B12
deficiency.

Inadequate absorption:

The most common cause of vitamin B12 deficiency is inadequate
absorption. The following conditions can cause absorption to be
inadequate:

Overgrowth of bacteria in part of the small intestine

Malabsorption disorders (such as inflammatory bowel disease, celiac
disease, or certain pancreatic disorders)

Inflammatory bowel disease

Fish tapeworm infection

AIDS

Surgery that removes the part of the small intestine where vitamin B12
is absorbed

Drugs such as antacids and ⁠metformin⁠ (used to treat diabetes)

Some Trade Names
GLUCOPHAGE

Lack of intrinsic factor

Decreased stomach acidity (common among older people)

Intrinsic factor may be lacking because abnormal antibodies, produced
by an overactive immune system, attack and destroy the stomach cells
that produce intrinsic factor—an autoimmune reaction called autoimmune
metaplastic atrophic gastritis. Intrinsic factor may be lacking
because the part of the stomach where intrinsic factor is produced was
surgically removed. Vitamin B12 deficiency due to lack of intrinsic
factor causes a type of anemia called pernicious anemia.

Among older people, absorption may be inadequate because stomach
acidity is decreased. Decreased stomach acidity reduces the body's
ability to remove vitamin B12 from the protein in meat. However, the
vitamin B12 found in vitamin supplements can continue to be well
absorbed even in people with decreased stomach acid.

Inadequate storage:

Liver disorders may interfere with the storage of vitamin B12.

Symptoms

Anemia due to vitamin B12 deficiency develops gradually, allowing the
body to adapt somewhat. Consequently, symptoms may be mild even when
anemia is severe. Symptoms of anemia are paleness, weakness, and
fatigue. If severe, anemia causes shortness of breath, dizziness, and
a rapid heart rate. Occasionally, the spleen and liver enlarge.
Younger adults who have pernicious anemia (due to lack of intrinsic
factor) are more likely to develop stomach and other gastrointestinal
cancers.

In people with nerve damage, the legs are affected earlier and more
often than the arms. Tingling is felt in the feet and hands, or
sensation in the legs, feet, and hands is lost. People become less
able to tell where their arms and legs are (position sense) and to
feel vibrations. Mild to moderate muscle weakness develops, and
reflexes may be lost. Walking becomes difficult. Some people become
confused, irritable, and mildly depressed. Advanced vitamin B12
deficiency may lead to delirium, paranoia, and impaired mental
function, including dementia.

Diagnosis

Usually, vitamin B12 deficiency is suspected when routine blood tests
detect large red blood cells. Doctors sometimes suspect it when people
have typical symptoms of nerve damage, such as tingling or loss of
sensation. If the deficiency is suspected, the level of vitamin B12 in
the blood is measured. Usually, doctors also measure the blood level
of folate to rule out folate deficiency, which can also result in
large red blood cells.

If vitamin B12 deficiency is confirmed in an older person, no other
tests are done because the cause, such as low stomach acidity, is
usually not serious. In a younger person, other tests, including other
blood tests, may be done to determine the cause. These tests
(including the Schilling test) usually focus on intrinsic factor. For
the Schilling test, people are given two doses of vitamin B12. The
first is labeled with a small amount of a radioactive substance and is
taken by mouth. The second is an injection of a larger amount of
vitamin B12 that is not radioactively labeled. After the injection is
given, the amount of labeled vitamin B12 in urine is measured to
determine whether the body absorbs a normal amount of the vitamin. If
it does not, the deficiency is confirmed, and the test is repeated to
check for the cause. This time, people are given intrinsic factor with
the vitamin B12 taken by mouth. If intrinsic factor enables the body
to absorb more of the vitamin, the deficiency is caused by lack of
intrinsic factor.

Endoscopy (use of a flexible viewing tube to directly examine internal
structures) may be done to check for destruction of stomach cells that
produce intrinsic factor.

Prevention and Treatment

For infants of vegan mothers, starting vitamin B12, supplements
immediately after birth helps prevent the deficiency.

Older people with vitamin B12 deficiency benefit from taking vitamin
B12 supplements because the deficiency usually results from difficulty
absorbing the vitamin from meat. They can absorb the vitamin more
easily from supplements than from meat.

