In a new study from the United Kingdom, researchers found that more than half of vegan men were deficient in vitamin B12 based on their serum levels. The findings are part of the EPIC-Oxford study and will be published in the European Journal of Clinical Nutrition.
The researchers looked at diets and serum levels of B12 in 226 omnivores, 231 vegetarians and 232 vegans. Mean serum B12 levels in vegans were 33% lower than in the vegetarians and 57% percent lower than in the omnivores.
In addition, the vegans had much higher serum levels of folate—not surprising since vegan diets are typically high in this nutrient. Since folate can mask B12-deficiency anemia, there are concerns about diets that are low in B12 and high in folate.
One especially unfortunate finding: Only 19% of the vegan men said they took vitamin B12 supplements. And surprisingly, their serum levels of vitamin B12 were no higher than those of vegan men who didn’t take supplements.
Why are some vegans not getting adequate vitamin B12? Most likely there continues to be some reluctance among vegans regarding B12 supplements. But there is also an ongoing problem of inadequate advice within the vegan community. According to the EPIC-Oxford researchers, “[…] it may be necessary to improve the understanding of the need to regularly consume supplements containing adequate amounts of the active form of vitamin B12.”
Although most vegan advocates, especially within the animal rights community, provide good information about vitamin B12 nutrition, there are still some popular sources of information that fall short. For example, the book The China Study, offers up this advice “If you do not eat any animal products for three years or more, or are pregnant or breastfeeding, you should consider taking a small B12 supplement on occasion.” (Emphasis added) Other equally popular vegan advocates have suggested that a B12 supplement isn’t necessary until after three years on a vegan diet and that, at that point, a small supplement will do.
But does the average vegan start out with a 3-year supply of vitamin B12? Those who were eating a lacto-ovo vegetarian diet or a “flexitarian” type of diet before going vegan could very well have much smaller stores of B12. And research suggests that blood levels can decline fairly rapidly in just months when B12 intake is low. Furthermore, if you wait until stores are depleted and blood levels have dropped, it is unlikely that a “small” and “occasional” supplement is going to restore B12 to healthful levels.
Taking a B12 supplement is the easiest thing in the world. It doesn’t make sense to wait until stores diminish or you are approaching deficiency before you start to supplement. And it certainly is not good vegan advocacy to promote inadequate advice about vitamin B12.
From the day you go vegan, you should begin to supplement with vitamin B12 or use a variety of fortified foods. Absorption of B12 drops dramatically as the dose goes up, so if you are supplementing just once a day, you need a fairly high amount—at least 10 ug per day. (If you have been vegan for a while and haven’t been supplementing, you may need much more.) It’s important to choose a supplement that can be chewed or allowed to dissolve beneath the tongue.
And when new (or experienced) vegans ask about vitamin B12, veganhealth remains the best and most reliable source of information.
can you tell me why the B12 supplement should be chewable or sublingual?
ReplyDeleteRose, there is some evidence that chewing B12 pills or allowing them to dissolve beneath the tongue increases their absorption quite a bit. That's why it may not be enough to just swallow a multi-vitamin pill that includes vitamin B12.
ReplyDeleteGreat advice, Ginny! I always recommend B12 spray now. My B12 levels went from 262 to 893 after switching from a daily pill to a spray twice a week.
ReplyDelete"Absorption of B12 drops dramatically as the dose goes up, so if you are supplementing just once a day, you need a fairly high amount—at least 10 ug per day."
ReplyDeleteThis is a confusing statement - I think it would help to explain that you can't just take a somewhat higher dose every few days, and expect to absorb the same amount. If I understand correctly, you have to increase the dose exponentially, b/c of what you say about the absorption at higher doses.
I don't think many people are going to dose more frequently than once a day, btw.
It would also help to check the actual blood levels even if you supplement, since you might be ingesting enough, but not making use of it. That would reflect badly on the vegans/B12 issue.
Thanks for posting about his new study!
The VeganHealth article says "Do not rely on any seaweed (e.g., algae, nori, spirulina), brewer's yeast, tempeh, or 'living' vitamin supplement that uses plants as a source of B12." Does this mean that the B12 source must be from an animal?
ReplyDeleteThanks, Ed. I always forget about the B12 sprays which really do seem to be pretty effective.
ReplyDeleteSusan, you're right that no one is likely to supplement more than once a day. And, yes, you have to increase the dose exponentially if you supplement only a few times a week. So if someone is getting B12 from fortified foods, then a couple servings per day providing around 1.5 to 2.0 micrograms each would be enough. But when you take just a single daily dose via a supplement you may need as much as 10 micrograms. And if you are taking a supplement just once a week, you may need as much as 2,000 micrograms!
