Debbie Does B12 Pt 1 (Do I Care?)

I've been asked so many times when I'd be writing about B12, but have always ducked out. Too difficult, too much info to go through...

But having my own B12 tested has rather forced the issue, so....it's a LONG ONE! But, B12...could it be anything else?

Part One contains the background to it all, basic info on B12, sources, symptoms etc. In Part Two (to come) I'll discuss the options available for raising B12.

Usual disclaimers - not a doctor, not a nutritionist.


MY B12 ADVENTURE - HOW IT STARTED

As Vitamin B12 is found in largest quantities in foods of animal origin, it must be one of the most frequently-occurring topic threads on vegan internet forums. At the time my 'adventure' started, there it was again, on the 30BaD forum. Well-known raw vegan Harley Johnson (aka durianrider) had taken B12 shots and, as usual in any B12 thread, there was lively discussion/debate about what some refer to as 'The B12 bogeyman'. B12 deficiency can result in some rather unpleasant things happening (and more on that later).

Now, in the week that thread was up, I'd woken up at night a couple of times with 'pins and needles' in my fingers. I'd also had a strange mental 'thing' where,for an hour or so, I'd had problems separating two strands of my life and had had a memory blank-out. Before we go on, I had not decided these were definitely 'symptoms of B12 deficiency'. I'd been launching a new business and had had hardly any sleep for two days - and I'd also developed a passion for knitting! Two simple explanations for the phenomena. But, sure, as these things also happened to be on the (very long) list of things that could (could) be due to B12 deficiency, and it was a hot topic on the forum that week, I decided it was about time to have my own B12 level checked. I don't think I'll ever know for sure what was actually causing these symptoms, but they certainly motivated me to go through all the B12 info I'd collected over the years and try to make sense of it, the results of which I hope will be of interest to you.

Prior to that, I had rather stuck my neck in the sand on the B12 thing. I am 'broadly anti-supplements' (note the first word), hadn't supplemented for B12, but hadn't been as confident in my position on this as with other nutrients.

For example, on the main website (http://www.rawforlife.co.uk/) I'd said this:

'With the possible/debatable exception of B12 in some cases, supplements...are generally unnecessary.'

And in my blog article August 08 entitled 'Anti-Supplements. Why?', I'd said this:

'Whether or not raw vegans need to take Vitamin B12 for example is a hugely-debated area. At present, I do not supplement for B12. There are many healthy long-term raw vegans who do not, and some symptoms that have been attributed to B12 deficiency may well be due to other factors, eg deficiencies of other vitamins/poor absorption. But - OK - I'll admit I'm not totally sure on the B12 thing, but I'd be far more likely to switch to a raw vegetarian diet than supplement.'

The only thing that I'd rap myself for here is the use of the words 'long-term', as, without quantification, that could mean anything, and I'll discuss that later.

So, I've always been pretty much 'on the fence' where B12 was concerned. I knew the raw vegan diet was no problem for protein, iron, calcium, various other nutrients, and that supplementation in general was unnecessary. But B12...wasn't sure.


MY B12 TEST RESULTS

(After three years of raw - one year 100% vegan and the other two years, taken as a whole, 95-99% vegan.)

There are different ways of testing for B12, and some say that the blood test (the most common way) isn't the most accurate. According to the Vegan Society, the blood test can give a falsely optimistic picture of the B12 level eg if algae is consumed, as B12 'analogues' can imitate true B12). However, as I don't eat algae, or another sea veg in any significant quantitiy, I felt the blood test a fair starting point at least. B9 (folate), iron and calcium were thrown in.


B9/folate Fine Way-hay!

Calcium Fine Way-hay! (And bone density test last year good as well)

Iron Fine Way-hay!

B12 Low. Below the lower boundary of the normal range.
Bother, bother, bother. A spanner in the works!


