Exploring the Truth of Vitamin B12 and Vegans

I'm coming out of the closet with my B12 deficiency story - well because, it really happened. Never being deficient in anything before, I subsequently looked into the B12 issue. This is a report, from my point of view (which is a vegan's diet is the quintessential diet for humans…it's for everybody!) The following might be of service to the vegan community.

After 25 years of being vegan (I was vegetarian for the 11 years before that since age 12), I became highly deficient (according to "normal standards") in my Vitamin B12 (Cobalamin) stores; a vitamin that plays an important role in the function of the brain and nervous system, the metabolism of cells, DNA regulation, and the creation of blood. The normal range is 200-900 pg/mL (picograms per milliliter). Levels below 80 clearly represent B12 deficiency. My levels were 60.

Most of the long-time vegans I know were not deficient when they had a blood test (which is not an accurate test for vegans who also consumes algae or spirulina because they contain B12-analogues that mimic true B12 in blood tests while actually interfering with B12 metabolism.) And there is also this view: "Just because there is a low level of B12 in the bloodstream, this does not mean that there is a deficiency in the body as a whole, it may well be being utilised by the living cells (such as the central nervous system). More reliable tests appear to be that of homocysteine levels and Methyl Malonic Acid tests." Dr Gina Shaw, D.Sc, M.A.- source:  However, when I have surveyed the vegan community, there were others that did develop Vitamin B12 deficiency; mostly long-time vegans, but sometimes only after 5 years of being vegan (it is estimated that we have a 5-20 year reserve in our liver).

Some health practitioners don't feel that vegans get B12 deficiency any more than non-vegans; a certain percentage of the general population becomes deficient; for various reasons such as: they lose their own Intrinsic factor (a glycoprotein necessary for the absorption of B12) - malabsorption problems - or alcohol, drugs, antibiotics, and smoking could affect ones' stores of B12. However, if a vegan does not supplement B12, it can result in a dietary deficiency. Because of the recirculation of B12 in our bodies, it may take 20-30 years to become deficient after eating a strictly vegan diet. I'm guessing that is what happened in my case.

Vitamin B12 is claimed to be a necessary nutrient; however only a miniscule amount is needed (less than 3 micrograms per day). Vitamin B12, no matter where it is sourced from, is a microbe or bacteria produced by micro-organisms. Rather than killing a cow to eat him/her because the cow has B12 stored in their gut, I choose to take a liquid B complex (with B12) or a vegan sublingual nugget/dot, and let the cow live his/her life. (I tested "normal" several times after supplementing with B12 dots, so I know they work).

Whether vegans need less B12, I don't know. Whether I really felt symptoms of Vitamin B12 deficiency – I can't say for sure. Whether we can or cannot reabsorb Vitamin B12 in our own body (there is controversy over the bacteria being produced too low down in the intestines to be reabsorbed) I don't know – and you can find sources for either position of that debate. I only know that I was highly deficient and was never deficient in any other nutrient. At the time I was eating out of a veganic garden and drinking fresh water out of streams, so according to some sources, I should have been getting some B12, organically from the natural environment.

The one thing I used to consume, (but was not at the time I was found deficient), was Red Star Vegetarian Support Formula; a B12 fortified good tasting Nutritional Yeast; which was not available in New Zealand. Rumor has it that Nori, unpasteurized miso, a certain mushroom, or comfrey contain some B12, but a B12 dot (sourced from micro-agriculture that cultivates it on a bed of yeast) seems to be more count-on-able. When I was found to be deficient, I was not consuming anything with B12, as I don't eat processed foods such as B12 fortified vegan cereals, soy milks or plant-based meats, and at the time could not get B12 enriched nutritional (savoury) yeast. Now you can though!  