Treatment of vitamin B12 deficiency or pernicious anemia consists of
high doses of vitamin B12 supplements. If people have the deficiency
but no symptoms, the vitamin may be taken by mouth. Blood tests are
done periodically to make sure the vitamin B12 level returns to and
remains normal. People who have symptoms due to nerve damage are
usually given vitamin B12 by injection into a muscle. Injections,
which may be self-administered, are given daily or weekly for several
weeks until the vitamin B12 level returns to normal. Then injections
are given once a month indefinitely, unless the disorder causing the
deficiency can be corrected.

Anemia usually resolves in about 6 weeks. But severe symptoms due to
nerve damage—for example, dementia in older people—may not resolve.

http://www.merckmanuals.com/home/disorders_of_nutrition/vitamins/vitamin_b12.html

Vitamin B12 deficiency can be sneaky, harmful

Posted January 10, 2013, 10:03 am

Patrick J. Skerrett, Executive Editor, Harvard Health

What harm can having too little of a vitamin do? Consider this: Over
the course of two months, a 62-year-old man developed numbness and a
"pins and needles" sensation in his hands, had trouble walking,
experienced severe joint pain, began turning yellow, and became
progressively short of breath. The cause was lack of vitamin B12 in
his bloodstream, according to a case report from Harvard-affiliated
Massachusetts General Hospital published in The New England Journal of
Medicine. It could have been worse—a severe vitamin B12 deficiency can
lead to deep depression, paranoia and delusions, memory loss,
incontinence, loss of taste and smell, and more, according to another
article in today's New England Journal.



The human body needs vitamin B12 to make red blood cells, nerves, DNA,
and carry out other functions. The average adult should get 2.4
micrograms a day. Like most vitamins, B12 can't be made by the body .
Instead, it must be gotten from food or supplements.

And therein lies the problem: Some people don't consume enough vitamin
B12 to meet their needs, while others can't absorb enough, no matter
how much they take in. As a result, vitamin B12 deficiency is
relatively common, especially among older people. The National Health
and Nutrition Examination Survey estimated that 3.2% of adults over
age 50 have a seriously low B12 level, and up to 20% may have a
borderline deficiency.

Are you at risk?

There are many causes for vitamin B12 deficiency. Surprisingly, two of
them are practices often undertaken to improve health: a vegetarian
diet and weight-loss surgery.

Plants don't make vitamin B12. The only foods that deliver it are
meat, eggs, poultry, dairy products, and other foods from animals.
Strict vegetarians and vegans are at high risk for developing a B12
deficiency if they don't eat grains that have been fortified with the
vitamin or take a vitamin supplement. People who have stomach stapling
or other form of weight-loss surgery are also more likely to be low in
vitamin B12 because the operation interferes with the body's ability
to extract vitamin B12 from food.

Conditions that interfere with food absorption, such celiac or Crohn's
disease, can cause B12 trouble. So can the use of commonly prescribed
heartburn drugs, which reduce acid production in the stomach (acid is
needed to absorb vitamin B12). The condition is more likely to occur
in older people due to the cutback in stomach acid production that
often occurs with aging.

Recognizing a B12 deficiency

Vitamin B12 deficiency can be slow to develop, causing symptoms to
appear gradually and intensify over time. It can also come on
relatively quickly. Given the array of symptoms it can cause, the
condition can be overlooked or confused with something else. Symptoms
may include:

strange sensations, numbness, or tingling in the hands, legs, or feet

difficulty walking (staggering, balance problems)

anemia

a swollen, inflamed tongue

yellowed skin (jaundice)

difficulty thinking and reasoning (cognitive difficulties), or memory loss

paranoia or hallucinations

weakness

fatigue

While an experienced physician may be able to detect a vitamin B12
deficiency with a good interview and physical exam, a blood test is
needed to confirm the condition. (Vitamin B12 deficiency is so easily
overlooked that the Centers for Disease Control has a course for
physicians called "Why Vitamin B12 Deficiency Should Be on Your Radar
Screen.")

Early detection and treatment is important. "If left untreated, the
deficiency can cause severe neurologic problems and blood diseases,"
says Dr. Bruce Bistrian, chief of clinical nutrition at
Harvard-affiliated Beth Israel Deaconess Medical Center.

B proactive

It's a good idea to ask your doctor about having your B12 level checked if you:

are over 50 years old

take a proton-pump inhibitor (such as Nexium or Prevacid) or H2
blocker (such as Pepcid or Zantac)

take metformin (a diabetes drug)

are a strict vegetarian

have had weight-loss surgery or have a condition that interferes with
the absorption of food

A serious vitamin B12 deficiency can be corrected two ways: weekly
shots of vitamin B12 or daily high-dose B12 pills. A mild B12
deficiency can be corrected with a standard multivitamin.

