Vegan Epidemic

Vitamin B12 deficiency is common among those eating vegetarian and particularly vegan diets because of failure to take B12 supplements or eat B12-fortifed foods.

August 27, 2011
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  • Michael Greger M.D.

    Check out my blog post Vegan B12 Deficiency: Putting It into Perspective to put this subject into context.

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    • http://www.facebook.com/profile.php?id=706601419 Peter Heeks

      *likes*

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    • Rick1

      Hold on Doctor Greger, a bigger study was done in the U.S. back in 2000, and it clearly showed that even 39 percent of meat eaters are B-12 deficient, so don’t automatically believe that 1% stuff regarding British meat eaters, that the British study showed. Bottom line is everyone should take a B-12 supplement. Sublingual tablet, or shots, are best, as you know. Anyway, below is the 2000 study link.
      http://www.ars.usda.gov/is/pr/2000/000802.htm

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  • http://www.facebook.com/profile.php?id=676800493 Benjamin Stone

    Puzzling, as so many alternative milk products are well fortified. Don’t these people eat cereal or oatmeal where they could easily use fortified soy/almond/rice milk etc.? Or is fortification not a reliable source, does only direct supplementation meet the criteria? If the latter is the case, I am afraid this will only be a growing problem. Most people cannot be trusted to take care of themselves (self medicate with B12 in this instance).

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    • http://www.facebook.com/profile.php?id=706601419 Peter Heeks

      So true, but I know vegans who purposely avoid the fortified soy milks in favour of the “organic” ones and same with cereals etc, so they are missing alot of the easiest ways to get their B12 cause they think it’s a myth.

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  • mainlinebooker

    How often should you have your B12 measured? I just had mine done and without any supplementation, I have normal levels..

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    • Michael Greger M.D.

      Please see my response below at the bottom.

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  • mainlinebooker

    ps. I am a 60 year old vegan with a normal liver!

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  • imgreen

    Please tell us what is is a sufficient supplement? Is fortified nutritional yeast, fortified rice milk sufficient? How much (i.e. in tablespoons or cups) is adequate?

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    • Michael Greger M.D.

      Please see my reply below–thanks for that important question!

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  • LouiseF

    It’s shocking because its so easy to take a supplement daily or even a few times a week. Get with it Brits, don’t give vegans a bad name!

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  • http://www.facebook.com/profile.php?id=706601419 Peter Heeks

    If you’re in the UK and drink soya milk just buy fortified soya milk (i.e. not organic) with your cereal and you’re there! 250ml provides the RDA. Also, crappy keloggs cereals are all fortified so you don’t need to fork out for expensive suppliments every day.

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  • http://www.facebook.com/profile.php?id=1621151310 Nouh Alaoui

    I’ve just read that the “best” way to supplement B12 is either a daily intake of 100µg or to take 1000µg twice a week, better if it is showed.
    Those people that don’t take their b12 really give vegans a bad image, instead of people seeing how great and healthy they will be when following a vegan diet, they see these horror stories one after the other and the worse thing is that the media seem to focus enormously on these sick people more than they would focus on people who recovered from heart illnesses or slowed their cancer enormously with a vegan diet.
    The best thing a vegan can do to promote the diet is to look great and tell people how he did it.

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    • http://www.facebook.com/profile.php?id=706601419 Peter Heeks

      Well said!

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      • beansngreens

        Exactly! Especially when the B12 vitamins and fortified foods are completely vegan.

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  • http://www.msadventuress.com MsAdventuress

    I’m so grateful to hear all this, spelled out. Doctors need to watch these videos, too! ♥

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  • healthcoach7

    In reading this info I wonder if any of you have read the book “The Whole Soy Story by Kaayla Daniel. Soy is not recommended for babies, children, women who are trying to conceive, women in perimenopause basically everyone. Soy should NOT be eaten unless it is fermented, ie, miso, tempeh,natto etc. Phytoestrogens are precursors for breast cancer and infertility. Soy products are being forced down our throats just like corn products and neither one are healthy. Chinese women feed their unfaithful husbands soy. Soy was never intended as a food and only in the US is it subsidized and put in over 60% of our food.

