Vitamin B12 Recommendation Change

Vitamin B12 Recommendation Change
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Based on two biomarkers of functional vitamin B12 (cobalamin) status, B12 recommendations formulated more than a half century ago may need to be updated.

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How much B12 do we need? Well, the recommended dietary allowance is 2.4 micrograms; 2.4 millionths of a gram every day. That number, I was surprised to learn, was based on a study of just seven people, performed so long ago that four were described as, capital “N” “Negroes.” Both society and science have moved on a bit since then, and the new numbers were recently published, and it appears “4 to 7” is the new 2.4.

How did they come up with that? Well, two reactions B12 facilitates are the metabolism of methylmalonic acid and homocysteine. And so, if we’re B12-deficient, these two compounds can build up in our bloodstream, because there isn’t enough B12 to run these reactions. So, low levels of MMA and homocysteine can be a sign of good B12 status.

And as you can see, 2.4 micrograms is good in terms of lowering methylmalonic acid levels and homocysteine, but 4 appears to be better. These biomarkers of functional B12 status hadn’t even been discovered when quote/unquote “Negroes” walked the earth. And once you hit 7 a day, you basically max out, so there’s no need to get more—though there appears to be no danger in doing so; you just pee the excess out.

So that’s where they got the new 4 to 7 a day recommendation, though, as we’ll see, we may need to take much more than that to absorb that amount.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is transcript contributed by Bruce A. Hamilton.

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How much B12 do we need? Well, the recommended dietary allowance is 2.4 micrograms; 2.4 millionths of a gram every day. That number, I was surprised to learn, was based on a study of just seven people, performed so long ago that four were described as, capital “N” “Negroes.” Both society and science have moved on a bit since then, and the new numbers were recently published, and it appears “4 to 7” is the new 2.4.

How did they come up with that? Well, two reactions B12 facilitates are the metabolism of methylmalonic acid and homocysteine. And so, if we’re B12-deficient, these two compounds can build up in our bloodstream, because there isn’t enough B12 to run these reactions. So, low levels of MMA and homocysteine can be a sign of good B12 status.

And as you can see, 2.4 micrograms is good in terms of lowering methylmalonic acid levels and homocysteine, but 4 appears to be better. These biomarkers of functional B12 status hadn’t even been discovered when quote/unquote “Negroes” walked the earth. And once you hit 7 a day, you basically max out, so there’s no need to get more—though there appears to be no danger in doing so; you just pee the excess out.

So that’s where they got the new 4 to 7 a day recommendation, though, as we’ll see, we may need to take much more than that to absorb that amount.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is transcript contributed by Bruce A. Hamilton.

Please consider volunteering to help out on the site.

Doctor's Note

This is the first of a five-part video series on B12, similar to my series on vitamin D, where I delved into the derivation of my recommendations, found for B12 in Vitamin B12: how much, how often? and in general in Optimum Nutrition Recommendations. For more context, check out Vegan B12 Deficiency: Putting It into Perspective and The Safest Source of B12.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

101 responses to “Vitamin B12 Recommendation Change

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  1. This is the first of a five-part video series on B12, similar to the series I did on vitamin D where I delve into the derivation of my recommendations, found here for B12 and here in general. To put vitamin B12 in context, please check out Vegan B12 Deficiency: Putting It into Perspective. Tomorrow I’ll identify the safest sources of B12. If you can’t wait until tomorrow for your NutritionFacts.org video-of-the-day fix, please feel free to check out videos on 1000+ other topics.

    1. All whole plant foods contain the 9 essential amino acids, therefore complimentary foods are not required. Protein needs satisfy energy expenditures so if you eat whole plant foods, till your full, your satisfying your protein requirements. this is made clear in the paper Position of the American Dietetic Association: Vegetarian Diets.
      http://www.vrg.org/nutrition/2009_ADA_position_paper.pdf

      Also, check out Dr. Greger’s video on vegan protein status showing that vegans had higher circulating protein levels than omnivores due to reduced inflammation in the liver.
      http://nutritionfacts.org/videos/vegan-protein-status/

    2. Is it really true that there are 9 essential amino acids in plants? I heard some sources say there are even 12 twelve. I am confused!??

  2. Please make all your videos accessible on your YouTube home page by default, Doc. It’s the only way I can see them with my old Palm. And my old Palm is my only access to the web.

  3. Dr Greger: I hope you will say something about cyanocobalamin vs. methylcobalamin. In some places (the country where I live is one) the only oral B12 available is methylcobalamin, coming in capsules of 500mcg a hit. And then on the packages it recommends taking (over the course of a day) 1500mcg. Now, is methylcobalamin especially hard to absorb, or what? I only take 500 or 1000mcg a day. Enough?

