Vitamin B12 – the Hidden Deficiency  

Vegetarians & Vegans even greater risk than supposed, reports show

As a vegetarian or vegan you are probably aware of the dangers of nutrient deficiency in the nutrients B12 and also ( but less well known), choline. Despite this knowledge, what you may not be aware of is the research showing vegetarians, and more particularly vegans suffer widespread deficiencies of these vital nutrients.

If you do follow an exclusively plant-based diet to improve your health you will probably have done your homework but if – over time, you’ve started to experience troubling symptoms such as brain fog, fatigue, poor memory, and even numbness or tingling in your hands and feet – it may be due to a vitamin B12 deficiency.

Omnivores are also at risk, with reports indicating that vitamin B12 deficiency is far more prevalent than previously estimated, with at least 40 percent of Americans having suboptimal levels, and millions more going undiagnosed altogether.

The consequences of B12 deficiency are serious and can cause irreversible damage if left untreated. The classic symptom of vitamin B12 deficiency is anemia, but is only one symptom of B12 deficiency. There are others that occur long before anemia sets in.

They include: dementia, cognitive decline, memory loss, brain fog, depression, cardiovascular problems, peripheral neuropathy, impaired immune function, infertility, developmental and learning disabilities.

Unfortunately, such symptoms are often mistaken for other health conditions and often missed by     physicians in the clinical setting, with serious implications for patients’ long-term health.

Fortunately, new, more sensitive tests for B12 deficiency exist and studies using these improved methods of B12 assessment reveal much higher levels of deficiency than studies using only serum B12 testing. The best of these, the Holo-TC is the earliest, most sensitive indicator of B12 deficiency. Serum B12 being the least.

Vitamin B12 is found almost exclusively in animal foods. For this reason, vegetarians and vegans are doubly prone to deficiency. While early studies showed that vegetarians and vegans had only slightly higher rates of deficiency than omnivores, these studies used relatively insensitive markers, such as serum B12. The newer, more sensitive measures of B12 status indicate that the prevalence of B12 deficiency is much higher in vegetarians and vegans than previously believed.

Veganism is a valid, if not admirable, life choice but anyone adopting the diet needs to have done their homework or may pay a stiff price. The history of medicine and healthcare is littered with unintended consequences.

Most notorious of these being the low-fat, so-called “heart healthy” diet, where in a prolonged campaign of distorted science and staggering mendacity, aide and abetted by wilful negligence, practiced over decades we were told to avoid fat and cholesterol at all costs, with no consideration for the quality of the carbohydrates we ate, leading to the proliferation of highly processed and refined, low-fat, high-carbohydrate foods that we now know increase the risk of heart disease—unlike the fats we were told to avoid…

Those same forces also seek to profit from the current popularity and promotion of the vegan diet.

While many vegans are aware of the risks and take appropriate steps to mitigate them, most importantly supplementing with vitamin B12, many more are not.

But more to the point, supplementation doesn’t always solve the problem. Many studies show even vegans that supplement with B12 are deficient, and one study found that vegans that supplemented with B12 had lower levels than those that didn’t.

What does that say about the absorbability of a lot of B12 formulations you may well ask?

If you simply don’t eat meat it’s not to hard to get the vitamin B12 you need; dairy, fish and seafood can do it. The best dietary sources of getting vitamin B12 into your diet are: liver, clams, oysters, mussels, fish eggs, octopus, fish, crab and lobster, beef, lamb, cheese and eggs.

If you think you have a deficiency the first step is to get a holo-TC and/or urinary MMA test. If either of them is abnormal, take immediate steps to increase B12 levels, either eating B12-rich foods or by supplementing.

Methylcobalamin is by far the most effective form of B12 supplementation because it bypasses several steps in the B12 absorption cycle and readily crosses the blood-brain barrier. It also provides the body with methyl groups that play a role in various biological processes critical to overall health.

To work you must take an adequate dose. We now know that the dose of B12 in a supplement needs to be 100 times higher than the RDA and you need 250 micrograms/day. If deficient the dose needs to be 500 micrograms/day.

The take-away message is, essentially, conventional B12 testing misses the 70 percent of vegetarians and 40 percent of vegans that are B12 deficient.

That is a massive oversight that can have devastating consequences for the long-term health of both vegetarians and vegans.


Don’t forget Choline…

Choline is another master nutrient that vegans don’t get enough of.

Neither do most omnivores —which is why, however counter-intuitive it may be for many of us, we are advised to include liver and egg yolks in our diet.

Choline is crucial for almost everything. Let me count the ways… the gut, skin, brain and nervous system, and reproductive system. Choline deficiency can lead to mood disorders, muscle spasms, poor memory and learning, poor fetal and infant development, and a whole lot more. Low choline levels have been associated with everything from Alzheimer’s disease to liver disease.

Choline plays an especially important role during pregnancy. The amniotic fluid surrounding the baby in the womb is highly enriched with 14 times the level of choline found in the mother’s blood.

Sadly, reports show that 90 to 95 percent of women fail to meet recommended choline intakes during pregnancy.

All of which raises an important question: given that most people—especially pregnant women – don’t get enough choline as it is – should mainstream dietary organizations (not to mention celebrities) be recommending a diet that makes it almost impossible to meet the RDA for this critical nutrient without supplementation?

In a recent editorial in British Medical Journal, a nutritionist in the UK argued that the answer to this question is an emphatic no.

The highest food sources of choline (by 100 g weight):

  • Beef liver: 431 mg; Eggs: 226 mg; Beef steak: 106 mg; Salmon: 90 mg; Pork chops: 78 mg; Chicken breast: 62 mg; Almonds: 53 mg; Broccoli: 40 mg

100 g of liver contains 10 times as much choline as does the same amount of broccoli. So pescatorians and vegetarians, let alone vegans take note, and up your fish (salmon), nuts and green veggies accordingly.

As the BMJ points out, eggs, organ meats, and meats are the primary sources of choline in the diet, and “further movements away from the consumption of these could have unintended consequences for choline intake/status”, they warn.

This has to be a concern in light of veganism’s growing popularity in the US and other industrialized countries—especially because few organizations that promote a vegan diet are recommending choline supplementation.

So, if you or someone you know—particularly a woman of childbearing age—is on a vegan diet or considering starting one, pay attention to choline intake.

And – if you’re on an omnivore, but you’re not eating eggs or organ meats, pay heed too.



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