When being compared to the "normal range" – we are being compared to flesh eaters and those who are drinking the milk of another species; this is not the "normal" that vegans want to be compared to (because frankly, we don't think it's normal to exploit, harm and eat other animals.) I question if there are some answers that we do not yet know. After 33 years of being vegan, I'm totally convinced that we should be eating plants, so therefore we should be able to get all we need directly from plant sources and sunshine, easily. That's the B12 controversy. That's the issue that has not been resolved. Perhaps vegans need less Vitamin B12 or are not eating "B12 supplemented Twinkees" (see below). Perhaps people didn't wash the microorganisms off their food and were less sterile than we are today, or some other possibility, but for now, I supplement, because very low B12 intake can cause anemia, nervous system damage, and has serious consequences such as dementia or fatality!

"We do have to look at the reality that most grain products, especially those that are called "enriched grain products," cereal, breads, and pasta, and whatnots, are typically enriched with B12. So, although you might be eating Twinkees, it's enriched with B12, which means you're taking a B12 supplement every day. What we call the normal level of B12 is based on testing people who are supplementing with B12 at every meal. This is an abnormally high level of B12 compared to the normal population or compared to a population which isn't supplementing..."  Douglas Graham; doctor of chiropractic, long-time raw foodist, author of the 80-10-10 Diet, and professional fasting supervisor. 

Generally, I believe in getting your nutrients from plants and the sun; the way nature intended for us to take them; grouped a certain way; as in the B complex. But after investigation, it's reasonable for vegans to supplement Vitamin B12 or they are putting themselves at serious risk. It's an absolute must (according to vegan medical doctors) for pregnant vegan mothers and children! Infants that drink only their vegan mother's milk might have limited reserves of B12 and can develop deficiency within months of birth. Untreated, vitamin B12 deficiency in infants can result in severe and permanent neurological damage. That explains this:

"The American Dietetic Association recommends supplemental vitamin B12 for vegans during both pregnancy and lactation to ensure that enough vitamin B12 is transferred to the fetus and infant. Pregnant and lactating women who follow strict vegetarian or vegan diets should consult with a pediatrician regarding vitamin B12 supplements for their infants and children."

It is inexpensive to supplement, it is water soluble and won't accumulate in the body over time, and has no known side effects even when taken in large quantities, and is a precautionary measure. If vegans supplement with B12, generally they are at far less risk of heart disease than the general population. However, if vegans don't supplement with B12, they might be at more risk! Strong evidence has been gathered over the past decade that even slightly elevated homocysteine levels (which can be elevated from B12 deficiency) increase risk of heart disease and stroke and pregnancy complications.

"But there is room for improvement in any diet, and the analysis, published in the Journal of Agricultural and Food Chemistry, suggested that vegans who have low intakes of vitamin B12 and possibly omega-3 fats could lose out on the benefits of healthful plant-based eating. Inadequate B12 is associated with elevated levels of homocysteine, an amino acid that is linked to increased heart disease. But that's an issue only for vegans who fail to supplement with vitamin B12. Those who consume recommended amounts of B12 have healthy levels of homocysteine." Source link: http://www.whatsonchengdu.com/wine-msg-14.html 

"Studies have found that people who have low levels of vitamin B12 (including those who are not classified as deficient in B12) tend to have high levels of homocysteine. This reduces life expectancy and increases the risk of cardiovascular diseases (such as heart attack and stroke) and dementia. This is another reason why it is very important to ensure an adequate intake of vitamin B12, from supplementation and fortified foods. It is not simply about avoiding overt vitamin B12 deficiency, but about avoiding high homocysteine levels and the negative health consequences of this. I recommend that vegans supplement with 5 to 100 mcg of vitamin B12 per day, or 2000 mcg as a weekly dose."
Amanda Benham, Accredited Practising Dietitian and Nutritionist  www.humanherbivore.com

Position of the American Dietetic Association:

"The vitamin B-12 status of some vegetarians is less than adequate due to not regularly consuming reliable sources of vitamin B-12. For vegans, vitamin B-12 must be obtained from regular use of vitamin B-12-fortified foods, such as fortified soy and rice beverages, some breakfast cereals and meat analogs, or Red Star Vegetarian Support Formula nutritional yeast; otherwise a daily vitamin B-12 supplement is needed. No unfortified plant food contains any significant amount of active vitamin B-12. Fermented soy products cannot be considered a reliable source of active B-12. Vitamin B-12 status is best determined by measuring serum levels of homocysteine, methylmalonic acid, or holotranscobalamin II." 