    1. re: cyanocobalamin (the inexpensive form) vs. methylcobalamin. Vitamin B12 supplements are so cheap to produce that supplement manufacturers try to come with all sorts of fancy ways to “add value” to products so they can make more money. The coral calcium scam is the classic example–how else can you charge $20 for a bottle of chalk? Likewise, unless you’re a smoker, have kidney failure, or base your diet around cassava root, cyanocobalamin should be fine. If it’s unavailable, then I would shoot for about 2,000 mcg a day of methylcobalamin.

      1. Sorry, maybe I missed something … what if you are a smoker, have kidney failure or base your diet around cassava root — why do these factors affect which form of vitamin B12 you should take?

      2. 2000 mcg daily? Are you saying that methylcobalamin is inferior? that it’s less bioavailable, not just more costly than cyanocobalamin?

        Dr Fuhrman’s Gentle Care Formula MVM has only 30 mcg. Do you mean it’s time for him to reformulate?

      3.  I’m totally confused now :? So, since I’ve been taking the Methylcobalamin for years now, I should either start taking the cyanocobalmin or take 2,000 — thousand!! — per DAY of the Methylcobalamin??

        I take a 1000 mcg of Methylcobalamin about twice a week.

        Wow. Please advise!

      4. My research indicates that the reason cyanocobalamin costs less is because it requires less processing than methylcobalamin. As well cyanocobalamin is more stable when exposed to heat and/or light which may also may also lower production and distribution cost.

        “Vitamin B12 is produced industrially by microbial fermentation, using almost exclusively Pseudomonas denitrificans and Propionibacterium species as described in Japanese Patent 03244376, then converting the natural vitamin B12 into the
        cyanocobalamin form by chemical processes including cyanidization followed by extraction and purification steps using organic solvents (as reviewed by Spalla et al., 1989 “Microbial production of vitamin B12″, E.J. Vandamme ed., Elsevier, London, New York, pp. 257-284; Schliwa et al., Proc. Natl. Acad. Sci. USA, 1981, 78, pp. 4329-4333). The chemical conversion step and any subsequent purification steps cause this production process to be expensive, unsafe to the operators and environmentally unfriendly.” Hendrik Louis Bijl http://www.google.com/patents/EP0824152B1

      5. 2,000 mcg a day of methylcobalamin? Could you please do yet another video on B12, particularly on this methylcobalamin type? I’m confused, I also have been taking 1000 mcg twice a week like the other commenter Strix has, based on your recommendations. This is insufficient for this type of B12? Almost all the supplements for sale contain this type, so lmaybe it’s worth clarifying. Thanks doc.

        1. Now I am wondering too. Dr. Fuhrman’s current multivitamin for men contains only 100mcg per day. It would seem this is greatly deficient, and that is alarming.

          Why is so much methylcobalamin required? Does Dr. Gregor explain this anywhere? it would be a great help if he would (or know where he has).

            1. Hi Joseph
              Could you please help clarify all these questions on why the difference in recommended daily amounts of methl vs cyno complained? I have the same questions.

              Thanks,
              Mark G.

                1. No, sorry. What I want to know is
                  (a) what is the preferred form of B12 and why?
                  (b) why is there a difference in the recommended levels?

                  Also, I notice on the same page in response to a comment you posted, there was this post and I don’t know what it means. Is it saying that methyl is better or not? (Maybe just answering the above questions is the bottom line and all that’s needed.)

                  William Hiatt’s reply to Joseph Gonzales R.D.
                  a month ago
                  “our methy ls groups are already being taxed to failure due toxins in food, environmental toxins, depleted glutathione levels, why pile on more work for the methylation groups, and this is not even addressing those with SNPs- Methylcobalamin is as cheap and in the form of transdermal applications higher in efficacy without the risk of dosage dumping. The other area Jack does not address is the Lock and Key fitting of synthetic vitamins. Methyl is the bioavailble form. By supplementing with transdermal nano patches you do not have to be concerned with problems in binding with IF (Intrinsic Factor) Many medications as well as PPI interfere with this so even if you are eating foods high in B-12 you still may suffer from malabsorption”

                2. I also found this reply by Laloofah on a different page. Is what she shares correct?

                  Laloofah
                  (4 months ago)
                  I’m about to re-stock my Vitamin B-12 stash and wanted to learn more about the cyanocobalamin vs methylcobalamin issue first. Since every one of Dr. Greger’s informative B-12 videos and articles seem to contain at least one question about the differences, efficacy, safety, etc, of the two types, I thought I’d share this except from an article on B-12 by Dustin Rudolph (the “Plant-Based Pharmacist”) that I found very helpful (the original article cites sources & includes links to additional info, which are not included here):

                  “Cyanocobalamin is a synthetic version of vitamin B12. After ingestion, cyanocobalamin is broken down into the two active forms of B12 known as methylcobalamin and 5-deoxyadenosylcobalamin. The active form methylcobalamin is an essential co-factor in the production of healthy red blood cells. The other active form, adenosylcobalamin, is an essential co-factor in the maintenance of healthy nerve cells and healthy red blood cells. Because cyanocobalamin is broken down into both active forms of B12, it is the preferred supplement for use in healthy individuals.

