What you read here may shock you… as you know, we have been trying to access safe and effective B12 injections OTC from pharmacies for nearly a decade and yet…

A pricy self injectable drug called Saxenda can be bought from your chemist without the knowledge of your GP. It’s even available for 12 -17 year olds and is in high demand so is often out of stock.

Drugs such as Saxenda, contain GLP-1 receptor agonists and were originally developed as a treatment for type 2 diabetes as they suppress appetite and promote the feeling of fullness.

This drug has the possibility of inducing several serious side effects...

Serious side effects may happen in people who take Saxenda^®, including:

Possible thyroid tumors, including cancer. Tell your health care professional if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rats and mice, Saxenda^® and medicines that work like Saxenda^® caused thyroid tumors, including thyroid cancer. It is not known if Saxenda^® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.

And this list of side effects from the online doctor which you’ll notice makes no reference to the thyroid but details pancreatitis in it’s serious side effects section and kidney failure in it’s rare section…

Serious side effects of Saxenda®

Serious side effects of Saxenda® are rare. There have been some reports of severe allergic reactions (anaphylaxis). If you experience breathing difficulties or swelling of the face and throat call 999 or visit A&E immediately.

Inflammation of the pancreas (pancreatitis) is also a rare but serious side effect. Pancreatitis is a serious, potentially life threatening medical condition. Stop taking Saxenda® and contact your doctor immediately if you notice any of the following serious side effects at the same time, as they could be a sign of pancreatitis:

Severe and persistent pain in the abdomen (stomach area) which might reach through to your back

Nausea and vomiting

Very common side effects of Saxenda®
The very common side effects of Saxenda® are likely to affect more than 1 in 10 patients. These side effects include: 

• Feeling sick (nausea)
• Vomiting
• Diarrhoea
• Constipation
• Headaches

Patients experiencing these side effects often report that they go away after several days or weeks.

To help manage the nausea, get fresh air whenever possible, sip a cold drink or peppermint tea, and eat smaller more frequent meals.

We also recommend that you don’t cook anything strong smelling and avoiding greasy and fried foods.

Common side effects of Saxenda®
Common side effects may affect up to 1 in 10 people. They include: 

• Tiredness
• Weakness
• A change to your sense of taste
• Feeling dizzy
• Stomach problems such as indigestion, discomfort, heartburn, feeling bloated, wind and belching, dry mouth, and gastritis (this is inflammation in the lining of the stomach)
• Difficulty sleeping
• Reactions around the injection site, such as bruising, itching and pain
• An increase in pancreatic enzymes, such as lipase and amylase
• Gallstones

Low blood sugar is also a common side effect. The symptoms of low blood sugar may appear suddenly and include:

Feeling anxious or nervous
Cool pale skin
Feeling sick
Feeling hungry
Tremors

Uncommon side effects of Saxenda®
Uncommon side effects of Saxenda® may affect 1 in 100 people. They include: 

• Increased pulse rate
• Feeling generally unwell
• Dehydration – this is likely to be a side effect of the common side effects of vomiting and diarrhoea
• An inflamed gall bladder
• A delay in the emptying the stomach

Rare side effects of Saxenda®
The rare side effects of Saxenda® include reduced kidney function and kidney failure and may affect up to 1 in 100 people. The signs are a metallic taste in the mouth, a reduction in urine volume and skin that easily bruises. You should contact your doctor immediately if experiencing these side effects.

Saxenda and other weight loss drugs are also in the news as the MHRA has received reports of suicidal thoughts following its use.

It’s important to note here that B12 injections have one incredible and exceedingly common side effect…. and that is, wait for it……

wellness!

How much does this drug cost?

Pharmacy magazine July 2020 states: The programme, which costs £260 per month, is available in 1,400 branches and is aimed at helping people with obesity lose weight and reduce their risk of developing weight-related health problems.

Your consultation

Some of the pharmacies selling this drug ‘under prescription’ do so by asking you to fill in an online questionnaire which is then sent to an ‘online doctor’ following payment. Whilst taking this drug the user is advised that they will need to eat a balanced, reduced-calorie diet and exercise regularly… 

1. Consultation 

   Saxenda®

   • Is a daily injection for weight loss
   • Acts on receptors in the brain that control your appetite, making you feel fuller and less hungry
   • May help you eat less food, which may help you lose weight
   • Treatment starts at a low dose, which will gradually increase over 5 weeks
   • Should only be continued if you’ve lost at least 5% of your initial body weight after being on Saxenda for 16 weeks
   • Can be used if you have a body mass index (BMI) of 30 or more or 27 – 30 and a weight-related health problem
   • May cause mild side effects like nausea, vomiting, diarrhoea or headaches. These usually settle after a few days or weeks
     

All this can happen without you having seen a doctor and without your own GP being aware of your purchase, that’s because the onus is on you to tell them. Obviously, the way this process is set up means it could be open to abuse. If you want these weight loss injections and you choose not to be honest about your health or medication and the pharmacist does not look at your Summary Care Record – which they are not required to, then the gaps in the process could lead to tragedy.

What is a PGD?

PGD’s are ways of making POM (prescription only medications) available via pharmacies without seeing your GP. The medicines that can be given in this way are apparently commissioned locally and there is no national medicine list. The kinds of medicine commonly given under a PGD are; malaria tablets, flu vaccines, drugs for erectile dysfunction and for period delay.