A B12 deficiency can cause an interruption of normal metabolism and result in the accumulation of substances like 'methylmalonic acid' and 'homocysteine'. Tests showing increases in these metabolic products are used to diagnose early B12 deficiency. Elevated homocysteine levels occur long before any of the following symptoms are noticeable:

Some reported Symptoms of B12 deficiency
*Mild problems with the nervous system characterized by numbness and tingling in the hands and feet, or down the side of the body. For example, symptoms have been described like this: "a weird 'zinging' thing that went from jaw down the arm." -or- "sharp stabbing, tingling pain in the palm of one or both hands". These sensations are reversible in early stages; however, damage to the nervous system can become irreversible.
*Fatigue, weakness, weight loss, loss of appetite, constipation
*Itchy, tingly or sore tongue, sores at the corners of the mouth and sometimes along the edge of the lip.
*White spots in the skin, resulting from melatonin becoming absent in the area –or- paleness
*Nerve shock in the side of the body. It can be felt coming on a few seconds before it hits, and then it hits almost like a mild but deep electric shock and quickly subsides.
*Shortness of breath, when walking just a few yards, respiratory problems
*Eye twitch, usually in one eye or the other -or- facial pain, usually on only one side of the face at a time, blurred vision, abnormal gait, memory loss, disorientation, confusion, hallucinations, personality changes, cognitive decline, depression
*deafness has been associated with B12 deficiency link: 
*Infants typically show more rapid onset of symptoms than adults. B12 deficiency may lead to loss of energy and appetite, failure to thrive, movement disorders, or developmental delays. If not promptly corrected, this can progress to coma or death. It is very important for pregnant vegans to supplement and supplement their young child with B12 (and vegan DHA).

Doctor Recommendations and dosage: 
"I knew forty years ago that vitamin B12 would become the last bastion for meat-and dairy-lovers (and the industries that profit from them), because this is the only criticism with any merit that could be lodged against the McDougall Diet (a plant diet). In order to avoid that condemnation and the small risk of harming anyone, I have recommended and printed in the beginning of my books and DVDs the following advice: If you follow the McDougall Diet for more than 3 years, or if you are pregnant or nursing, then take a minimum of 5 micrograms of supplemental vitamin B12 each day." John McDougall, MD drmcdougal/p>

"In over 60 years of vegan experimentation only B12 fortified foods and B12 supplements have proven themselves as reliable sources of B12, capable of supporting optimal health. It is very important that all vegans ensure they have an adequate intake of B12, from fortified foods or supplements. This will benefit our health and help to attract others to veganism through our example. National recommendations for B12 intakes vary significantly from country to country. The US recommended intake is 2.4 mcgs a day for ordinary adults rising to 2.8 mcgs for nursing mothers. The German recommendation is 3 mcgs a day. Recommended intakes are usually based on 50% absorption, as this is typical for small amounts from foods. To meet the US and German recommendations you need to obtain sufficient B12 to absorb 1.5 mcgs per day on average. This amount should be sufficient to avoid even the initial signs of inadequate B12 intake, such as slightly elevated homocysteine and MMA levels, in most people. Even slightly elevated homocysteine is associated with increased risk of many health problems including heart disease in adults, preeclampsia during pregnancy and neural tube defects in babies." Stephen Walsh, Ph.D., Trustee of The Vegan Society [U.K.]

Conclusion
They told me I was going to die when I became vegetarian at age 12, and I thought "I'll take my chances" rather than consume those who I considered friends, not food. I literally didn't know that it was healthier to be vegan when I first became vegan three decades ago. I'm vegan because using other animals needlessly for human purposes is unjustifiable. I am opposed to all harm, sexual assault, oppression, slavery, and murder - no matter what species the victim is; human or any other fellow sentient animal. So since I will always be vegan, B12 supplementation is in order, at this point. But the facts are not all in on the B12 controversy. Upon the recommendation of vegan health professionals, it's wise for vegans to supplement. It would greatly benefit the vegan community if we could create scientific studies comparing vegans and their B12 levels.