My level was 147. Normal range in the UK is 211-911. The lower boundary varies by country between 100 and 200. So, if I was Canadian, where the low end of the range is 150 I'd be hanging to the 'normal' cliff-edge with my fingernails.

So...

I had to ask myself...

Do I CARE about 'low'?

And, if I do care about 'low', should I increase my B12 by:

a) staying raw vegan unsupplemented and trying to increase my B12 by whatever means
or
b) staying raw vegan but supplementing for B12
or
c) switching from raw vegan to raw vegetarian (ie including some dairy - for me, animal-eating would never be an option and I'm not attracted to raw eggs).

More about a) b) and c) in Part 2. (I don't think there's a d), but if there is, I'm sure someone will let me know!


DO I CARE ABOUT HAVING 'LOW' B12?

Firstly, it is possible that there are shortcomings in the blood test. A Raw Food UK forum contributor (Jack) suggested that blood levels could be irrelevant, as this is simply where the B12 enters the body from the food before being transferred to the liver where 50-80% of B12 is stored. He felt that meat-eaters would have a glut of B12 in the blood because the liver is already full of it, and that to get a true reading of one's B12 level, the liver should be tested rather than the blood.

And I know there are other ways of testing B12 (eg urine). I know, I know....but, unlike some of my raw food buddies, I don't actually believe that doctors know nothing and, if the blood test is the standard measure of B12 level used by the medical profession, I'll go with there being some value in it.

There are plausible arguments in favour of not caring whether one is 'low' on a particular nutrient compared with the average population. I've used them myself. The average person ingests a host of nutrient-destroying substances (eg coffee, alcohol, nicotine etc) and the RDAs/RNIs are set deliberately high to take account of this.

And, sure, my B12 is bound to be low compared with the average, as I've eaten very few foods of animal origin for three years (none for the last fifteen months). But 'lower than average' - I'd be relaxed with that. 'Lower than the lowest of the normal range' - no, I'm not comfortable with that, and I'll explain why.


WHAT IS B12 AND WHY IS IT IMPORTANT?

Vitamin B12 is a water-soluble vitamin manufactured by microorganisms (bacteria). Another name for it is 'cobalamin', which comes from the presence of the mineral cobalt in the centre of its structure.

As with the other B vitamins, B12 helps build the material that makes up our genetic blueprint - our DNA. It's also important in the production of red blood cells, in maintaining a healthy nervous system, helps release energy from our food, is of great importance in the growth and development of children, and it's important for...about a million other things. For example, it acts with Vitamin B9 (folate) to synthesise methionine - one of the eight essential amino-acids. It also limits the build-up of a potentially damaging molecule called homocysteine (which can raise the risk of heart attack), allowing it to be converted to methionine. (Although it has to be said that high homocysteine is normally characteristic of a diet high in concentrated protein, ie meat rather than vegan diet.)


HOW MUCH DO WE NEED?

The UK RNI (Reference Nutrient Intake) for adults is 1.5 micrograms a day. This is tiny compared with RNIs for other nutrients - 1.5 millionths of a gram. The reason supplement manufacturers recommend such large doses - 1-2000 mcg once a week, or even a day, is that only a small proportion of the B12 we ingest is absorbed. Can we have too much? Consensus in the nutrition world is that high doses of B12 should be no problem, which of course (caveat emptor) only means there's no 'scientific evidence' to suggest otherwise. B12 is water-soluble, but excreted via the faeces rather than the urine.

We store B12 in the liver, so have reserve supplies that can last for sometime (how long? No one's sure, let alone able to say in individual cases.) We also recycle B12 in various ways, such as through recycling of bile. But we only recycle a percentage of that originally ingested, which means that if stores run down and are not replenished, our B12 level will gradually reduce over a period. And how long can we keep going on recycling B12? The $64K dollar question...again, the answer is: we can't know for sure.


WHERE CAN B12 BE FOUND?