                  There have been concerns brought up by some individuals that during the metabolic breakdown of cyanocobalamin, cyanide is released as a byproduct. Cyanide can be toxic to the human body in large amounts. However, the amount of cyanide contained in a B12 supplement is not physiologically toxic to the human body. The only possible theoretical exception might be in patients who have kidney disease. Keyword emphasis on the word might. These patients have an impaired ability to clear cyanide, which could lead to elevated cyanide levels over time. A better option for those with kidney disease may be methylcobalamin due to this.”

  4. There are 2 items I am seeing called for in cookbooks, and I’d like to know if they are harmless. One is baking seitan in aluminum foil. Is there any transfer of aluminum into the food? And the other is liquid smoke. I had heard that this was mutogenic. Is that true? If so, could you please give me some idea of the risk? I think it is an ingredient not just in recipes, but also in vegan bacon and ham.

  5. I’m a vegan of 4 years (I supplement B12), and I just had my B12 serum levels checked, and they were at 1900 (don’t know the units) where the max end of the normal range is 900. Do you think it is necessary to get my homocysteine and MMA levels checked as well? Or since my serum level is so high, am I probably OK?

  6. Dr. Greger: Like you, I was also surprised to learn that the RDA for vitamin B12 is based on an obsolete study. I think that a great future addition to nutritionfacts.org would be a section which provides the latest on RDA recommendations together with sources on which they are based. It would be useful to users of your website to be able to look up any nutrient/supplement (e.g. calcium, vitamin D, etc.) and find the corresponding source information that describes how the RDA was determined. When new studies are published that challenge the RDA, you could then indicate the updates directly on that section. I think that this addition would be a great enhancement to your website.

      1. Yes, a great idea!

        I’ll add my twist: I want a link at the top of the page, right next to “videos, blog, about, …” that takes us directly to Dr. Greger’s latest recommendations (which may or may not relate to RDA) – with links on where those recommendations come from. Right now, if we want a summary of Dr. Greger’s recommendations, we have to hunt for the blog post on it, and I don’t think that post gets updated at these new findings come out.

  7. Dr. Greger: I have been following your advice about vitamin B-12 by taking a weekly sublinguil (sp?) pill. While the vitamin B12 daily recommendations have changed, have the weekly recommendations also changed?

  8. Dr Greger: Since then, for one reason or another (non-availibility of cyanocobalamin being one them), there are those that have no choice but to take methylcobalamin, would you be so good from now on as to include methylcobalamin dosage in your Optimum Nutrition Recommendations?

  9. Thanks for the video!

    If I’m not mistaken Vitamin B12 was first discovered 60-90 years ago. One can say it is relatively recent. What if there are more vitamins that we are not yet aware of?

    Is it possible that there is another vitamin, call it Vitamin X, that we still haven’t discovered and vegans might need to supplement their diet with? How can we be certain that this is not the case and that we don’t actually harm ourselves somehow following a vegan diet?

    I’m a vegan and actually not worried about it at all. There were many vegans who reached old age. I am asking the question out of curiosity alone…

    1. Yes it could be so, but even if vegans consume less of this vitamin X, it could be so that the vegan body uses it less (like in the case of Zinc).

  10. Dr. Greger can you please do some videos on homocysteine lowering. Seems like an important stuff yet couldn’t find much info here. I’d really like to know what your advice would be (yeah, “eat greens, avoid animal foods” ;)), but wouldn’t mind some details esp which food in particular was proven helpful

  11. I am confused Michael. In this video you said the excess B12 we pee out, but everywhere else I heard B12 stays in our bodies for a long time, like some 20 or 30 years. What is the verdict? Thanks! btw I love your work…

    1. We absorb 1.5 mcg plus 1% of the original dose and everything else is urinated out. If we took a 500 mcg dose, this is the math that follows.
      1.5 + .01(498.5) = 6.48 mcg total absorbed.

