A Note of Caution - Vitamin B12

IVU Online News | International Vegetarian Union | 08/26/10

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By now, readers of IVU Online News should aware that vegetarians need to pay attention to their B12 levels.

As Dr Michael Greger explains in this video (starting about minute 13) from our friends at Vegetarian Society of Hawaii - - the consequences of low B12 levels are very serious, including death and lifelong incapacitation.

Other sources of information on B12 include and

Here is a summary of a study comparing B12 levels among meat eaters, lacto ovo vegetarians and vegetarians. The findings strongly suggest that vegetarians on plant based diets may be more susceptible to low B12 levels and their consequences.

European Journal of Clinical Nutrition. 2010 Jul 21

Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study.

Gilsing AM, Crowe FL, Lloyd-Wright Z, Sanders TA, Appleby PN, Allen NE, Key TJ.
Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.

Background/Objectives: Vegans, and to a lesser extent vegetarians, have low average circulating concentrations of vitamin B12; however, the relation between factors such as age or time on these diets and vitamin B12 concentrations is not clear. The objectives of this study were to investigate differences in serum vitamin B12 and folate concentrations between omnivores, vegetarians and vegans and to ascertain whether vitamin B12 concentrations differed by age and time on the diet.

Subjects/Methods: A cross-sectional analysis involving 689 men (226 omnivores, 231 vegetarians and 232 vegans) from the European Prospective Investigation into Cancer and Nutrition Oxford cohort.

Results: Mean serum vitamin B12 was highest among omnivores (281, 95% CI: 270-292 pmol/l), intermediate among vegetarians (182, 95% CI: 175-189 pmol/l) and lowest among vegans (122, 95% CI: 117-127 pmol/l). In all, 52% of vegans, 7% of vegetarians and one omnivore were classified as vitamin B12 deficient (defined as serum vitamin B12<118 pmol/l). There was no significant association between age or duration of adherence to a vegetarian or a vegan diet and serum vitamin B12.

In contrast, folate concentrations were highest among vegans, intermediate among vegetarians and lowest among omnivores, but only two men (both omnivores) were categorized as folate deficient (defined as serum folate<6.3 nmol/l).

Conclusion: Vegans have lower vitamin B12 concentrations, but higher folate concentrations, than vegetarians and omnivores. Half of the vegans were categorized as vitamin B12 deficient and would be expected to have a higher risk of developing clinical symptoms related to vitamin B12 deficiency.


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20 Comments | Leave a comment


I'm glad to see Vegsource shinging the spot light on B12. It is a very important matter for vegans & vegetarians. Supplementation is necessary, best sooner rather than later.


For those who feel no urge to supplement (in general) or eat "enriched" stuff, this might be interesting. Based on the principle that "Every nutritional supplement results in more imbalance than it started with or it tried to overcome." (Sorry to have to disagree with you there deborah, but I'm with you on the milk thing!).

On that page, take it from here (about halfway into the article):

Kevin: So you mentioned B12. If someone encounters a B12 deficiency, so they are there, then what's the approach to get out of it?


Doug Graham does a lot of good work and I agree with much of what he says. However, I have serious concerns about the attitude attributed to him in that article regarding B12.

Firstly, waiting until there are deficiency symptoms to test someone's B12 level is ill-advised. Deficiency symptoms can manifest in too many ways to be selective: everything from the classic Pernicious Anemia to much less obvious problems like infertility or mood disorders. Basically, when a person has ANY symptoms, B12 deficiency may be a factor.

Secondly, some symptoms are irreversible once they have manifested, notably, neurological damage. This is of particular concern for children, especially babies of mothers deficient in B12. Those babies are at risk of being born with a permanent malformation such as Spina Bifida, heart defects and hypospadia in boys.

Thirdly, while supplements CAN cause imbalances with certain nutrients, Vitamin B12 is a unique little vitamin. Our bodies limit how much we can absorb, and whenever we have more than we need circulating, it is stored safely in our tissues and livers for use later. Stored B12 can last for a long time and has sometimes given people a false sense of security about their status, only to find out rather suddenly that even they require a supplement.