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    • Michael Greger M.D.

      Please see my response below.

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  • http://www.facebook.com/profile.php?id=676800493 Benjamin Stone

    I agree that fermented soy products are most healthful, but I disagree with your general condemnation of soy. In fact there is evidence with specific diseases it may be helpful. http://www.happyhealthylonglife.com/happy_healthy_long_life/2011/03/breast-cancer-and-soy.html

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  • http://www.facebook.com/profile.php?id=688695468 Cyclo Uten Etternavn

    Excellent video!
    Vegans should take B12-supplements, period.

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  • mainlinebooker

    Hoping Dr.greger will answer my question about how often to test if B12 is normal and no liver issues..

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    • Michael Greger M.D.

      Please see my response down below.

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  • http://www.facebook.com/profile.php?id=613285734 Heidi Woodruff

    That’s why I take a multi with B12 in it, and a B12 sublingual once a week!

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  • Michael Greger M.D.

    Sorry it took me so long to reply (Irene knocked our power out!). First let me repost the recommendations I added to the B12 blog entry:

    In my opinion, the easiest and cheapest way to get our B12 is to take at least 2,500 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement (you can’t take too much–all you get is expensive pee).

    Or, if you’d rather get into the habit of taking something daily (instead of once-a-week), I recommend at least 250mcg (I know the math doesn’t seem to “add up” but that’s due to the vagaries of the B12 receptor system–I’m going to post a video on how I arrived at these recommendations soon).

    Or, if you’d rather get it from B12-fortified foods, I’d suggest three servings a day, each containing at least 25% of the “Daily Value” on its label (again, I’ll explain). Such foods can be as exotic as a certain type of “nutritional yeast” or as simple as a bowl of Cheerios.

    One would assume all products such as soymilk (soya for you, Peter :) and plant-based meat substitutes would have B12 added, but sadly that’s not the case. You just have to look at the label. Once one starts looking on packages you might be surprised how frequently you’ll find it in often unexpected places (such as Celestial Seasoning’s “tension tamer” tea).

    imgreen: In terms of what constitutes a sufficient serving (see above) of various fortified foods, typically this would mean a half a cup of most soymilk brands (though a cup for one popular rice milk), a cup of most popular (i.e. loaded with added sugar) breakfast cereal brands, a heaping teaspoon of B12-fortified nutritional yeast (not all is fortified), one veggie hot dog, five slices of veggie bologna, etc. You should check the label, looking for the “25%” next in the B12 Daily Value box (see above).

    In my 20 years eating a plant-based diet, I’ve personally found the cheapest and simplest method to just take the once-a-week supplement I described above, which if you share with a bunch of friends can cost as little as $2 a year — cheaper than Cheerios! :).

    mainlinebooker: At your age (over 50) everyone should be supplementing with vitamin B12 regardless of their diet according to the Institute of Medicine (the official body that brings us the “Recommended Daily Allowances”). Because your physician likely doesn’t know any better, you probably got a serum B12 level drawn (a relatively specific but insensitive test). So a “normal” vitamin B12 blood level does not rule out even potentially severe B12 deficiency. There are better tests your doctor can order, such as a urine MMA level (“methyl-malonic acid,” though there appears to be an even better test on its way–I’m planning to record a new video about it), but I’d recommend you just follow the IOM recommendations and supplement.

    healthcoach7: There certainly is all sorts of crazy stuff on the internet about soy (and just about everything else I imagine). Thankfully the public appears resilient to such internet rumors (at least according to a United Soybean Board survey released last week). You may find this article by author John Robbins useful. I can’t vouch for everything he writes (haven’t checked his sources), but it’s his response to the kind of legume defamation you describe :)

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    • tonyattanasio

      Just two naive questions–how much research has been done into “vitamin-B12 deficiency” after the first studies between the end of the 1920′s and the end of the 1940? And how many of us are still relying in Prontosil to treat infectious diseases?