  12. Twinlab brewers yeast has a single ingredient, debittered brewers yeast. Each single tablespoon has 33% of the daily value of B12 (2mcg) according to the package. The package claims that it is also naturally occurring. Would taking 3 to 4 tablespoons of this throughout the day satisfy the B12 needs of a vegan? Or is this B12 not useful, like the type that comes from algae?

  13. Dr. Fuhrman pointed out to me (via his forum) that the recommendation of 4 to 7 mcg / d of B-12 in the 2010 study is INTAKE, not ABSORBTION (my emphases).

    So, on what basis is Dr. Greger building a case for 4 to 7 mcg / d absorbtion?

  14. I am new ( 5yrs ) to being a vegetarian and Is there any truth that the B12 shots are better as it goes straight to the blood stream rather than the tables because those are water soluble and we pee most of it out? This is what a cardiologist told my friend after coming in for heart palpitations and was very deficient in B12

  15. Hi Mr. Greger, thanks for your advices. I wonder if B12 excess is bad: the graphs shown in the video show that above 7 mcg the levels of MMA and homocysteine start to rise. Does the body know to “stop absorving” when it’s fed up of B12?

  16. Hi Dr Greger. Can you please advise us or make a video on when to start supplementing b12 in babies and children and how often to supplement per age and dose. Can you also please make a video on plant based diets for babies and children.

      1. Thanks for the info. Once the babies don’t want breastmilk anymore, how do you supplement B12? I am still feeding my twins at 11 months old 3-4x daily and 1-2x during the night. I really hope Dr Greger makes a video on this topic as I want to know if what I am doing is correct.

        1. We’ll see if he can do a video on this thank for the suggestion! In the meantime, check with your doctor about B12 supplements for babies. Note this is super duper important and I cannot say enough for B12 for those who follow a vegan diet. Children 1-3 yrs old need 0.9 micrograms of B12 per day, and kids 4-8 yrs old 1.2 micrograms per day. That is easy to obtain just assure they start supplementing post breastfeeding, and that you are good B12 stores and are supplementing as well :)

  17. I gotta say … I am looking for information about B12, what to take, how to take it, how much, and in what form … and it is frustrating to have to go through all these videos to find a little bit of information here, and then some more over here … why not just have a B12 video that you update with all the B12 information in it in one place! Please?????

  18. Hi !
    There is a mistake in the interpretation of this study : http://ajcn.nutrition.org/content/91/3/571.full
    The study shows that a daily intake of 4 to 7 mcg of vitamin B12 is optimal for an “omnivore”, not the absobtion of 4 to 7 mcg per day. 4 to 7 mcg / day is the intake, not the amount of the vitamin that is absorbed.
    Therefore, what amount of vitamin B12 is it necessary to take ? Are 10 mcg per day enough ?

  19. Hey Dr Greger: I’m a practicing Ob, and came across this link (below) regarding excess folate and B12 levels in women , and a possible link to higher incidence of autism. What intrigues me about the study (not as yet published), is that the only patients we supplement with b12 are those on a WFPBD, while, as you know, all women are supplemented with folic acid because most are on the SAD, and don’t get enough in their meals. I am very interested in seeing the study when it is publised- I think we may be seeing B12 really as a marker for a high animal protein /dairy based diet, and therefore, as a marker for animal protein, and it’s hormones, antibiotics, and other contaminants. Would love to hear your thoughts…thanks.

    http://www.medscape.com/viewarticle/863216?nlid=104597_2581&src=WNL_mdplsnews_160513_mscpedit_obgy&uac=18963ET&spon=16&impID=1095314&faf=1

  20. Hello! So I recently got my b 12 levels checked and they show that I am at 462 and the ‘healthy range’ of b 12 my doctor used is 193-986 pg/mL. The weird thing is that I don’t take any supplements and I got the test recently because I have been experiencing really low energy even though I am eating, sleeping and moving the same. Are my levels normal? Or are they low and could that be why I am experiencing low energy? My doctor won’t prescribe b 12 injections(and I am trying to find a place that will, because injections seem more direct than tablets). Also I have been vegan for 3 years now.

    1. The serum B-12 doesn’t test for how effect the B-12 you have is being used. If you can I would ask for a methylmalonic acid and homosystine level blood tests. B-12 is central to the breakdown of these two substances, and so high blood levels would indicate that from a functional perspective you are B-12 deficient. There is also a methylmalonic acid urine test that I would assume would be cheaper, but I don’t know the relative accuracy of it compared to the blood test.

      And of course, you could just start taking a 1000 mcg B-12 a day and just see what happens. You need at least 4 mcg of B-12 a day. Given that amounts over about 1.5 mcg per meal are only absobed at a rate of about 1% by indirect diffusion through the gut a 1000 mcg tablet would result in 11.5 mcg being absorbed or only about 2-3 times the recommend amount.