In many people, a vitamin B12 deficiency can be prevented. If you are
a strict vegetarian or vegan, it's important to eat breads, cereals,
or other grains that have been fortified with vitamin B12, or take a
daily supplement. A standard multivitamin delivers 6 micrograms, more
than enough to cover the average body's daily need.

If you are over age 50, the Institute of Medicine recommends that you
get extra B12 from a supplement, since you may not be able to absorb
enough of the vitamin through foods. A standard multivitamin should do
the trick.

Not a cure

The Internet is full of articles lauding the use of vitamin B12 to
prevent Alzheimer's disease, heart disease, and other chronic
conditions or reverse infertility, fatigue, eczema, and a long list of
other health problems. Most are based on poor or faulty evidence.

Take Alzhemier's disease as an example. "Although there is a
relationship between low vitamin B12 levels and cognitive decline,
clinical studies—including those involving people with Alzheimer's
disease—have not shown improvement in cognitive function, even doses
of the vitamin as high as 1000 micrograms," says Dr. Bistrian.

For now, it's best to get enough vitamin B12 to prevent a deficiency,
and not look to it as a remedy for what ails you.


---------- Forwarded message ----------
From: Seema Sapra <seema.sapra@googlemail.com>
Date: Mon, 11 Aug 2014 11:02:06 +0530
Subject: Need for registration of FIR for conspiracy and attempts to
cause grievous bodily injury leading to ultimate death by inducing
severe vitamin B 12 deficiency in me in 2010, 2011 and 2012 - Seema
Sapra, lawyer - WP Civil 1280/2012 a corruption whistle-blower
petition in the Delhi High Court (Seema Sapra v General Electric
Company and Others)
To: amitshah.bjp@gmail.com, sanjayjain.chamber@gmail.com,
director@aiims.ac.in, lggc.delhi@nic.in, "rg.dhc@nic.in"
<rg.dhc@nic.in>, Bhim Sain Bassi <cp.bsbassi@nic.in>,
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"edfc@rb.railnet.gov.in" <edfc@rb.railnet.gov.in>,
"ml@rb.railnet.gov.in" <ml@rb.railnet.gov.in>,
"ppsml@rb.railnet.gov.in" <ppsml@rb.railnet.gov.in>,
"psml@rb.railnet.gov.in" <psml@rb.railnet.gov.in>,
"osdml@rb.railnet.gov.in" <osdml@rb.railnet.gov.in>,
"me@rb.railnet.gov.in" <me@rb.railnet.gov.in>,
"ppsme@rb.railnet.gov.in" <ppsme@rb.railnet.gov.in>,
"osdme@rb.railnet.gov.in" <osdme@rb.railnet.gov.in>,
"mm@rb.railnet.gov.in" <mm@rb.railnet.gov.in>, "ms@rb.railnet.gov.in"
<ms@rb.railnet.gov.in>, "ppsms@rb.railnet.gov.in"
<ppsms@rb.railnet.gov.in>, "dpc1@rb.railnet.gov.in"
<dpc1@rb.railnet.gov.in>, "mt@rb.railnet.gov.in"
<mt@rb.railnet.gov.in>, "srppsmt@rb.railnet.gov.in"
<srppsmt@rb.railnet.gov.in>, "ppsmt@rb.railnet.gov.in"
<ppsmt@rb.railnet.gov.in>, "dtcord@rb.railnet.gov.in"
<dtcord@rb.railnet.gov.in>, "secyrb@rb.railnet.gov.in"
<secyrb@rb.railnet.gov.in>, "pssecyrb@rb.railnet.gov.in"
<pssecyrb@rb.railnet.gov.in>, "dgrhs@rb.railnet.gov.in"
<dgrhs@rb.railnet.gov.in>, "ppsdgrhs@rb.railnet.gov.in"
<ppsdgrhs@rb.railnet.gov.in>, "dgrpf@rb.railnet.gov.in"
<dgrpf@rb.railnet.gov.in>, "srppsdgrpf@rb.railnet.gov.in"
<srppsdgrpf@rb.railnet.gov.in>, "edcc@rb.railnet.gov.in"
<edcc@rb.railnet.gov.in>, "aml@rb.railnet.gov.in"
<aml@rb.railnet.gov.in>, "legaladv@rb.railnet.gov.in"
<legaladv@rb.railnet.gov.in>, "amm@rb.railnet.gov.in"
<amm@rb.railnet.gov.in>, "amplg@rb.railnet.gov.in"
