Why You Should Care
B12: unsung hero of the vitamin world. Where many have a pretty decent understanding of the hazards of iron-related anaemia, the general population seem to know little about B12 and the important role it plays in keeping our nervous system, red blood cells, and brain healthy. As someone who has clinically diagnosed B12 deficiency and an extensive family history of pernicious anaemia, I can one-hundred-percent vouch for its heroic status. I went several years before being prescribed B12 injections and in that time I struggled with near-constant nausea, a lack of appetite, fatigue, heart palpitations and in the last few months, before I finally got a diagnosis, I had panic attacks and would regularly lose all feeling in parts of my hands and feet which would last for weeks at a time. For more information on early signs and symptoms of B12 deficiency see the NHS website: https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/symptoms/
I really cannot stress enough how important it is to factor B12 into any dietary changes you make – especially if you’re considering going, or already are, vegan.
Veganism and the Risks of B12 Deficiency
Rumours have been circulating that vegans don’t require B12 supplements, that you can absorb this complex vitamin from plant-based foods like seaweed and tempeh – this is not the case (1). Tom Sanders, professor emeritus of nutrition and dietetics at King’s College London, has said “Of all the micronutrients, B12 is the one we’re most concerned about. I’m concerned many people think B12 deficiency is a myth.” It is no myth, ladies and gentlemen. It is a known fact that humans can absorb B12 only from animal products – and as much as a vegan diet has environmental and other health benefits, it is important to acknowledge the potentially detrimental effects this lifestyle can have on an individual’s B12 levels. A 1955 British study on vegans found significant levels of B12 deficiency in its participants with some even suffering from nerve damage and dementia (2). Such symptoms, if left untreated, can be irreversible (3). In fairness, vegans are unlikely to become clinically deficient in B12, they nevertheless tend to express repressed activity of B12 related enzymes which increases homocysteine levels. Evidence collected over the past decade has demonstrated that even a slight increase in homocysteine exacerbates risks of heart disease, stroke, and pregnancy complications. (4).
Because I love them – with all my heart – I often nag my vegan friends to get their bloods checked, particularly if they’re complaining about fatigue or generally feeling under-the-weather. However, when it comes to B12, blood tests aren’t always the most reliable reflection of whether someone is deficient or not. The science is not an exact one and different areas of the U.K. have different deficiency thresholds. The recommended daily dose even varies from country to country; the U.S. recommended intake is 2.4 micrograms whereas the German recommendation is 3 micrograms (5). There’s also confusion between the analogous inactive and active forms of B12 floating around in our bodies as well as a huge question mark over whether the machines used to detect B12 in the blood are even effective at all (6). So, if your GP tells you your B12 is fine, but you’re still feeling sluggish, you should consider popping down to Holland & Barrett (or your local supermarket) and getting some supplements anyway. It’s also worth noting that, unlike iron, you can never have too much B12, so taking supplements regardless of serum levels poses no risk to your health (7). However, I should add, there are no benefits to having surplus B12 – it won’t transform you into a star athlete or superhero (unfortunately). The only people likely to feel the benefit are those suffering from a deficiency (8).
Incorporating B12 into a Vegan Diet – Is it Possible?
As much as I’d love for there to be some magic plant-based ingredient (like seaweed of tempeh) that could give everyone the B12 they need, there simply isn’t one. Fortified foods and oral supplements are the best way to ensure your body gets the B12 it needs to function properly. Fortified foods can include milks, cereals, and nutritional yeast. For example, our beloved Marmite contains B12 – but I highly doubt any sane person consumes enough Marmite in a day to get the B12 they need. If you’re not a Marmite fan (I mean, you either love or you hate it, right?) then fear not because you can get 3mcg of B12 in one cup (roughly 250ml) of fortified milk (9). And if you’re not big on milk and cereal for breakfast then oral supplements are the way to go; the usual dose is 250mcg per day, or 2,500mcg per week (10). Some prefer the weekly over the daily supplement to save on time, but if you’re forgetful, like me, a daily tablet can be easier to incorporate into a consistent routine. Personally, I recommend the BetterYou B12 spray; it contains 48 daily doses, is packaged sustainably in ocean waste plastic, and tastes really good – plus there’s the added convenience of not needing water on-hand to wash it down!
If Symptoms Persist…
If you’re vegan and have been fastidiously supplementing B12 into your diet but are still struggling to shake the recurring paraesthesia, fatigue, and have yet to regain your appetite then it’s worth visiting your doctor. Be sure to let them know you’ve already been taking oral B12 supplements so they don’t just prescribe you more of what you’ve been taking anyway. It could be that your B12 has dropped so low you require injections to recover your health – this is more likely to happen to long-term vegans than to anyone who merely jumped on the Veganuary bandwagon. The standard prescription for B12 injections is five ‘loading doses’ in the initial two weeks following clinical diagnosis followed by once every 12 weeks. With this treatment you should expect to see a full recovery and be able to rest easy, continuing a vegan diet as normal.
And if you are interested in vegan recipes, don’t forget that Reset Your Health offers a 4 week vegan recipe plan.
- Norris Jack, Vitamin B12 (2018). Accessed online on 23.06.20
Available at: https://veganhealth.org/vitamin-b12/
- NHS Symptoms Vitamin B12 or folate deficiency anaemia. Accessed online on 23.06.20
- Walsh Stephen, What Every Vegan Should Know About Vitamin B12 (The Vegan Society, 2001)
- ‘What’s the Difference Between Vitamin B12 Deficiency and Pernicious Anaemia?’ (Pernicious Anaemia Society). Accessed online on 23.06.20. Available at: https://pernicious-anaemia-society.org/b12deficiencyandperniciousanaemia/
- National Institutes of Health, Vitamin B12 (last updated 30th March 2020). Accessed online on 23.06.23. Available at: https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/
- Toups Kelly, Vegetarian and Vegan B12 Food Sources (Oldways, March 2018). Accessed online on 23.06.20
- Joshi Shivam, Why Every Vegan and Vegetarian Needs B12 (Forks Over Knives, August 2017). Accessed online on 23.06.20. Available at: https://www.forksoverknives.com/wellness/every-vegan-vegetarian-needs-vitamin-b12/