Fourthly, while it is true that bacteria make B12, it is only made by certain bacteria, and those bacteria require specific conditions in which to thrive.

In primates (including humans) the necessary conditions are found only in the large intestine. However, perhaps ironically, the receptors for B12 are in the small intestine. The only way therefore, for primates to absorb the B12 made in their large intestine is to expel it and then consume it. This is called coprophagy.

During the seasons when primates in the wild are eating their normal vegan diet, coprophagy is a natural source of B12. Since modern humans normally find the idea unacceptable and repulsive, a pharmaceutical supplement makes a much better option!


Jack Norris RD has responded directly to the comments made by Doug Graham, here:


I can only say one thing; I don't believe anymore to all those things. B12, vit C, calcium etc,etc.... I am really asking myself; where stops the true and begins somebody's interest in all of that? Of course,I think about pharmaceutical companies, and their huge profit from making people scared and extremely concerned about their health? "If you don't take your daily glass of milk, your bones will turn to dust, if you don't take our multivitamins, you'll be sick and at least some bad flu is guaranteed to you" (i just remember about swine flu,and their great vaccine for WHO admits,after many pressures, that swine flu was one big manipulation and a lie......
I am veggie. I am 28 now, I stopped eating any meat when I was 9. I don't drink milk,or cheese or anything like that (only sometimes when I eat pizza, it's with cheese, so..). I am more than healthy. Whenever I visit my doc,and make some blood tests, results are only that I DON'T MISS ANYTHING!What do I eat? Nothing special..but lots of,lots of fresh salads, boiled potatoes with olive oil, lots of fruit (always fresh!)Fruit juices from supermarkets are one "zero" and a poison.
But..I must say that being "vegetarian" means only "not eating meat",it doesn't have to mean anything else. You are still vegetarian if you take a cake in morning, fried salty potatoes for lunch, pancakes for dinner... It doesn't have to mean that you eat quality, it just mean that you "don't eat meat". You are still vegan if you eat only "burned", cooked vegetables,gmo soy tresh.. without any real vitamins, without fibers, without anything enough good for your organism.
So, when they mention that B12 is missing in vege diet, that's a lie! It is missing,as anything else, only in cases of persons who don't eat enough of right,quality food! Many,many carnivores have deficits of all those vitamins, minerals..too! Even much more than vegetarians.


Ivana, I'm so happy for you and your lifestyle choices!!! I'm glad also that you don't have b12 deficiency because I do and it's not fun. I posted my story above. If I don't take my supplements on an almost daily basis I get numb and tingly. I may have some permanent nerve damage but hope not I DO eat dairy and some meat even but not alot. I had virtually no b12 reserve in my body plus I know I have problems absorbing b6 as well. For me it is very real. I am not a supplement person at all. I don't take all the garbage that GNC tries to sell people etc. BUT, I must take b12 or I risk serious health issues.


Sorry for my lang. mistakes,I am from Croatia (Europe):)


Ivana, no need to apologize! Your English is 100% better than my Croatian! :-)

I'm glad you are visiting the doctor regularly and keeping track of your B12 level. That way, if at some point, it begins to drop, you will have the warning to start supplementing.

I agree with you that supplementing Vitamin C is silly when eating lots of fresh plant foods; and veggies are an ideal source of calcium. Vitamin B12 however, is in a catagory of it's own.

B12 really isn't a vitamin at all, it is a byproduct of the life cycle of cyanobacteria. Plant foods do not supply it to us. Vegetarian societies around the world now recommend that their members take a B12 supplement and/or eat foods that are fortified with it.


When a person has any symptoms, just about anything might be a factor, most often their diet, true, but not very specifically restricted to variations in B12 intake/production or being a vegetarian or anyting, more like intake of unwholesome food. Like Ivana says, vegetarians and also vegans can be super-unhealthy if they want to. (Besides, no point saving cows when you're going to remove yourself and your great ecological ideology from the planet prematurely by still eating unhealthy anyway).