<amplg@rb.railnet.gov.in>, "r_s_chidambaram@cat.com"
<r_s_chidambaram@cat.com>, "hiren.vyas@alstom.com"
<hiren.vyas@alstom.com>, "jojo.alexander@alstom.com"
<jojo.alexander@alstom.com>, "patrick.ledermann@alstom.com"
<patrick.ledermann@alstom.com>, "rathin.basu@alstom.com"
<rathin.basu@alstom.com>, "Dimitrief, Alexander (GE, Corporate)"
<alexander.dimitrief@ge.com>, "Eglash, Jeffrey C (GE, Corporate)"
<jeffrey.eglash@ge.com>, Nanju Ganpathy
<nanju.ganpathy@azbpartners.com>, "bradford.berenson@ge.com"
<bradford.berenson@ge.com>, "brackett.denniston@ge.com"
<brackett.denniston@ge.com>, "jeffrey.immelt@ge.com"
<jeffrey.immelt@ge.com>, "john.flannery@ge.com"
<john.flannery@ge.com>, "delhihighcourt@nic.in"
<delhihighcourt@nic.in>, "pmosb@nic.in" <pmosb@nic.in>,
"askdoj@usdoj.gov" <askdoj@usdoj.gov>, "CHAIRMANOFFICE@SEC.GOV"
<CHAIRMANOFFICE@sec.gov>, "help@sec.gov" <help@sec.gov>,
"fcpa.fraud@usdoj.gov" <fcpa.fraud@usdoj.gov>,
"radhakrishnan.k@ge.com" <radhakrishnan.k@ge.com>,
"tejal.singh@ge.com" <tejal.singh@ge.com>, Sonali Mathur
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"ombudsperson@corporate.ge.com" <ombudsperson@corporate.ge.com>,
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glen.lehman@progressrail.com, duane.cantrell@progressrail.com,
craig.johnson@caterpillar.com, alert.procedure@alstom.com, "Zia Mody
(zia.mody@azbpartners.com)" <zia.mody@azbpartners.com>, "Warin, F.
Joseph" <fwarin@gibsondunn.com>, "Chesley, John"
<JChesley@gibsondunn.com>, pk65sharma@yahoo.co.in,
confidential@sfo.gsi.gov.uk, public.enquiries@sfo.gsi.gov.uk,
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renn.cannon@ic.fbi.gov, stephen.gaudin@ic.fbi.gov,
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david.brooks@ic.fbi.gov, robert.clifford@ic.fbi.gov,
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kirk.striebich@ic.fbi.gov, "Snyder, David" <david.snyder@ic.fbi.gov>,
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vedbaldev@rediffmail.com, rakeshtikuadvocate@yahoo.com, kkmanan
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<advrajivkhosla@gmail.com>, rakeshkochar@hotmail.com,
khatri.surya@hotmail.com, puneet mittal <puneetmittal9@gmail.com>,
"advamit.sharma@gmail.com" <advamit.sharma@gmail.com>,
Attorneynitin@yahoo.com, Rajesh Mishra <attorney.rmishra@gmail.com>,
jaibirnagar@gmail.com, Sho-lodhicolony-dl@nic.in, csrhw@csrhw.com.cn,
cnriec@chinacnr.com, raymond.l.conner@boeing.com,
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dridzu@nic.in, NDBox Library Reference <Libdel@state.gov>,
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asutosh lohia <lasutosh@gmail.com>, Vikram Singh Panwar
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Pamidighantam <psnarasimha@gmail.com>, nandita rao
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Cc: gurmeharsistani@gmail.com, secy-mci@nic.in, Seema Sapra
<seema.sapra@gmail.com>, Seema Sapra <seemasapra@hotmail.com>

An FIR must be registered that there was a planned criminal conspiracy
to physically destroy me by deliberately inducing severe vitamin B 12
deficiency in me in 2010, 2011 and 2012 to prevent me from blowing the
whistle on General Electric Company's corruption in the Indian
Railways locomotive factory tenders.

I have complained that in July 2011, I smelled nitrous oxide inside my
house in Jangpura Extension.

