One woman’s crusade for awareness on B12 deficiency changed the health care industry.
Based off the true story of Sally Pacholok, the film follows an aggressive ER nurse who faced a stubborn medical establishment over physicians misdiagnosing patients on B12 deficiency. Thanks to her dedication, she may have saved thousands of lives and eventually published a best-selling book.
The film stars Annet Mahendru (“The Americans”) in the title role.
Latino-Review had exclusive phone interview late last month with director Elissa Leonard before its official premiere at the DC Independent Film Festival. We discussed the issues and medical diagnosis of B12 deficiencies, the real Sally Pacholok, changes from the real story to film and the challenges with making a medical-based drama.
“Sally Pacholok” will be expanded into more film festivals in the future.
Read the interview below.
Latino-Review: I’m here to talk about your film, “Sally Pacholok.” I just checked it out. Tell me on why you were so attracted on making her into a film project.
Elissa Leonard: Yes. I became interested in it because it happened to me. I read her book in 2009. As soon as I read her book, I said, “Wow! I have the best health care in the world and I didn’t know about this.” So I called her up and I told her that we should make a movie out of this. I wasn’t sure if it should be a documentary or a feature film. She was totally game and I went out met her. I went around with a camcorder and discovered there were so many people involved with B-12 vitamin deficiency.
There were lots of injured patients. Lots of physicians were injured, because they didn’t know. I ended up posting it on YouTube to research on my screenplay. Hundreds of people called me and e-mailed saying that information saved their lives.
It was clear there was a huge knowledge deficit. Vitamin B-12 has become the Rodney Dangerfield of vitamins. People think it’s a joke. Oh! A B-12 shot. There’s so much that they don’t know about it, including many physicians.
After that happened, my writing partner and I (Patrick Prentice) decided to make this into a feature film. We interviewed Sally and we wrote the script. We sent the script around to a bunch of screenwriting competitions. It was highly rated in the top percent of screenplays.
I even went to a women and film event in Washington, D.C. about women screenwriters. This woman got up and said, “Don’t die with your screenplay in your drawer. No one is going to pay you to make your first feature. You just have to go home and decide to do it.”
I was inspired by that and told my husband, “I’m just going to do it.” He said, “Yes! You go girl!! Make this movie.” We just decided to shoot it in a fast and low budget way in the Washington, D.C. area.
Annet Mahendru was the only actor I’ve brought in from Hollywood. Everyone else is from the local area Screen Actors Guild. Did that answer that question?
Latino-Review: Absolutely. Now you did mention that this happened to you. What exactly happened to you that proved to be that inspiration?
Elissa Leonard: The interesting thing about vitamin B-12 is co-factor with other vitamins—B-6, B-9, B-12—all work together in synergy. That is called one carbon metabolism. You have to enough of each of them for your very important part of your life to be working in sync. What we did was to add a lot of folic acid, which is vitamin B-9, to prenatal vitamins in the 1980s. It’s one of the three co-factors.
Folic acid is a synthetic form of folate. It’s not the real folate you find in food. It’s a synthesized folate that is made in a lab. If you’re low in B-12, the folic acid could build up in your body. Suddenly, you’re out of sync. The one carbon metabolism isn’t working anymore. I believed it happened to a lot of women who started to take a lot of folic acid. If you don’t have enough B-12, you can’t metabolize the folic acid. Well, I didn’t know any of that. My doctor didn’t that [either]. We didn’t expect them to know that. It was a long time ago. This happened back in the 1980s.
Another thing about folic acid is that it masks the B-12 deficiency. Doctors were taught to look for macro synchro-immunities and large red blood cells. That’s the signs of not having enough B-12. That doesn’t happen anymore especially with women taking folic acid.
Folic now is even added into all flour products by law from 1996 to 1998. We mandated that all enriched flour products to have folic acid in them. We done it over a lot of objections by B-12 experts who said, “Wait a minute! You’re going to mask B-12 deficiencies in anybody who has low B-12.” They’re not going to know it now. Folic acid was not the sign that doctors were taught to look for.