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  • http://www.facebook.com/profile.php?id=100002328778542 Robert Edmands

    Awesome. No Irene effects here. Colorado is a long way from the east! I think that 2% milk I drank last week has me in the black. Not a vegan yet- but this site has me thinking….I’ve never been vitamin tested at all to my knowledge. Hmmm……………

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  • http://www.facebook.com/profile.php?id=1621151310 Nouh Alaoui

    My question is what type of B12?? I keep reading in many blogs and articles that the most potent form of vitamin B12 is methylcobalamin and not cyanocobalamin (the one I’ve been taking for over a year now).
    To tell you the truth, I’m really scared I may be harming my body!
    Dr. Greger, do you have a justified answer to this? If so, please enlighten me.

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    • http://www.facebook.com/profile.php?id=544252364 Precious Bautista

      Nouh, if you click on Dr. Greger’s blog post link (very first comment), he answers your question in the comment section following the article.

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      • http://www.facebook.com/profile.php?id=1621151310 Nouh Alaoui

        Thanks for the info ;)

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  • http://www.facebook.com/profile.php?id=544252364 Precious Bautista

    Great info. I recently began taking a sublingual form of B12 and have been pleased to see my energy levels steadily increasing. I have anemia also, the cause of which my docs haven’t been able to pinpoint. Hoping I see improvement in this area also.

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  • Kim

    One of the comments mentioned liver issues. Is a deficiency in B12 related to liver issues? During a preventive visit to my doctor she said I had slightly elevated AST and ALT levels. She said she was puzzled as I don’t drink, don’t take tylenol (or any medications, except a 3 day course of Nutrofuran 3 months ago for a UTI) am not overweight, exercise regularly. I told her I rarely eat animal products. (Note: I am now taking a supplement after watching your video).

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  • KJ56

    Nutritional yeast is commonly used by the vegans I know. It is a tasty addition to many dishes, and provides 130% of the daily B12 requirement in 1 1/2 T. Shouldn’t that be enough? It also has other B vitamins. Love this site by the way, new discovery.

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    • http://www.facebook.com/profile.php?id=676800493 Benjamin Stone

      Yes, this is my primary source of B12 in addition to daily consumption of fortified nut milks. And it does taste great in many dishes!

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  • GregV

    I live in Phoenix and try to sun 20 minutes a day at 11am. I have heard that after you sun, you should not use soap on the majority of your skin for 24 hours in order to allow the surface B12 to be absorbed. I would like your thoughts on this information?

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    • Toxins

      Hello GregV,
      You actually do not absorb vitamin b12 through your skin, what you are referring to is the absorption of vitamin D. Humans cannot create their own b12 and must obtain it from outside sources, such as through supplementation. Check Dr. Greger’s video http://nutritionfacts.org/videos/vitamin-supplements-worth-taking/ to see that you should be getting 15-30 min. per day of pure sunshine in the summer for adequate vitamin d levels as well as supplementing vitamin b12. Also note that getting sun on your head and arms is probably not enough, you should lay out with as little clothes as possible, like wearing a swimsuit. Also note that in the winter is extremely difficult to get adequate vitamin d absorption. Regarding bathing after tanning though, it has been discussed by Dr. John Cannell that a significant amount of vitamin D is produced on the surface of the skin and may in fact require absorption for adequate levels. The scientific literature states that vitamin d is produced deep within the skin, although this is true, it is only half the story. In the words of Dr. Cannell “Holick, et al’s, landmark 1980 study showing most human Vitamin D production occurs in the deep epidermis was incomplete. It was based on surgically obtained (and assumedly surgically prepped) skin samples that had any remaining surface oils removed by washing with hot water. Indeed, to accurately address the question of where Vitamin D is made, one would need to obtain unwashed human skin, difficult to do even from cadavers.” Right now it is unclear where most of the vitamin D is created as their isnt enough research on the subject. You could go with Dr. Mercola’s theory of not bathing for 48 hours for adequate absorption. Due to our modern era, its hard for tanning to be a reliable and consistent source of Vitamin d. Most doctors recommend between 2,000 to 4,000 IU’s of vitamin d per day. You could supplement a lower amount and also tan just to be on the safe side. If you are really curious, you could also get a blood test now and another one a month later to see how well your vitamin d levels are. Hope this helps!