      Any extra B-12 is quickly and easily eliminated by the kidneys, so no worries about getting too much.

  21. I’m giving a talk next week refuting a paper that argues against veganism. My question regards one of the author’s empirical arguments against veganism. After citing the ADAs statement that well planned vegan and vegetarian diets are suitable for people of all ages, the author then cites another report by W.J. Craig that reports that “eliminating all animal products from the diet increases the risk of certain nutritional deficiencies. Micronutrients of special concern for the vegan include vitamin B12 and D, calcium, and long-chain n-3 (omega-3 fatty acids. Unless vegans regularly consume foods that are fortified with these nutrients, appropriate supplements should be consumed. In some cases, iron and zinc status of vegans may also be of concern because of the limited bioavalability of these materials.” The author (a philosopher) then notes that women are more susceptible to this kind of nutrient deficiency. Is this true? Are vegans, especially female vegans, at special risk of not getting these micronutrients? I was under the impression that vegans needed to get B12 and that all people, no matter their diet, need to make sure to get these micro nutrients.

    1. 2500 cyanocobalamin once a week is good. methylcobalamin doesn’t stay in the system long and should be taken once a day but at lower dose.

  22. Once a week of 2500 cyanocobalamin is good enough. Methylcobalamin doesn’t stay in the system long and should be taken once a day but at lower dose. That’s what I heard from Dr. Greger on his live chat.

  23. I’m obviously coming into this discussion late, but I’m confused as to how much (and what source) vit B12 to give my 4 and 7 year old girls? They take a multivitamin (includes vit B12 5mcg) and vit D drops, hubby and I take a sublingual B12 twice a week @ 1000mcg. I’d appreciate some better direction. Thanks!

    1. As one of the moderators for NF.org, I’m glad you are aware of the need for Vit B12. One of our other moderators fashioned a good response to Vit B12 questions which I’ll post below with encouragement to review the mentioned NF videos.
      Best of health to your entire family! Joan-Nurse-Educator

      Joseph Gonzales R.D. NF Moderator Jeff and Karen Hay • a year ago
      Aloha Jeff and Karen! Thanks for reposting. B12 is super important. Adults needs roughly 2.4 micrograms per day. In supplement form it comes in higher doses. Taking in excess doesn’t appear to pose a threat, as there is no upper limit. Any brand should be fine and you can find cheap sources. Dr. Greger talks about exactly what B12 is in this video. You are right it’s a soil bacteria. Many people believe we can obtain some from dirt but there is no strong proof of this, if any. From dietitian Jack Norris’s post: “Vitamin B12 is a complicated vitamin with a unique absorption mechanism and a number of inactive analogues (molecules that appear to be active B12, but actually are not) that possibly interfere with its function. Vitamin B12 is generally found in all animal foods (except honey). Contrary to the many rumors, there are no reliable, unfortified plant sources of vitamin B12, including tempeh, seaweeds, and organic produce.”

      We have tons of videos on B12, including the safest source where it mentions how we actually do produce B12 it’s just too far downstream to be absorbed.

      Check out more of Dr. Greger’s Optimal Nutrition Recommendations. Let us know when you have more questions! So many folks here have solid answers and suggestions.

      Thanks,
      Joseph

  24. Hello,
    I cite the study (http://www.ajcn.org/content/91/3/571.full.pdf+html) :
    “In conclusion, this study provides evidence that, for healthy adults between the ages of 18 and 50 y, a dietary vitamin B-12 intake of 4–7 lg/d is associated with normal vitamin B-12 status as judged from measurements of cobalamin, holo-transcobalamin, tHcy, and MMA.”
    “Conclusion: In persons with normal absorption, our data indicate that an intake of 4–7 lg vitamin B-12/d is associated with an ade- quate vitamin B-12 status, which suggests that the current RDA of 2.4 lg vitamin B-12/d might be inadequate for optimal bio- marker status even in a healthy population between 18 and 50 y of age.”

    Dr Greger, you seem to have mistakingly understood “absorption” instead of “intake”. The study does not back up your recommandation to take 250 µg daily, or maybe you could cite the passage of the study that goes in this direction ?

    1. “a dietary vitamin B-12 intake of 4–7 lg/d is associated with normal vitamin B-12 status”
      Obviously, it was 4-7 µg/d. The pdf document’s copy didn’t work well.

  25. I am switching my family to plant based diet… whilst it is clear how much B12 to supplement with for adults there is no recommendation for children… what do you recommend for kids and are there any other supplements you recomment plant based children take? Being a physician myself it is so hard to walk away from that ingrained training at medical school that you NEED dairy and animal products but I am re-training my brain.