Without going into too much detail, I had low B-12 and high folic acid. I almost died in childbirth. My organs started shutting down. I ended up on a respirator. I needed to have a blood transfusion. It happened a long time ago and it’s not the basis of this screenplay at all. It did make me interested in this topic since it’s something that’s so basic. It’s a primordial molecule that every cell in your body needs B-12. What I’ve learned it was not well known by physicians, especially in the age of folic acid fortification.
Latino-Review: My knowledge of B-12 is fairly limited. I have a bottle of it, but I always thought it was used in case for going out to drink.
Elissa Leonard: It’s good know that alcohol washes the B-vitamins out of your body. If you’re drinking alcohol, you do need your B-vitamins. Vitamins do work in synergy and that’s why people take a B-complex.
The thing about B-12 is that it’s different from any other vitamins and not like everything else. It’s the only vitamin that has a trace mineral constituent with cobalt. That’s why the chemical name is cobalamin. It’s also the largest vitamin molecule and the hardest to digest from food. It’s always found naturally in animal products. Any vegans or vegetarians will have a hard time getting B-12.
Elissa Leonard: And people don’t know that. Even doctors. We talk about vegetables as a source of B-12. There is NO vegetable sources of B-12. They are in enriched foods like cereals. There’s no naturally occurring B-12 except to found in animal protein. The animals graze on cobalt and bacteria that turns it into the molecule called cobalamin.
I’m not trying to pose as a medical person at all. I’m a filmmaker. I made a film about it, because it interested me that people need to know about it in order to prevent injuries. I’ve talked to scores of doctors who had patients in wheelchairs, in diapers and even demented. They didn’t know that they themselves had B-12 deficiencies.
Latino-Review: When you were doing your research, how did you come up with the story for “Sally Pacholok?” Did you sit down with Sally and took on her life story?
Elissa Leonard: Patrick [Prentice] and I interviewed Sally. She was in Detroit while we were in Washington, D.C. We talked with numerous times. We came up with a way to structure the story for the fifteen years leading up with her writing the book. So we decided to stop the screenplay in 2005 when she wrote, “Could it be B12?” Now it’s in its second edition. It has been a huge underground hit. It’s the bible of B-12 deficiency. Everyone refers to that book.
She has a new book coming out in a week called, “What’s Wrong with My Child?” It looks into the pediatric B-12 deficiency. It’s also a huge problem. It’s so sad. If you see a child who has low B12—it looks exactly like autism. Their brains stop growing and they regress.
Latino-Review: That’s interesting. Why did you suppose Annet Mahendru was perfect to play Sally in this role?
Elissa Leonard: We really adore Annet. I was looking for the right actress and be that right person. I was in bed at home with my husband and we watched “The Americans” on TV. It was the first episode of the second season. There Annet came on. I turned to my husband and said, “That actress! She’s the Sally I want.” While we were watching, I googled Annet Mahendru and I found her manager. I e-mailed her manager and the manager immediately wrote me back with “Send us the script.” I sent the script and she immediately wrote me back that she sent it Annet.
Within a few days, Annet and I were talking and making plans to make this movie. It was the most perfect thing. The way it worked out was great.
Latino-Review: So why didn’t you just do a documentary?
Elisaa Leonard: I did do on what started to be a documentary. I put it on YouTube for no money. I put it out there for public awareness to get more people to know about it. I spent years as a health and sciences reporter/TV producer with small documentaries in these subjects. So I went back to PBS and places I’ve worked in the past to pitch this idea to them. I wanted to do an hour-long thing on vitamin B12 and why it’s important. Their eyes rolled and I couldn’t get anyone’s attention. “You’re going to do a vitamin documentary? You must be kidding me.”
They couldn’t really understand the extent of the damage that was done and the patients’ stories that were out there. I’ve decided like “Erin Brokovich” that it’ll reach more people if it was a fiction film.
