Here’s a subject that will stir up the juices! And the subject is vitamin B12.
Vegans are aware of it for two reasons:
- One, it’s essential for metabolism, red blood cell formation and central nervous system maintenance.
- Two, you can’t get it from a plant-based diet. (Or can you?)
Before I changed to a vegan diet in 2011, I was unaware of B12, what it did, where I got it or didn’t get it, what my levels were, what vegans were doing about it OR that there is a holy war of disagreement about it on the internet.
After I told my doctor about my diet, she advised me to take vitamin B. I bought vitamin B Complex from the health food store and Pete and I took that haphazardly, whenever we thought about it or remembered it. That’s where things stood yesterday, but I was pretty sure I had more to learn. The B12 dosage in my B Complex pill was 100 mcg.
My goal for yesterday was to sit down, untangle the information and decide what’s best for us at our house once and for all.
It turns out, that was a silly goal, but here’s what I came up with:
Where does a person get vitamin B12?
First of all, vitamin B12 is an essential vitamin, one required for the body to work properly. People commonly think that only animal products contain B12, including meat and dairy. Vitamin B12 is generated in the intestinal tract of animals from a bacteria found in the soil. The animals graze on grass, for example, and the soil contains bacteria. The animal ingests the bacteria, which generates B12 in its body. Humans eat meat and dairy and get their B12 in this way.
There is (complicated) disagreement here, though. In other words, some experts say animal products are the only way to get vitamin B12. Some say you can get it from the bits of dirt left on vegetables and root crops. You can get it from the dirt under your fingernails from farming or gardening. Some say, no, due to changes in farming techniques and how we treat vegetables after harvest, obtaining B12 from soil on vegetables like this is totally insufficient. Some argue vitamin B12 is found in nuts, greens and fruits so that we would get sufficient B12 amounts given we had no underlying medical conditions.
I can’t make sense of it. I decided it’s not as important to argue, as it is to assess your own B12 sufficiency and to discuss it with your doctor.
Certain populations are at risk for B12 deficiency.
A vitamin B12 deficiency is a serious, sometimes severe, life-threatening disorder. Fatigue, paleness, anorexia, mental confusion, delusions, paranoia, weight loss and respiratory problems are just some indications that a person may have a B12-deficiency. Fatigue and tingling in the hands or feet are often reported as early signs of deficiency. People are diagnosed with anemia or pernicious anemia and are usually encouraged to include meat and dairy back into their diets if they are vegan. They receive other medical treatment including vitamin B12 supplementation, often in the form of B12 shots (if underlying absorption conditions exist) or high-dose oral vitamins (if no other B12 absorption problems exist).
Some people believe vegans are at special risk because they are not getting sufficient B12 through their diet, and others believe a vitamin B12 deficiency is no more widespread in vegans than it is for meat eaters and the general population. These latter people argue the real problem is that “B12 deficiency” is actually a failure of digestion and food absorption, not a dietary deficiency at all. Everyone (vegan or otherwise) who takes antibiotics, for one example, experiences changes in intestinal flora, affecting B12 absorption. These experts recommend discovering the underlying cause of poor B12 absorption rather than B12 supplementation.
Beyond antibiotic use, there is a list of other reasons why a person (regardless of diet) has trouble getting enough B12: Celiac disease; Crohn’s Disease; history of certain gastrointestinal surgery; failure to produce enough hydrochloric stomach acid (a condition that affects 10-30% of older adults); being over age 50; taking certain gastroesophageal reflux, peptic-ulcer or diabetes medications.
It’s a sensitive topic. Here’s why.
I see no harm in making a conservative assumption that B12 can’t come from a vegan diet as long as we don’t blame things unnecessarily on vegan diet rather than a legitimate underlying condition. We want to make sure our doctors treat the appropriate symptoms and causes, after all.
But let’s go with that assumption: B12 can’t come from a vegan diet.
Non vegans often point to this as a reason a vegan diet is “insufficient” or “unhealthy.” There are many examples on the internet of people who followed a vegan diet and then ran into serious health problems. They really did. If we were meant to have B12, then isn’t a vegan diet unnatural and unhealthy?
I like what the No Meat Athlete, Matt Frazier says on this.
My answer to this question often surprises the person asking me, and it might surprise you, too: I don’t think we’re “meant” to be vegan. If there’s anything we’re meant to do, from an evolutionary perspective, it’s “reach reproductive age and have kids that do the same.” On whatever diet our environment affords us. ~Matt Frazier
Do I want to follow a diet my body was “meant” for? Or do I want to follow a diet that maximizes longevity in this age when people are living way longer than ever?
I also like what Thomas Campbell says on the topic.
I believe it to be clear that humans did not evolve as strict vegans. From what we currently know, I believe our requirement for B12 supports this point of view. I believe that in the environment of scarcity we evolved in, we adapted to do quite well with a wide range of foods. That being said, we likely evolved from primarily plant-eaters millions of years ago and remain close genetic relatives to primarily plant-eating primates. Modern nutritional science has shown a dietary pattern dominated by unrefined plants, even exclusively containing plants, to be superior for prevention and reversal of chronic disease. Are we designed to be eating some insects, or some dirt, or some meat? Perhaps, but we don’t need to, and in our current environment of overabundance and profoundly sedentary lifestyles, I actually think this type of recommendation would do more harm than good. ~Thomas Campbell, MD
My advice: Don’t argue about things with people on the internet things you can measure for yourself. You’ll only get upset.
In other words, if you are worried about your veganism and vitamin B12, go to the doctor. Certainly, if you have symptoms, consult your doctor RIGHT AWAY. It’s very important. Revise your diet if you need to and don’t worry what people on the internet say about it. You can still stay plant strong! See how you feel and make further changes as necessary. The doctor will help you. If you discover problems early, you can reverse symptoms and damage. People do report difficulty climbing out from under B12 problems. It often takes a long time.
I decided to stick with my conservative assumption that my vegan diet does not offer B12 and to take a supplement as my doctor advised.
I’ll end by expressing my unmet goal.
I originally wanted to end with a specific recommendation for B12 supplementation, like how much to take and how often. I did personally go to the health store yesterday. I did speak with an expert at the store and I did come home with a B12 supplement. However, I am not going to share the dosage information, because, I have to tell you the truth, I’m throwing darts. There is absolutely no consensus out there!
So that while most doctors appear to agree your body doesn’t need much B12, only a few micrograms per day, and that if everything else is working normally, even if you supplement high amounts, a healthy body will absorb what it needs and discard what it doesn’t. However, doctors recommend wildly different dosages. I mean, wildly, from 4 mcg, to 100 mcg, to 500 mcg, to 1000 mcg, to 5000 mcg. Some say take it twice daily. Some say take it once a day about three days a week.
Given all that, the responsible thing to do is leave you to follow your own path. Visit your doctor. Get several trusted opinions if necessary.
For myself, I’m going to keep asking and continue learning. Just for today, I am going to put this difficult, contentious issue to bed and hope for–YOU GUESSED IT–world peace.