    1. Hi Vivian,
      So the US National Institute of Health gives guidelines on B12 intakes dependant on age, here.
      This document here gives the UK recommendations (just search for B12 in the document).
      Well done on the lifestyle change, and on changing attitudes too!

    2. Vivian Chen: You got a great reply from Eleanor. I thought I would add my own 2 cents as this question comes up often, and I have a pre-written reply/set of reliable resources for figuring out how to meet the nutritional needs of children on a health plant-based diet. Also, I was moved by your post. Good for you. Doctors have a huge influence over our society and people’s behavior. I am always thrilled when another doctor learns about nutrition.

      In addition to the post below, I’ll mention that I personally know several children at various ages who are absolutely thriving on a WFPB diet. I’ll also expand on the information below about the Becoming Vegan book. That book has an age chart that shows how much vitamins and nutrients are needed by age range for a set of nutrients, not just B12. Finally, I’ll point out that knowing what to do (eating a more calorie dense WFPB diet for children) and getting people/kids to accept it are two different issues. If you get to the point where you know what to do, but are getting some resistance from the family, there are resources/ideas out there to help with that.

      ———————————————-
      With that introduction, here is the information I like to share regarding children and nutrition:

      First, note the following quote from a position paper from the ADA: “It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.”
      .
      Also note this quote from Dr. Greger’s book, How Not To Die, page 411-412: “Vitamin B12-fortified plant-based diets can offer health benefits for all stages of the life cycle. [When] Dr. Benjamin Spock, the most esteemed pediatrician of all time,…died at ninety-four, he advocated children be raised on a plant-based diet with no exposure to meat or dairy products. … ‘Children who grow up getting their nutrition from plant foods have a tremendous health advantage and are much less likely to develop health problems as the years go by.’ ”
      .
      But having said that, there are some ‘gotchas’ when it comes to young children and whole plant food diets (just like there are gotchas with children and any diet). So, it really is worth spending some time reviewing accurate, evidence-based information on the topic. Here’s some ideas for specifics:
      .
      PCRM is the Physician’s Committee For Responsible Medicine, headed up by Dr. Barnard. Dr. Greger has mentioned Dr. Barnard and PCRM favorably in posts and his book. Here are two articles from PCRM that I think contains the type of information you are looking for:
      http://www.pcrm.org/health/diets/vegdiets/vegetarian-diets-for-children-right-from-the-start
      http://www.pcrm.org/pdfs/health/info_children.pdf
      http://www.pcrm.org/pdfs/health/info_advchild.pdf
      .
      I’ll also refer you to a site called the Vegetarian Resource Group, VRG. Their articles are usually very well researched and Dr. Greger has mentioned VRG favorably at least once. VRG has a whole section on kids on their website.
      Here’s the main page. Scroll down to the Nutrition section:
      http://www.vrg.org/family/kidsindex.htm
      This is one of my favorite articles on that page. which starts with babies and goes on up:
      http://www.vrg.org/nutshell/kids.php
      .
      Finally, I highly recommend getting a book called, Becoming Vegan, Express Edition. That book is a great over-all reference book for the whole family. It also has an entire chapter on children and what to feed. The authors of that book have been guest bloggers here on NutritionFacts. They are very well respected and extremely knowledgeable about nutrition science and how it applies to all ages. [As a doctor, you may want to get the more advanced version of the book. Or get both…]

      I hope this helps!

    1. Natural news is a site promoting pseudo-science. This article is bullshit : cyanocobalamin works, there’s a load of studies about it. Not as much about methylcobalamine.

      Cyanocobalamin is also more stable in time (better conversation) and cheaper.

      The so-called specialist is trying to create fear through the use of the term “cyanide”, though he does not talk at all about the quantity which is a hundred times less than what a conventional diet brings everyday.

      Our body deals with way more cyanide everyday that what’s present in for exemple 2000 µg of b12.

    1. Hey Liz, thanks for writing. I would only recommend that your Pediatrician knows about this, and that (s)he has measured their growth on growth charts and found them to be in the 25th-75th percentile range – i.e., normally-nourished, neither over- or under-nourished. I am guessing this is already the case with your two adorables, if they are eating ‘mostly’ plant-based – meaning, you allow some variety, which should be fine given they are in their growing years. If they are under the 25th percentile then a multiple vitamin-mineral would be a good start, and perhaps a more liberal diet until they are back on the normal growth curve.

  26. Hello, please can you tell me where I can find the article where Dr Gregor lists the recommended dose of various supplements. Thanks. (Sorry, I couldn’t find anywhere to ask a general question like this).