Our film is fiction since we’ve condensed fifteen years into 82 minutes. It largely follows injured people who wanted their stories told. There are a couple fictions.
The biggest fiction is that in the movie we have this magical doctor who diagnosed Sally with B12 deficiency. In fact, Sally diagnosed herself. We needed that character to give out a lot of information. You know Hermoine in the “Harry Potter” story?
Latino-Review: I do.
Elissa Leonard: Whenever J.K. Rowling needed an explanation in the story, Hermoine would explain it. This doctor is our Hermoine. We needed something to be explained so he explained it. That’s the reason on why we had somebody else diagnose Sally. In real life, she diagnosed herself. All this was in the face of very smug physicians who said, “You couldn’t possibly at the age of 19 have a B-12 deficiency.” She has to be on B-12 shots for life, because she has autoimmune pernicious anemia. She can’t absorb B-12 from food.
Latino-Review: So there were a few changes from the real life story then.
Elissa Leonard: You have to do that when you’re making an 82-minute film. If it wasn’t changed then it would’ve been a 15-year film, right? So we had to condense things. That was the biggest fiction. The other fiction was that Sally’s father actually lives with her and she never sent him to live in an assisted senior living. We needed to get into a senior living for a scene. She was fine with that.
It’s just the little things you have do to make a movie.
Latino-Review: Is that also including the romantic elements in the film?
Elissa Leonard: No, she is actually married to Jeff Stuart, who is the co-author of her book. She did actually meet him in ER and he is an ER physician. They diagnosed his mother later outside the hospital. All of that is true that his mother had signs of B-12 deficiency. No one would test her. Sally said we should test her. Sure enough, everything was from her B-12 deficiency.
Latino-Review: There’s a lot of scientific jargon throughout the movie. How do you try to keep the balance to keep the audience interested in the film rather than just being bombarded with B-12 language?
Elisaa Leonard: I know. That’s so hard. That’s why Patrick [Prentice] and I worked together. I kept telling Patrick that, “I’ll make sure that the medicine is right. Just make sure that we don’t get too much of the medicine in there.” The film festival director called me to tell me, “You’re really gutsy to make this film on vitamin deficiency.” I think you’re right. It’s really hard to seek the balance. You don’t want to put people to sleep, but you want them to have the right information. I don’t want to add to confusion.
It’s just a starting point. If anyone who is interested or worried, then they go read Sally’s book. Or they could just watch the YouTube documentary that explains a little more. Or they could go to their physicians.
Latino-Review: I’ve also noticed that this was your first feature film you’ve directed. What was supposedly the greatest challenge for you on this project?
Elissa Leonard: Wow. Everything about it was really fun. The greatest challenge was getting over my fears. Once you start producing and directing a feature film, you can’t stop. You gather 47 crew members and scout the locations—all this stuff is happening. You just have to get over your fears and start doing it.
And that’s when I mentioned the story that I went to Women in Film event and a woman told me to “Just do it.” I really needed that inspiration to know that you could just give yourself permission to just do it.
Latino-Review: Could you talk about any future projects for yourself?
Elissa Leonard: My writing partner, Patrick Prentice, and I have a couple of things developing. I don’t want to talk about too much about them. I have another memoir that I’m thinking about. It’s not memoir, but someone else’s. And I would love to do a comedy especially after doing a medical thing. It’ll be fun just to do a straight comedy. That’s my wish list.
Latino-Review: Basically, you’re telling that you’re definitely going back behind the camera again.
Elissa Leonard: Oh, yeah. It’s really fun. After the launch of this project, I’ll be free.
Latino-Review: Anyways, it’s been a pleasure speaking with you. Good luck with the film.
Elissa Leonard: Likewise. It’s been a pleasure. Appreciate the talk.
“Sally Pacholok” premiered at the DC Independent Film Festival late last month and was an official selection at the Los Angeles Women’s International Film Festival this past weekend. It will be expanded into more film festivals in the future.