This was obviously not the only time that nitrous oxide was released
into my accommodation. It was probably being released into my home in
2010 and all of 2011 as well.

Nitrous oxide exposure causes vitamin B 12 deficiency.

I had weakness, fatigue and difficulty with breathing in July/ August
2011. At that time, I had symptoms of numbness and tingling in my
hands and feet. I had anemia in July/ August 2011.

Earlier in Feb 2011, a gastroenterologist at Apollo was used to
misdiagnose nausea on account of poisoning as heartburn and prescribed
a stomach acid blocker. I took this for about 10 days in Feb 2011. I
was going to Apollo because of persistent coughing inside my house and
was consulting a pulmologist who sent me to the gastroenterologist. In
Feb 2011, it had not occurred to me that I was being poisoned.

Another doctor at Apollo again encouraged me to resume taking the
stomach acid blocker in June 2011 when I went to see him for a visibly
swollen lymph node in the front of my neck. This swelling was also on
account of ongoing poisoning. I have already complained that this
doctor deliberately prescribed me double dosage of sedating
anti-histamines which I did not take. I told this doctor that I did
not need a proton pump inhibitor.

Stomacd acid is required for the body to absorb vitamin B 12. A proton
pump inhibitor would have further aggravated vitamin B 12 deficiency.
The prescription for a proton pump inhibitor was part of this
conspiracy to further aggravate B 12 deficiency that was being induced
by release of nitrous oxide into my accommodation. This would have
prevented my body from absorbing B 12 from my diet.

In August, a doctor at the Defence Colony market told me to take oral
Vitamin B 12. I had gone to her only to get an opinion on lung Xrays,
because Max doctors were covering up lung congestion. This was in
August 2011 after I had made written complaints of poisoning to the
CJI, the police and to Max Healthcare. By then I had expressly
complained in writing that I had been exposed to nitrous oxide,
because I had identified the gas after I smelt it in Max Hospital
while waiting outside the ultrasound room. This doctor told me to take
vitamin B 12 after a telephone call which she took after asking me to
leave the room. My consultation with her could have given her no
indication that I needed vitamin B 12.

The test for B 12 at Max hospital was done in August 2011 more than 10
days after I had already started taking daily doses of vitamin B 12.

I reproduce below articles describing the severe health consequences
of vitamin B 12 deficiency.

Extracts from wikipedia

Vitamin B12 deficiency can potentially cause severe and irreversible
damage, especially to the brain and nervous system. At levels only
slightly lower than normal, a range of symptoms such as fatigue,
depression, and poor memory may be experienced.[2]

Vitamin B12 deficiency can also cause symptoms of mania and psychosis.[27][28]

...

▪ H2-receptor antagonists: include cimetidine (Tagamet), famotidine
(Pepcid), nizatidine (Axid), and ranitidine (Zantac). Reduced
secretion of gastric acid and pepsin produced by H2 blockers can
reduce absorption of protein-bound (dietary) vitamin B12, but not of
supplemental vitamin B12. Gastric acid is needed to release vitamin
B12 from protein for absorption. Clinically significant vitamin B12
deficiency and megaloblastic anemia are unlikely, unless H2 blocker
therapy is prolonged (2 years or more), or the person's diet is poor.
It is also more likely if the person is rendered achlorhydric(with
complete absence of gastric acid secretion), which occurs more
frequently with proton pump inhibitors than H2 blockers. Vitamin B12
levels should be monitored in people taking high doses of H2 blockers
for prolonged periods.

...

▪ Nitrous oxide: Nitrous oxide inactivates the cobalamin form of
vitamin B12 by oxidation. Symptoms of vitamin B12 deficiency,
including sensory neuropathy, myelopathy, and encephalopathy, can
occur within days or weeks of exposure to nitrous oxide anesthesia in
people with subclinical vitamin B12 deficiency. Symptoms are treated
with high doses of vitamin B12, but recovery can be slow and
incomplete. People with normal vitamin B12 levels have sufficient
vitamin B12 stores to make the effects of nitrous oxide insignificant,
unless exposure is repeated and prolonged (such as recreational use).
Vitamin B12 levels should be checked in people with risk factors for
vitamin B12 deficiency prior to using nitrous oxide anesthesia.
Chronic nitrous oxide B12 poisoning (usually from use of nitrous oxide
as a recreational drug), however, may result in B12 functional
deficiency even with normal measured blood levels of B12.[37]

...