  27. I have high homocysteine level between 12 to 15 umol/L the last few years after being vegan for 6.5 yrs. I take Methylcobalamin between 800-1000 mcg a day. My serum B12 numbers often exceed 1000 pg/mL (above the range for that test). I have not done any MMA urine test, is this something I should try to see if I am absorbing B12?
    I don’t have the MTHFR C677T variants but has one variant of the MTHFR 1298C.
    My Functional Medicine MD has requested I take methylation supplements (B6, B12 and Folate comination) the last 12 months but so far homocysteine level remains high (I tried three different brands).
    I have started to experience some internal tremors (not visible to others) since I became a vegan and I am concerned this due to B12 deficiency.

    Appreciate any advice from this forum?

    Thanks.

  28. Hello D. Greger,

    I have a question about your recommandations. The study says “4 to 7 microgrammes a day intake”. What does it means really ? Is it the amount of vitamin B12 from the food sources in total who need to be between 4 to 7 or is it the absorption by the body ?
    Because if I follow your process and your calculation (video “Daily sources of B12”), you use this number as the absorption isn’t it ?
    I am not sure to understand exactly.

    Thanks for your answer.

      1. Thanks,
        But it didn’t reply to my question. 4 to 7 microgrammes a day intake (from food sources) says the study.
        So why D. Greger used this to calculate his recommendations. In another way, why it didn’t use the amount of B12 absorbed from the 4-7 mcg a day (from ressources, intake).
        Many vegan’s associations advice 10 mcg a day, because they explain that the “4 to 7 mcg” a day recommandation is “intake” and not “absorption”. So they use another way of calculation…
        To be honest, I follow the D. Greger’s recommendations about the B12 and advice it too, but the vegan association (France) said that I was wrong because D.Greger was wrong too…
        Thanks again !

  29. Could you comment on the study published in the Journal of Clinical Oncology in the August 22,2017 issue linking vitamin B12 intake with lung cancer? Those taking greater than 55 mcg/day had 2-4 times the risk….smokers had the greatest risk. I am completely plant based and taking 1000 mcg/day which is way more that 55. I hope that just eating plants will protect me from this increased risk…and the article did no address plant vs. animal based diets. Any thoughts or suggestions from your current recommendations in light of this study?

      1. Hi Mike, So I just reread Dr. Greger’s textbook How Not To Die, page 408….he states “For those over sixty-five who eat plant-based diets, the supplementation should probably be increased from at least 2,500 mcg a week (or 250 mcg a day) up to 1,000mcg of cyanocobalamin each day.” I realize that Dr. Greger has been reviewing the almost 100000 articles in the medical literature with his staff of 19 other reviewers for many years…so I have to go with his assessment on this topic. With that said, I agree with NurseKelly that the study did not control for diet…and it is entirely likely that most all in the study were not completely plant based…or if there were some plant based…I doubt that the plant based were separated from the SAD participants. I hope someday a study will be done to clarify this issue….in the interim I am staking my life on Dr. Greger’s best advice.

    1. Hi I’m a RN and health support volunteer with nutritionfacts.org. Thanks for your great question.

      I took a quick look at the study. I’m no expert at reviewing clinical research like Dr. Greger is, but it looks like the conclusion was “vitamin B supplements are not chemopreventive for lung cancer and may be harmful.”

      I don’t know how much you can draw from this one study. I think it need to, and will be studied more. It doesn’t say what factors they controlled for. It doesn’t look like they controlled for diet. And if you know Dr. Greger, you know the role of diet in cancer prevention. Was the B12 supplement group eating a diet full of processed meats? If so, who is to say it is the B12 is causing the cancer? This seems preliminary at this time. I think we’ll need more studies to draw a firm conclusion.

      But, having said that, it does bother me that you can’t find a lower dose B12 supplement. The supplement industry seems to go with the philosophy, if a little is good, massive megadoses are better. That of course may not be the case.
      The daily recommended Vitamin B12 intake is 2.4 mcg for adult women:
      https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

      The lowest dose supplement I could find was 500 mcg. There is no need for this massive dose. I wish I could find a 2.4mcg supplement. Dr. McDougall, a mentor and college of Dr. Greger’s, says about B12:
      “As little as 0.3 to 0.65 micrograms per day of vitamin B12 has cured people of megaloblastic anemia;9 however, to add an extra margin of safety I have recommended a higher dosage of 5 micrograms per day. You may be surprised to discover that you cannot purchase these tiny dosages. Supplements sold contain 500 to 5000 micrograms per pill. These exaggerated concentrations will correct by passive absorption B12 deficiency caused by disease of the intestine.16-17 Everyone else is being overdosed by a factor of 1000. If you are an otherwise healthy vegan and are using typical dosages of B12 (500 micrograms or more per pill), a weekly dose of this vitamin will be more than sufficient.”
      https://www.drmcdougall.com/misc/2007nl/nov/b12.htm

      That’s what I’ve gone to. Just taking a supplement once a week. You can also get your B12 level checked every year or so. You don’t want to be deficient either.