Ginny, I've been taking Now brand Ultra-B12 in liquid form since 1. getting over my "natural / complete diet" absurdity (even omnivores are often B12 deficient) and 2. reading that athletes deplete their B12 quicker than non-athletes. I have been taking the form 5000 mcg in a teaspoon serving about once a week, on top of the fortified foods (soymilk, smoothies, etc.) that I eat. Do you see any glaring deficiency in this? I've been meaning to get my blood tested lately (though I feel strong!) just to get a better understand of where I'm at, which is probably the best solution.
ReplyDeleteIs there such a thing as too much B12? What if your levels are high, above normal range?
ReplyDeleteEli, all vitamin B12 is synthesized by bacteria, including the B12 that ends up in animal flesh, milk and eggs. Supplements use B12 from bacterial synthesis. So no, it doesn't have to come from animal foods. But some plants are contaminated with bacteria that produce B12 analogs, compounds that are similar to B12 but have no actual vitamin activity. Some of these foods--tempeh, miso,spirulina, etc--have a reputation among vegans for being good sources of B12, but studies show that they provide only analog. There are some indications that certain sea veggies could have active B12 but this isn't really clear and it's not reliable.
ReplyDeleteRhea--no, there doesn't seem to be any danger from high levels of B12 and the Institute of Medicine doesn't have any upper limit for intake.
Kipwinger, 5,000 micrograms per week plus fortified foods sounds pretty safe to me! But I agree that getting B12 tested every once in a while can be a good idea.
Thank you so much for this post. I have VERY HIGH folate levels, which doctors have been unable to interpret (if you google "folate" you find tons of articles on LOW folate, which is a major health concern and which is pretty darn common). They've said it's "probably" not anything to worry about. ...so for now, I do not. But I do take B12 for exactly the reasons you describe here. I'm comforted to know that my bloodwork is actually "typical" of a vegan...at least I conform to those "norms". :)
ReplyDeleteI'm confused about this statement:
ReplyDeleteOne especially unfortunate finding: Only 19% of the vegan men said they took vitamin B12 supplements. And surprisingly, their serum levels of vitamin B12 were no higher than those of vegan men who didn’t take supplements.
Does that mean they're not taking enough supplements? Or does this mean once you've lost a certain amount of b12, supplements can't help? Thank you!
When I started working with the Fibromyalgia & Fatigue Center, one of the things they tested was my B-12. It was critically low, which explained some of the "neuropsychiatric" symptoms I'd had - poor balance & coordination, depression, hypomania and wild mood swings... essentially my low B-12 levels (coupled with low Omega 3) were making it look like I had bipolar disorder.
ReplyDelete**Once we addressed the deficiency, the symptoms went away.**
While I completely agree that there are some conditions that need medication, my experience made me wonder how many people are on psychotropic medications unnecessarily prescribed by psychiatrists or doctors who never considered checking for B-12 and other nutritional deficiencies that might be the root cause of what looked like a mental illness.
Any suggestions where I can find a good B-12 spray? I've been injecting, do not like!
ReplyDeleteThere are different types of B12 tests available, aren't there? Is there one that's more accurate that we should ask for when getting our blood tested?
ReplyDeleteDoes it affect us to take B12 only? I had heard that the B-complex has to be taken in the proper proportions or signs of a lack of one of the B's would show up. I think I remember reading this a long time ago in a book by Adele Davis.
ReplyDeleteYes, it's confusing that those taking supplements were still likely to have low levels. I think the possibilities are that they weren't taking enough or that their levels were depleted before they started supplementing.
ReplyDeleteAnd, yes, there are a number of different ways to test B12 levels and none of them are perfect. I don't know that one is any better than another; the ideal situation is to use more than one test. But I don't know how realistic that is with the standard tests that doctor's order.
LDM, no you don't need to take the Bs in any particular ratio. You just need to get enough of all of them. You may be thinking about the situation with high folate and low B12 (which Elaine is smartly trying to avoid!) because it makes it easier to miss the B12 deficiency.
And UrbanC, there is definitely concern that some psychiatric disorders, or especially dementia, memory loss, etc associated with aging could be related (or at least made worse by) B12 deficiency. This is the case for omnivores as well since many older people don't absorb B12 from animal foods (and therefore need supplements or fortified foods).
Vegan Essentials sells a spray (and also lozenges and sub-lingual tablets.)
Urban Critter...NOW brand foods makes a sweet liquid form called Ultra-B12 that you take from a dropper. You leave it in your mouth for 30 seconds and then swallow. Forget injections unless all other methods prove difficult to absorb into your system.