I just meant to inject a different viewpoint by citing a bit of Doug Graham for people to take a look at, amidst the "B12 deficiency scare" for those who have a good intuition for what their bodies are really asking and how they really feel (hence the "no urge to supplement" I wrote), and maybe need some pause to not worry overly about "B12" and start guzzling down supplements with no end in sight, just because the internet seems to worry about it.

That said, as with anything, if anybody feels they need certain supplements for certain reasons, then go for what you think is best ofcourse, nobody will stop you in this world where supplements seem the norm, but do keep thinking :) The problem with them is that once you start taking them as a precaution, you feel you "need" them while maybe there is nothing wrong.


I agree that keeping an open mind is wise. While I too value intuition about my body, experience has also taught me to also pay attention to information from study and research.

The report posted on Vegsource clearly shows that unsupplemented vegans often do have deficient B12 levels that put them at risk. It's very likely that few, if any of them, knew that until they were tested.


For anyone who feels concerned about a B12 supplement being unnatural, I hope this article may help ease your mind.

As a LONG time vegan and health advocate, I want all vegan be demonstrate the glowing good health and longevity that is so very possible.


For several years I went to several specialists trying to figure out what was wrong with me. My face constantly went numb and my leg was so bad that I started to sort of drag it behind me. I was convinced that I had MS. Finally, I found through questioning another dr., a very good neurologist. I waited about 4hrs to see him. I expressed to the nurse my unhappiness at waiting so long and was going to leave. She urged me to stay saying that he takes as much time as needed with his patients and that I wouldn't be disappointed. Well, I have to say-he tested me for b12 deficiency and found that I had virtually no reserve in my body. I was put on 1000mcg of b12 per day and can you believe it? I'm fine now. I was beyond hopeless and severely depressed because not one other dr. even took the time to ask me so much about my diet and lifestyle. I seem to have problems absorbing several B vitamins so I must take supplements. Please, if you are suffering from any similar symptoms have it checked out. I now am ok because of a wonderful, caring doctor and a $8 bottle of b12.


I'm so very glad you found the right answer. Your experience makes me wonder how many people are falsely diagnosed with any manner of illnesses when really, their problem is untested and therefore, undetected B12 deficiency.


What I find interesting is that ALL of these test subjects would have tested b12 deficient in Japan.

Japan gives anyone with a b12 serum level lower than 500 a b12 supp to take. Japan has one of the lowest rates of dementia in the world.

I give myself b12 injections just as all my cycling mates do. Im the only vegan. I keep my levels between 800-1450 via monthly 1000mcg hydroxycobalamin shots. No probs.

Read the book 'could it be b12?' if you are interested more in the subject. So many people develop b12 deficiency in western nations due to ill health, pollution, excess stress etc.

I used to think b12 deficiency was a vegan thing until I asked my carcass eating mates to get their levels checked and some came up low serum b12 and with elevated homocysteine.


Happily, regular use of sublingual tablets has been shown to be as effective at bringing levels up into the optimal zone. We take 1000 mcg every other day, dissolved under the tongue.


In response to an article published on denying the possibility of B12 deficiency for vegans, American dietician Jack Norris RD kindly prepared the following:

quoted from:

On Saturday, August 21, published an article by Cindy Jones-Shoeman, Vegan Vitamin B12 Deficiency is a Myth.

The article starts out by saying that “nothing could be further from the truth” than the idea that vegans can suffer a B12 deficiency from their diet.

The article by Jones-Shoeman appears to be a rehashing of an old article (apparently from 2004 or earlier) by Vivian Vetrano, “Rethinking & Clarifying the Vitamin B12 Issue” which appears on the Rest of Your Life Retreat website:

Although Vetrano’s article is one of the most fanciful stories I’ve ever read about vitamin B12, it is rather detailed and I will only respond to the excerpts from the Jones-Shoeman article:

“According to Dr. Vivian V. Vetrano, vitamin B12 actually comes from coenzymes, which are already present in bacteria found on the human body (in and around the mouth, for example).”