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  • GregV

    I did mean Vitamin D, sorry. My head is a bit spinning from all the great info i’m getting from this site!

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  • becochic

    The B12 stuff keeps making me nervous about raising my baby on a vegan diet, but while eating the SAD junk diet I was low in iron and b12! I ate animal products constantly.

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    • Rick1

      Nothing to be nervous about, just get a good book on how to raise a baby on a healthy vegan diet. Check out a show called ‘It’s all about food’ with Caryn Hartglass. Anyway, email her for book advice on the subject of raising a child vegan. You can find her show at http://www.progressiveradionetwork.com/its-all-about-food/

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  • http://www.facebook.com/profile.php?id=1333777681 Mark Biddy

    does rain water contain b12 or any other micro/macro nutrients?

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  • http://www.facebook.com/rebeccabrookecorby Rebecca Corby

    I am still confused about B12 (and I think many are)
    I have not taken regular supplements of any kind and have been vegetarian for 13 yrs and vegan the past 3 yrs. I recently had a blood test and my B12 was ‘on the high side’ at 811 (the normal range was something between 200-900) Now I keep reading all these things that say vegans need to supplement so just to be ‘better safe than sorry’ I now pop a B12 supplement every once in a while (I also use nutritional yeast in my cooking quite often)
    Here’s why I am still confused, my understanding is that people who eat animals get their B12 (which I’m told is a bacteria not a vitamin) from the animal products. When asked how the animals have B12 and we don’t (when these animals are vegan too, like cows)
    I’m told that the cows eat the grass off the ground and because its not washed and the ground is teeming with bacteria including the B12 bacteria, the cows ingest it this way….so if the cows ingest the Bacteria how does it get into their flesh? Also how does eggs and cheese have B12 ? Do certain animal products have more B12 than others? Also if B12 is a bacteria and it somehow gets transferred from the cows’ stomachs to their flesh, people cook their meat before eating it specifically to kill bacteria so wouldn’t the B12 bacteria be killed too?
    Also there are meat-eaters who have B12 deficiency as well as many other deficiencies, in fact based on my personal experience the people I have known who had any deficiencies were non-vegans but anytime I tell someone I’m vegan (including other vegans these days) I’m told I need to be very careful to supplement with B12 because my vegan diet is not adequate. In addition to answering my questions posed, Dr. Greger, can I suggest that you put together a chart or visual showing all types of deficiencies and how nutrient deficiencies in general compare from vegans to non-vegans…because it would be my guess that non-vegans do suffer more deficiencies than vegans but everyone just focuses on this one mysterious bacteria called ‘Vitamin B12′. I would also suggest to be more accurate that people stop calling it a vitamin if it’s a bacteria, this confuses people too. With all the weird info about B12 I see that in a few years it will be like the ‘pluto phenomenon’ where for so many years scientists said pluto was a planet and now they say actually pluto is just a moon…I suspect with more research into this topic, it may come about that B12 ‘deficiency’ has nothing to do with a vegan diet or its not the way we thought it was. Thank you for answering my questions.

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    • Toxins

      Hello Rebecca, I see you have much concern for b12, let me explain.

      B12 is a byproduct of bacteria, not the actual bacteria itself. We use very tiny amounts of b12 everyday so we wont find deficiencies until 20 years have passed in some cases. Nutritional yeast has a daily amount of b12 but if your taking a sublingual supplement with a big dose, then you only need to do this once a week. It doesn’t matter if you take too much though because if you take excess b12, you pee it out.