ReplyDeleteHi,
ReplyDeletethanks for the article, I am not a vegan but have been worrying about my B-12 intake and would like your advice if possible.
My diet is the same as a vegan except for that I eat egg whites and tinned salmon around 2-3 times a week. Would this be enough B-12 or should I supplement my diet with B-12 tablets?
Thanks for any advice you can offer,
Emily
Supplements don't work when they are not taken.
ReplyDeleteI've posting Jack Norris' article about vitamin b-12 ( http://veganhealth.org/articles/vitaminb12 ) for years and it never fails to generate an argument from *some* vegans who are misinformed or who have loaded a bunch of fantasy ideals onto their diets and who find the idea offensive.
I even got banned from a vegan forum, called veganforum.com for posting Norris' article about b-12. The administrator, "Korn", thought it was all hype designed to make money off of scaring people.
Telling him that my daily b-12 lozenges only cost 7 cents a day didn't seem to alter his opinion.
I got similar arguments and quoting of other types of misinformation this time around posting your article to a few vegan forums.
Posting facts is simply not enough.
I just saw a great quote in the comment section of the Facebook page for vegan.com
ReplyDeleteAn early sign of lack of sufficient b-12 is crazy talk, like suggesting that it is not an important nutrient that we need a reliable source of.
Emily, I can't tell whether you are eating 3 servings per week each of eggs and salmon or just three servings of animal foods total. Either way, I think I would be inclined to take a B12 supplement. Your intake is probably borderline and there is no downside to supplementing.
ReplyDeleteBeforewisdom--even though I know that this opinion is out there, it is still so distressing to hear how many vegans refuse to believe that B12 supplements are necessary!
Hi, great post about an continually important issue. You, Jack Norris and some other vegan writers are very good at continually raising awareness. But underestimation of the need to supplement is still prevalent. So I think there is need for a "B12 hub" for vegans - a definitive, cover-all-bases website aimed only at handling this issue, geared for maximal accuracy, guidance and simplicity. The B12 pages at veganhealth.org go a long way but I think more is needed to cover all bases. Here is some brainstorming on that:
ReplyDelete- B12 TESTS. We need much more details on B12 tests. What different tests are available? What are the costs? How do they differ in effectiveness? Are there any self-test kits available? If not, why not, is it really not viable to produce such kits. if so, what are the roadblocks on the way to such self-tests? Is there room for activism/lobbying to make progress on that?
- B12 SUPPLEMENTS. What types of B12 supplements are available? What brands? How are they verified (if they are)? What are the costs involved? Especially important: many vegans will already be eating some fortified foods and perhaps some multi-vitamin that contains some B12. How does that interact with stronger, single-purpose B12 supplements? What common food products would be useful and viable targets for (more) fortification? How can activism and lobbying help with such things?
It is especially important that information on supplements is geared not only toward US readers but also to readers in other countries where other brands and products are more widely available.
- INTERACTION WITH MEDICAL SERVICES. How much do average physicians know about vegans and B12? What tests and supplements are likely to be offered? What is the best way to interact with your physician about this? From hearsay I suspect some people drop veganism after a worrisome B12 diagnosis IN COMBINATION WITH a not well informed physician and some form of "better be on the safe side" thinking.
- BEST PRACTICE HABIT FORMATION. What habits of intake are most reliable? What helps one stick to that habit? Any useful mnemonics? Is use of a "pillbox" effective or is that overdoing it (possible also too "medicalizing" on a psychological level)? What advice does different vegan oriented website offer? How is the message structured (comparisons of different strategies can be useful here). The fact that the negative effects are relatively long-term and the symptoms vague and varied generally makes it harder to motivate and keep a habit I'd think. That means even more effort should go into planning it well and for the long term.
- EDUCATIONAL ISSUES. How best
inform others (vegans and prospective vegans) of B12 issues in a way that is confidence building yet informative, helpful and effective?
- ARGUMENTATIVE ISSUES. How to deal with B12 when it crops up in animal rights related discussion?
If B-12 is better absorbed when delivered by sublingual tablet/lozenge/spray, is the same true of vitamin D2? I found a D2 spray on vegan essentials but each dose has only has 400iu. Would there be any advantage to a daily (double) spray of liquid D2 instead of a 800iu traditional pill?
ReplyDeleteretaan, I think your B12 website is a great idea!
ReplyDeleteHumanimal, I think vitamin D is pretty well absorbed from pills swallowed whole. So the sprays are fine, but I don't know that they are any better than the pills.