      Hope that helps. Keep up with the plant based diet and you are doing the best thing you can to prevent cancer and a lot of other health problems.
      NurseKelly

      1. Hi NurseKelly, So I just reread Dr. Greger’s textbook How Not To Die, page 408….he states “For those over sixty-five who eat plant-based diets, the supplementation should probably be increased from at least 2,500 mcg a week (or 250 mcg a day) up to 1,000mcg of cyanocobalamin each day.” I believe that Dr. McDougall promotes the use of methylcobalamin at much lower doses. Dr. Greger on the same page states, “there is insufficient evidence to support the efficacy of the other forms, like methylcobalamin.” So the two of them have different opinions on this. I really like Dr. McDougall and all he has done to promote plant based diets….but I realize that Dr. Greger has been reviewing the almost 100000 articles in the medical literature with his staff of 19 other reviewers for many years…so I have to go with his assessment on this topic. With that said, I agree with you that the study did not control for diet…and it is entirely likely that most all in the study were not completely plant based…or if there were some plant based…I dought that the plant based were separated from the SAD participants. I hope someday a study will be done to clarify this issue….in the interim I am staking my life on Dr. Greger’s best advise.

  30. Hello D. Greger,

    I have a question about your recommandations. The study says “4 to 7 microgrammes a day intake”. What does it means really ? Is it the amount of vitamin B12 from the food sources in total who need to be between 4 to 7 or is it the absorption by the body ?
    Because if I follow your process and your calculation (video “Daily sources of B12”), you use this number as the absorption isn’t it ?
    I am not sure to understand exactly.
    So why D. Greger used this to calculate his recommendations. In another way, why it didn’t use the amount of B12 absorbed from the 4-7 mcg a day (from ressources, intake).
    Many vegan’s associations advice 10 mcg a day, because they explain that the “4 to 7 mcg” a day recommandation is “intake” and not “absorption”. So they use another way of calculation…
    To be honest, I follow the D. Greger’s recommendations about the B12 and advice it too, but the vegan association (France) said that I was wrong because D.Greger was wrong too…
    Thanks again !

  31. Alex,

    Let’s start with a quick it depends. No two people have the same need nor will they have the same absorption and ultimately serum and tissue levels demands. These levels are a moving target, hence the ranges.

    As to the numerics, why do we really care when discussing an inexpensive , exceedingly low toxicity water soluble vitamin? The downsides to an overly aggressive supplementation intake might result in a limited set of symptoms, including an upset stomach or acne, as reported in the literature. However, if you address the necessary intakes to actually cause an adverse event it’s highly unlikely to occur without other factors at play, such as a cobalt sensitivity or a kidney disorder.

    I and many other practitioners use “large” doses, including intramuscular injections, of B-12 frequently and have not seen actual signs of overdose. Most commonly I have seen hyperactivity in some of my ASD patients, which is dose related directly and responsive quickly to moderating the timing and doses used.

    A good set of information on this issue can be found at: b12-vitamin.com/overdose/.

    Feel comfortable about your use of B-12 and don’t sweat the exact numbers.

    Dr. Alan Kadish Health Support Volunteer

    1. Hello drkadish,

      Firstly thanks for your answer.
      I am not worried about a highest dose of B12 by supplement at all. The only problem is why the vegan society advices to take 10 microgramme a day ?
      I asked them and they explained me that this recommendation is based on the 4-7 microgrammes a day from the study using by D. Greger too. In fact, from the same study, D. Greger find after calculating 250 micro grammes per day. They said that this recommandation is a mistake.
      I totally agree with you but I need to be able to reply to this question as I advice to take 250 microgrammes a day…

      Thanks again for your help

      Alex

    2. Hello Dt. Kadish,

      I have been following this B12 thread for several months now, and I posted the question (as have several others) of what to make of ghat study (I believe originally published in the Atlantic) regarding b12 supplementation being linked to lung cancer. I have seen some responses that dismiss the article siting high dosing and/or that the study was a small sample and that the subjects already had ling cancer. but if you read it carefully I don’t think it should be so easily dismissed. The dosing the study refers to falls within the norms of what many people take as these are common quantities sold. Arr you familiar with the study?

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