      Dr. Greger explains b12 in many of his videos, particularly this one.
      http://nutritionfacts.org/videos/vitamin-supplements-worth-taking/

      Also, Dr. Greger does in fact show a comparison in this video http://nutritionfacts.org/videos/omnivore-vs-vegan-nutrient-deficiencies-2/ of omnivore and vegan nutrient deficiencies.

      I know that the best b12 supplements are the sprays or sublingual ones but I do not know how effective the pills that you swallow are. Cows achieve b12 because they grow that bacteria in their gut flora, we do not.

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  • Rick1

    Hold on everyone, a bigger study was done in the U.S. back in 2000, and it clearly showed that even 39 percent of meat eaters are B-12 deficient, so don’t believe that 1% stuff that the British study showed. Bottom line is everyone should take a B-12 supplement. Sublingual tablet, or shots, are best. Anyway, below is the 2000 study link.
    http://www.ars.usda.gov/is/pr/2000/000802.htm

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    • Michael Greger M.D.

      That was from the Framingham Offspring Study. I actually have a video coming out about it soon, so stay tuned! 39% didn’t qualify as deficient, though, as you can read but just “low normal.” I agree though, that supplements are fortified foods are the best cholesterol-free source of B12 for everybody.

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  • David tunison

    I ahve followed you for years and purchase your tapes. Met you in Ann Arbor at the food co- op.Is it true Cyanocobalamin b12 ( which you recommend for us as vegans)turns into cyanide and the best b12 to take is hydroxycobalamin?Per Raymond Francis MIT scientist. That’s what his website shows anyway. His comments were it is man made , not natural, and not well utilized. What is absorbed is turn into cyanide. Could you please clarify, help.

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    • Michael Greger M.D.

      Let me guess: Mr. Francis sells hydroxycobalamin supplements? It’s like the whole coral calcium scam. Calcium is cheap as chalk–in fact it is chalk! So how are you going to bilk people out of lots of money? You sell some sort of special calcium. Same with B12 supplements. They are so cheap to produce that supplement manufacturers try to come up with all sorts of fancy ways to “add value” to products so they can charge $30 a bottle. Unless you’re a smoker, have kidney failure, or base your diet around cassava root, cyanocobalamin should be fine.

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  • vegan gary

    Hi M ichael

    My wife and I are vegans and we take B12 supplement. I have a couple of questions:

    - we use methyl B12 1000 mcg 2/week. You often discuss the necessity of taking B12 for vegans. We swapped to methyl B12 as a workmate said the cyano B12 was unhealthy? I see from your site you recommend the cyanocobalamin and that methyl is expensive and unecessary. Is the methyl just as effective?

    - why is taking B12 as a supplement healthy and taking other vitamins as supplements unhealthy. I understand the argument for other supplements goes like this: taking supplements overloads the receptors on the cell for that group of vitamins and therefore other vitamins within that group can’t be taken up and imbalances occur. If that is correct, why doesn’t this happen for B12 in relation to uptake of other B vitamins. There seems also to be an issue about taking your nutrients in the context that they came from eg having an orange rather than drinking orange juice for vitamin C. How does this relate to B12?
    By the way congrats on nutrition facts. I have sent it to my kids but they haven’t become addicts yet!
    Thanks Gary

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  • Kelli

    I don’t buy these numbers, either, at least not in America. The Standard American Diet is conducive to digestive problems. It takes intrinsic factor or absorb B12. Also, it was my understanding that cyanocobalamin is not the human-active form
    and depletes the body of crucial methyl groups when being converted to
    methylcobalamin, the primary human-active form. Are you familiar with
    David Rainoshek, M.A.? He wrote a book called “B12 Exposed.” Based on
    his researching, B12 deficiency is widespread and mainly due to rampant digestive
    problems and a lack of intrinsic factor. The swallowed forms of
    supplementation aren’t going to do much if you can’t absorb it. Sublingual methylcobalamin and injections are more effective. The accurate test for B12 is the urinary MMA test, not the blood test. The blood test can show adequate levels when there really is a deficiency.

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