 Proton pump inhibitors (PPIs): The PPIs include omeprazole (Prilosec,
Losec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole
(Protonix, Pantoloc), and esomeprazole (Nexium). The reduced secretion
of gastric acid and pepsin produced by PPIs can reduce absorption of
protein-bound (dietary) vitamin B12, but not supplemental vitamin B12.
Gastric acid is needed to release vitamin B12 from protein for
absorption. Reduced vitamin B12 levels may be more common with PPIs
than with H2-blockers, because they are more likely to produce
achlorhydria (complete absence of gastric acid secretion). However,
clinically significant vitamin B12 deficiency is unlikely, unless PPI
therapy is prolonged (2 years or more) or dietary vitamin intake is
low. Vitamin B12 levels should be monitored in people taking high
doses of PPIs for prolonged periods.

...
Vitamin B12 (cobalamins), with folate, is necessary for the formation
and maturation of red blood cells and the synthesis of DNA
(deoxyribonucleic acid), which is the genetic material of cells.
Vitamin B12 is also necessary for normal nerve function. Unlike most
other vitamins, B12 is stored in substantial amounts, mainly in the
liver, until it is needed by the body. If a person stops consuming the
vitamin, the body's stores of this vitamin usually take about 3 to 5
years to exhaust.

People should not take high doses of vitamin B12 as a cure-all, but
otherwise the vitamin does not appear to be toxic.

Vitamin B12 Deficiency

Anemia develops, causing paleness, weakness, fatigue, and, if severe,
shortness of breath and dizziness.

A severe deficiency may damage nerves, causing tingling or loss of
sensation in the hands and feet, muscle weakness, loss of reflexes,
difficulty walking, confusion, and dementia.

The diagnosis is based on blood tests.

When high doses of vitamin B12 supplements are taken, symptoms due to
anemia tend to resolve.

Symptoms due to nerve damage, such as dementia in older people, may persist.

Vitamin B12 occurs in foods that come from animals. Normally, vitamin
B12 is readily absorbed in the last part of the small intestine
(ileum), which leads to the large intestine. However, to be absorbed,
the vitamin must combine with intrinsic factor, a protein produced in
the stomach. Without intrinsic factor, vitamin B12 moves through the
intestine and is excreted in stool.

Because vitamin B12 is necessary for the formation of mature blood
cells, deficiency of this vitamin can result in anemia. The anemia is
characterized by abnormally large red blood cells (macrocytes) and
white blood cells with abnormal nuclei. Anemia may not develop until 3
to 5 years after the deficiency begins because a large amount of
vitamin B12 is stored in the liver.

Vitamin B12 deficiency can cause nerve damage (neuropathy) even when
no anemia develops, particularly in people older than 60.

Causes

Vitamin B12 deficiency can result when people do not consume enough
vitamin B12 or when the body does not absorb or store enough of the
vitamin.

Inadequate consumption:

Vitamin B12 deficiency develops in people who do not consume any
animal products (vegans) unless they take supplements. If a vegan
mother breastfeeds her infant, the infant is at risk of vitamin B12
deficiency.

Inadequate absorption:

The most common cause of vitamin B12 deficiency is inadequate
absorption. The following conditions can cause absorption to be
inadequate:

Overgrowth of bacteria in part of the small intestine

Malabsorption disorders (such as inflammatory bowel disease, celiac
disease, or certain pancreatic disorders)

Inflammatory bowel disease

Fish tapeworm infection

AIDS

Surgery that removes the part of the small intestine where vitamin B12
is absorbed

Drugs such as antacids and ⁠metformin⁠ (used to treat diabetes)

Some Trade Names
GLUCOPHAGE

Lack of intrinsic factor

Decreased stomach acidity (common among older people)

Intrinsic factor may be lacking because abnormal antibodies, produced
by an overactive immune system, attack and destroy the stomach cells
that produce intrinsic factor—an autoimmune reaction called autoimmune
metaplastic atrophic gastritis. Intrinsic factor may be lacking
because the part of the stomach where intrinsic factor is produced was
surgically removed. Vitamin B12 deficiency due to lack of intrinsic
factor causes a type of anemia called pernicious anemia.

Among older people, absorption may be inadequate because stomach
acidity is decreased. Decreased stomach acidity reduces the body's
ability to remove vitamin B12 from the protein in meat. However, the
vitamin B12 found in vitamin supplements can continue to be well
absorbed even in people with decreased stomach acid.