My question and I’m sure yours too, is why can’t B12 injections be given in this way? And if they were, the questions need only ask – are you able to absorb B12 from food? Do you want to feel well? Job done.

Money

So why do these injections bypass the normal route to the patient? Clearly there’s money to be made at each step with the weight loss injections and the drug company, the pharmacy and the MHRA will all be paid. But how did this injection skip the rules that B12 injections have to follow if you have a medical need?
We already know that the MHRA bend the rules so that a hair salon or a private clinic giving botox can add B12 to their list of injectables. But the patient in desperate need may have to beg for more than four B12 injections a year, and that beg may be denied leaving that patient bed bound and mentally ill.

GP Practices and pharmacies compete for business, yes your practice is a business. GP’s don’t want you to have your flu vaccine at a pharmacy because they lose money.  Practices apparently profit each time they give a B12 injection – around £6 each time. So even though B12 injections are very cheap to buy they are rationed by doctors as if they are a dangerous narcotic. Maybe our GP’s don’t want to lose this nominal financial gain to pharmacists even though the pharmacies are under threat of closure due to lack of funding. I wonder if any pharmacist has asked for B12 injections to be accessed under a PGD or if only pricy harmful drugs get the go ahead?

You may have a similar poster in your Practice…

And there’s more of these injection’s on the horizon…NICE happily recommends new drug for people living with obesity…

Helen Knight, programme director in the centre for health technology evaluation at NICE, said:

“We know that management of overweight and obesity is one of the biggest challenges our health service is facing with nearly two thirds of adults either overweight or obese. It is a lifelong condition that needs medical intervention, has psychological and physical effects, and can affect quality of life.”

“But in recent years NICE has been able to recommend a new line of pharmaceutical treatments which have shown that those people using them, alongside changes to their diet and exercise, have been able to reduce their weight.”

However, You can already buy a semaglutide  called Ozempic – which is normally used for treatment of diabetes and is called off-label use for weight loss OTC –  these potentially dangerous drugs are often out of stock due to high demand!

Off label

You see above that it’s completely fine to sell weight loss drugs ‘off label’ this usually means that the drug was designed to treat one ailment but has been found to have another use.

You may have asked your GP for more frequent B12 Injections only to be told, I’m not allowed to do that as it would be ‘off label’ – this time meaning it’s outside of what the doctor thinks the frequency given can be. This is a doctor who’s ignorant of B12 deficiency and how B12 works in the body. This doctor may not have the confidence to defend themselves against scrutiny from a ‘prescribing pharmacist’ who might flag ‘unusual prescribing’. With B12 deficiency surely any critical thinking doctor would know they are covered professionally for giving you B12 injections at your rate of need? This is also what should be known as ‘doing no harm’. They’re not giving you B12 injections for treatment of athletes foot or for head lice, they are giving it to you because you cannot absorb B12 from food, and you need it to treat a deficiency. How on earth can anyone complain about that? And how, if someone questioned a doctor on this can’t they state – because the patient needs it to be well – and that be the end of the interrogation?

A healthy diet should consist of:

• plenty of fruit and vegetables
• meals based on potatoes, bread, rice, pasta and other starchy foods (ideally you should choose high fibre and wholegrain varieties)
• some milk and dairy foods or dairy alternatives
• some meat, fish, eggs, beans and other non-dairy sources of protein
• just small amounts of food and drinks that are high in fat and sugar

Isn’t that nuts?

Now clearly, I am not medically trained, however you would have to be living in another world to not know that “meals based on potatoes, bread, rice, pasta and other starchy foods” –  otherwise known as carbohydrates, would be so far wrong that it’s laughable. Carbohydrates are sugars. If you want to lose weight then carbs and indeed fruit should be heavily reduced or entirely avoided. They should not be recommended as part of a healthy diet for obesity. Why on earth is the NHS perpetuating this myth?

Obesity researcher, Dr Zoe Harcombe PhD does a brilliant breakdown and rebuttal of Slimming World’s Article “13 ways carbs can help you lose weight”  Following a daily Mail article  “Low-carb diets could make you FATTER, say Slimming World experts as they reveal the 13 ways carbs can help you LOSE weight”

Please read the entire article but here are two important quotes from Zoe:

The most important thing to say about carbohydrate is that we don’t need to consume it. But then an article raving about carbohydrate is not going to include that vital fact. I constantly see fibre being used as the rationalisation for why we should eat carbs, but carbs are not essential and so fibre is not essential – that is an inescapable fact combined with inescapable logic.

Because carbohydrates are not essential for human to consume, it cannot be the case that we need to consume carbohydrates for any micronutrients (vitamins and minerals). Carbohydrates can provide vitamins and minerals, but you will always be able to find a fat/protein (usually animal) food that provides more.

Could it be B12?

I wonder how many people struggling with weight loss are also B12 deficient but may never have been tested? B12 injections have been promoted for weight loss by private clinics but this is not a feature of the B12 injection. However, weight loss can occur in B12 deficient people who after receiving B12 injections begin to function properly both mentally and physically. Finding they have a new found vigour and can enjoy activity and exercise that was previously, virtually impossible.

We need safe effective inexpensive B12 injections to be made available OTC.

Whilst the vast majority of our doctors lag way behind their patients in understanding vitamin B12 deficiency, we should be able to keep ourselves alive and well by giving ourselves B12 injections purchased inexpensively from our pharmacies. People who buy online from German pharmacies can buy a 100 ampoules for £100 or less.