Surge in nitrous oxide abuse: New guidelines to help clinicians recognize cases and prevent spinal cord damage from resulting Vitamin B12 deficiency

FAB RESEARCH COMMENT:

So-called ‘laughing gas’ – the anaesthetic drug nitrous oxide – inactivates Vitamin B12.  

And yet most users still have no idea of the risks....

UK doctors are now seeing so many young people with actual spinal cord damage from B12 deficiency triggered by  nitrous oxide abuse that new, evidence-based recommendations for its diagnosis and treatment have been rapidly adopted as official clinical practice guidelines by the Association of British Neurologists.  See:

• Paris A Et Al 2023 - Nitrous Oxide-Induced Subacute Combined Degeneration Of The Cord: Diagnosis And Treatment

See also:

• 'Laughing gas' depletes Vitamin B12 and can cause irreversible brain damage

• B12 deficiency and Nitrous oxide: neurologists report a worrying rise in young people with paralysis

Early warning signs are often ignored untill too late

Initial B12 deficiency symptoms can include sensory problems such as tingling or numbness, blurred or distorted vision, movement or balance problems including muscle weakness, poor co-ordination and clumsiness, and a wide range of mental symptoms - all of which may of course have other causes.  

But if these symptoms are ignored, the nerve damage from a serious lack of Vitamin B12 can become irreversible - causing permanent spinal cord damage and paralysis (if not brain damage too).
 

• B12 is needed to make myelin - a fatty substance that protects and insulates nerves, and is essential for normal brain and nerve cell signalling. So as with multiple sclerosis (which involves auto-immune damage to myelin) deficiency symptoms can be highly variable.

• B12 is also needed to make red blood cells - leading to fatigue, and if severe, anaemia. But because these symptoms can be caused by other things too, B12 deficiency can easily be missed.

Vitamin B12 deficiency and Psychological or Psychiatric symptoms 

Importantly, B12 deficiency can 'mimic' many psychiatric as well as neurological disorders - including ADHD, anxiety, depression, schizophrenia or dementia.   

In fact for some people, psychiatric symptoms can actually be the first signs of B12 deficiency - before anaemia or any of the 'classic' neurological symptoms may become apparent - including:

• fatigue, 'brain fog', and concentration problems
• depression or anxiety
• mental states of confusion and paranoia, which can mimic symptoms of schizophrenia or other forms of psychosis

Better Awareness is Needed 

Commonly known as ‘whippets’ or ‘balloons’ (because this drug is still legally sold in canisters - supposedly for whipping cream - and the gas then inhaled from balloons) nitrous oxide is now the second most popular recreational drug among 16-25 year olds in the UK

Discarded canisters are collected in tons after any major festival, but they can also be seen daily in street gutters, car parks and school playgrounds.

Urgent action is needed to dispel current ignorance about the serious health risks of regular use and high intakes - because the potential consequences of abusing 'laughing gas' are very far from funny.

Although most cases of serious health problems involve excessive use, having low or 'marginal' B12 status to begin with can add to the risks.
 

• Vegans and vegetarians are at particular risk of B12 deficiencies, as only animal-derived foods (or supplements) provide this vital brain nutrient.

• Some common medications can also reduce B12 absorption - most notably drugs for 'indigestion' or acid reflux, but also metformin, widely prescribed for controlling diabetes.  

For further information, please see also:

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