Vitamin B12 does not come from co-enzymes, it is a co-enzyme. Bacteria do produce vitamin B12, but there is no proof that bacteria living in most people’s mouths produce active vitamin B12 or produce it in amounts large enough that it could prevent B12 deficiency. This is underlined by the fact that many vegans develop full-blown vitamin B12 deficiency, and in some cases permanent neurological damage, as can be seen here: In addition to those cases in the scientific journals, I have known many people who have suffered from B12 deficiency and cured it by supplementing with cyanocobalamin (the most stable form of vitamin B12).

About a dozen studies have correlated low vitamin B12 levels in vegans with elevated homocysteine levels. Elevated homocysteine levels have been linked to early death, primarily from cardiovascular disease, and Alzheimer’s Disease. More details on that are at

“In fact, vitamin B12 deficiency is often, according to Dr. Vetrano, a symptom of a larger problem; that is, it’s not caused from a poor diet but rather from deficiency diseases…”

While it is true that about 2% of the population has trouble absorbing vitamin B12, the vast majority of problems that have been seen in vegans have been caused by a low B12 intake, not from absorption problems.

“Vitamin B12 deficiency due to a vegan diet is simply a lie that finally needs to be put to rest.”

Unfortunately, this could not be further from the truth. The most common, serious damage that results from vitamin B12 deficiency is when a pregnant vegan who does not supplement has a baby who also does not get any B12 supplementation. Typically, around 6 months of age, the infant’s growth and neurological development ceases and then begins to regress. In many cases, such infants have sustained permanent brain damage.

Vitamin B12 deficiency among vegans is real and is not something to be flippant about. It is so important that a number of vegan health professionals and organizations have endorsed an open letter to the vegan community, What Every Vegan Should Know about Vitamin B12 ( This letter has been signed by The Vegan Society (UK), Vegan Outreach, and many members of the International Vegetarian Union science group.


From a Dr. and Biochemist perspective, There are several forms of B-12
The traditional one, which is the cheapest for companies to acquire and sell is
cyanocobalamin, and it does has side effects.

It is contaminated with poisonous cyanide during its chemical extraction from animal tissues. Hence the name.

You want a methyl donor, thus ONLY buy B-12 in the form of Methylcobalamin

Methylcobalamin has "metabolic and therapeutic" applications according to Dr. Sahelian. He notes methylcobalamin helps in the formation of S-adenosylmethionine (SAM-e), a popular mood-altering compound. Chronic Fatigue Syndrome and Fibromyalgia patients have also reported an increase in health with the use of B-12.


While we will agree that the methyl form is better, it can also be harder to find. Most pharmacies carry the cyano form since it is cheaper and more stable.

Thankfully, concern about cyanide from a cyanocobalamin supplement really only applies to people with compromised kidney function. See this website for more detail:

Quote: "While being a natural chemical produced in the body, cyanide is toxic, and the body turns it into thiocyanate in order to excrete it. If this pathway is defective or overwhelmed through ingestion of too much cyanide (such as in smokers, or people in Nigeria who eat large amounts of cassava which is high in cyanide)... a different form of B12 should be given... "

So when the methyl form is available, great! However, for those of us who are non-smokers, rarely eat cassava, and have a healthy detoxification system, taking the cyano form is still a whole lot better than not taking any B12.


of course pharmacies sell junk., and is my preference for buying quality with value, the NSI brand. Why take Vitamin D2 and make your body convert it to D3, why take B12 as cyanocobalimin and make your body convert it it. Plus, you want a Methyl donor.
Just like you want sulfates.... Thus Glucosamine Hydroxide is junk, while Glucosamine Sulfate is what u want. MSM is Methylsulfonylmethane. Taken at 4,000 per day it is effective.
I notice NOTHING with garbage B-complex sold by the masses. When i take a B-complex from 3 times a day, i don't need caffeine at all.

best of health.


Kidneys are NOT detected as impaired unless the nephrons are only working below 20% , less why in the world take your chances. Stop buying the Walmart and other store junk. You are not saving any money, spending more.... for garbage vitamins.

Plus, you need HCL to absorb your vitamins. If you on on a acid blocker, you are not going to absorb much. You really want to take apple cider vinegar with your vitamins.

cheers again.

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