Inadequate storage:

Liver disorders may interfere with the storage of vitamin B12.

Symptoms

Anemia due to vitamin B12 deficiency develops gradually, allowing the
body to adapt somewhat. Consequently, symptoms may be mild even when
anemia is severe. Symptoms of anemia are paleness, weakness, and
fatigue. If severe, anemia causes shortness of breath, dizziness, and
a rapid heart rate. Occasionally, the spleen and liver enlarge.
Younger adults who have pernicious anemia (due to lack of intrinsic
factor) are more likely to develop stomach and other gastrointestinal
cancers.

In people with nerve damage, the legs are affected earlier and more
often than the arms. Tingling is felt in the feet and hands, or
sensation in the legs, feet, and hands is lost. People become less
able to tell where their arms and legs are (position sense) and to
feel vibrations. Mild to moderate muscle weakness develops, and
reflexes may be lost. Walking becomes difficult. Some people become
confused, irritable, and mildly depressed. Advanced vitamin B12
deficiency may lead to delirium, paranoia, and impaired mental
function, including dementia.

Diagnosis

Usually, vitamin B12 deficiency is suspected when routine blood tests
detect large red blood cells. Doctors sometimes suspect it when people
have typical symptoms of nerve damage, such as tingling or loss of
sensation. If the deficiency is suspected, the level of vitamin B12 in
the blood is measured. Usually, doctors also measure the blood level
of folate to rule out folate deficiency, which can also result in
large red blood cells.

If vitamin B12 deficiency is confirmed in an older person, no other
tests are done because the cause, such as low stomach acidity, is
usually not serious. In a younger person, other tests, including other
blood tests, may be done to determine the cause. These tests
(including the Schilling test) usually focus on intrinsic factor. For
the Schilling test, people are given two doses of vitamin B12. The
first is labeled with a small amount of a radioactive substance and is
taken by mouth. The second is an injection of a larger amount of
vitamin B12 that is not radioactively labeled. After the injection is
given, the amount of labeled vitamin B12 in urine is measured to
determine whether the body absorbs a normal amount of the vitamin. If
it does not, the deficiency is confirmed, and the test is repeated to
check for the cause. This time, people are given intrinsic factor with
the vitamin B12 taken by mouth. If intrinsic factor enables the body
to absorb more of the vitamin, the deficiency is caused by lack of
intrinsic factor.

Endoscopy (use of a flexible viewing tube to directly examine internal
structures) may be done to check for destruction of stomach cells that
produce intrinsic factor.

Prevention and Treatment

For infants of vegan mothers, starting vitamin B12, supplements
immediately after birth helps prevent the deficiency.

Older people with vitamin B12 deficiency benefit from taking vitamin
B12 supplements because the deficiency usually results from difficulty
absorbing the vitamin from meat. They can absorb the vitamin more
easily from supplements than from meat.

Treatment of vitamin B12 deficiency or pernicious anemia consists of
high doses of vitamin B12 supplements. If people have the deficiency
but no symptoms, the vitamin may be taken by mouth. Blood tests are
done periodically to make sure the vitamin B12 level returns to and
remains normal. People who have symptoms due to nerve damage are
usually given vitamin B12 by injection into a muscle. Injections,
which may be self-administered, are given daily or weekly for several
weeks until the vitamin B12 level returns to normal. Then injections
are given once a month indefinitely, unless the disorder causing the
deficiency can be corrected.

Anemia usually resolves in about 6 weeks. But severe symptoms due to
nerve damage—for example, dementia in older people—may not resolve.

http://www.merckmanuals.com/home/disorders_of_nutrition/vitamins/vitamin_b12.html

Vitamin B12 deficiency can be sneaky, harmful

Posted January 10, 2013, 10:03 am

Patrick J. Skerrett, Executive Editor, Harvard Health

What harm can having too little of a vitamin do? Consider this: Over
the course of two months, a 62-year-old man developed numbness and a
"pins and needles" sensation in his hands, had trouble walking,
experienced severe joint pain, began turning yellow, and became
progressively short of breath. The cause was lack of vitamin B12 in
his bloodstream, according to a case report from Harvard-affiliated
Massachusetts General Hospital published in The New England Journal of
Medicine. It could have been worse—a severe vitamin B12 deficiency can
lead to deep depression, paranoia and delusions, memory loss,
incontinence, loss of taste and smell, and more, according to another
article in today's New England Journal.



The human body needs vitamin B12 to make red blood cells, nerves, DNA,
and carry out other functions. The average adult should get 2.4
micrograms a day. Like most vitamins, B12 can't be made by the body .
Instead, it must be gotten from food or supplements.

And therein lies the problem: Some people don't consume enough vitamin
B12 to meet their needs, while others can't absorb enough, no matter
how much they take in. As a result, vitamin B12 deficiency is
relatively common, especially among older people. The National Health
and Nutrition Examination Survey estimated that 3.2% of adults over
age 50 have a seriously low B12 level, and up to 20% may have a
borderline deficiency.

Are you at risk?

There are many causes for vitamin B12 deficiency. Surprisingly, two of
them are practices often undertaken to improve health: a vegetarian
diet and weight-loss surgery.

Plants don't make vitamin B12. The only foods that deliver it are
meat, eggs, poultry, dairy products, and other foods from animals.
Strict vegetarians and vegans are at high risk for developing a B12
deficiency if they don't eat grains that have been fortified with the
vitamin or take a vitamin supplement. People who have stomach stapling
or other form of weight-loss surgery are also more likely to be low in
vitamin B12 because the operation interferes with the body's ability
to extract vitamin B12 from food.

Conditions that interfere with food absorption, such celiac or Crohn's
disease, can cause B12 trouble. So can the use of commonly prescribed
heartburn drugs, which reduce acid production in the stomach (acid is
needed to absorb vitamin B12). The condition is more likely to occur
in older people due to the cutback in stomach acid production that
often occurs with aging.

Recognizing a B12 deficiency

Vitamin B12 deficiency can be slow to develop, causing symptoms to
appear gradually and intensify over time. It can also come on
relatively quickly. Given the array of symptoms it can cause, the
condition can be overlooked or confused with something else. Symptoms
may include:

strange sensations, numbness, or tingling in the hands, legs, or feet

difficulty walking (staggering, balance problems)

anemia

a swollen, inflamed tongue

yellowed skin (jaundice)

difficulty thinking and reasoning (cognitive difficulties), or memory loss

paranoia or hallucinations

weakness

fatigue

While an experienced physician may be able to detect a vitamin B12
deficiency with a good interview and physical exam, a blood test is
needed to confirm the condition. (Vitamin B12 deficiency is so easily
overlooked that the Centers for Disease Control has a course for
physicians called "Why Vitamin B12 Deficiency Should Be on Your Radar
Screen.")

Early detection and treatment is important. "If left untreated, the
deficiency can cause severe neurologic problems and blood diseases,"
says Dr. Bruce Bistrian, chief of clinical nutrition at
Harvard-affiliated Beth Israel Deaconess Medical Center.

B proactive

It's a good idea to ask your doctor about having your B12 level checked if you:

are over 50 years old

take a proton-pump inhibitor (such as Nexium or Prevacid) or H2
blocker (such as Pepcid or Zantac)

take metformin (a diabetes drug)

are a strict vegetarian

have had weight-loss surgery or have a condition that interferes with
the absorption of food

A serious vitamin B12 deficiency can be corrected two ways: weekly
shots of vitamin B12 or daily high-dose B12 pills. A mild B12
deficiency can be corrected with a standard multivitamin.

In many people, a vitamin B12 deficiency can be prevented. If you are
a strict vegetarian or vegan, it's important to eat breads, cereals,
or other grains that have been fortified with vitamin B12, or take a
daily supplement. A standard multivitamin delivers 6 micrograms, more
than enough to cover the average body's daily need.

If you are over age 50, the Institute of Medicine recommends that you
get extra B12 from a supplement, since you may not be able to absorb
enough of the vitamin through foods. A standard multivitamin should do
the trick.

Not a cure

The Internet is full of articles lauding the use of vitamin B12 to
prevent Alzheimer's disease, heart disease, and other chronic
conditions or reverse infertility, fatigue, eczema, and a long list of
other health problems. Most are based on poor or faulty evidence.

Take Alzhemier's disease as an example. "Although there is a
relationship between low vitamin B12 levels and cognitive decline,
clinical studies—including those involving people with Alzheimer's
disease—have not shown improvement in cognitive function, even doses
of the vitamin as high as 1000 micrograms," says Dr. Bistrian.

For now, it's best to get enough vitamin B12 to prevent a deficiency,
and not look to it as a remedy for what ails you."

Seema Sapra

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Seema Sapra



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Seema Sapra