In an omnivorous diet: It can be found in relatively large quantities in animal flesh and organs, because the animal has ingested it itself (perhaps via tiny creatures such as insects in its plant food and/or bacteria in its food or water which then manufacture B12 in its intestines, or via supplementation of animal feed, or even by eating poo (some animals do). It can also be obtained from the sources listed for cooked/raw vegetarian diet below, in cooked vegan diet below, and in raw vegan diet below.

In a cooked or raw vegetarian diet: It can be found in significant amounts in dairy and eggs. (USDA Nutrient Database records no figure for B12 in honey.) It can also be obtained from the sources listed for cooked vegan diet below, and in raw vegan diet below.

In a cooked vegan diet: B12 can be obtained from vegan processed foods that have had B12 added in the processing (sometimes known as 'fortified' foods), eg some grain products, spreads (eg sunflower/soya, and Marmite) burgers, soya milk etc. It can also be obtained from sources listed in raw vegan diet below.

In a raw vegan diet: Although some claim that we can simply manufacture B12 ourselves in our intestines from, effectively, nothing, most say that there needs to be something ingested, eg B12 or the bacteria that make it, for the B12 production, or recycling, to take place.

B12 can be obtained from bacteria in soil that has not been chemically treated (the chemicals kill the bacteria), insects (may be microscopically tiny) on plant food, and water that has not been chlorinated (bear in mind however brilliant your water cleaning system is, the water that went into it in the first place would have been chlorinated, ie bacteria killed).

I've said'on', rather than 'in' plant food. Some do claim that wherever other B vitamins are found, B12 will be as well, but that the amounts aren't detectable by measuring equipment and/or that when plant foods are prepared for laboratory analysis, acids and other substances are used that destroy the B12 (unlikely I'd have thought). Suffice to say that I haven't come across any scientific evidence that proves there is B12 in (as opposed to on) plant foods sufficient to meet our needs.

Usually in a raw vegan forum discussion thread on B12, someone will advocate sea vegetables, such as the algae spirulina, or nori. This is a controversial area. The snag could be that they contain compounds structurally similar to B12, known as B12 analogues, which may disrupt normal B12 metabolism by competing with true B12 for absorption. But others cite studies that show that true B12 is present as well and that the body can tell the difference between 'analogues' and true B12 and that there is no problem, pointing out that these 'analogues' can also be found in multivitamins, B12-fortified food and animal foods. My feeling is that unless sea veg is eaten straight from the sea, then surely B12 is going to be destroyed in the washing and processing (and, yes, even if it does come from 'pristine'(!) waters). For me, 'jury's out' on whether sea veg are a source of B12.

Some raw fooders believe that fermented products contain B12, or at least help promote a healthy flora internally conducive to making B12. Again, this is a controversial area. I haven't come across any proof that fermented foods contain B12. (The Vegetarian Society did report that studies showed B12 to be absent in substances such as shoyu, miso etc, which of course aren't raw anyway and very high in sodium chloride. ) Natural Hygienists believe we shouldn't be eating fermented (they would say 'rotting') food full stop and that if we follow the correct diet we shouldn't need any help with our 'intestinal flora' and that ingesting so-called 'healthy bacteria' will interfere with our own bodies' attempts to heal and be detrimental rather than beneficial.

B12 can also be produced in the lower part of the digestive system, but, unless we eat our own poo (which I don't feel 'drawn' to do) that's not much good to us, as it's 'on its way out' by then, ie past the stage where our bodies would absorb it.

And of course B12 will be found in breastmilk (as long as the mother has sufficient B12 herself).

So these are all possible sources of B12 on the raw vegan diet. I eat unwashed garden produce (often with tiny bits of soil - the crunchy bits (!) and quite likely various tiny creatures attached) for several months of the year, but this seems to have been insufficient to keep my B12 in the 'normal' range.


COULD IT BE....AN ABSORPTION ISSUE?

Even if we ingest lots of B12, or bacteria that make B12,will we be OK? Well, not necessarily.

What people on all sorts of diet have to bear in mind is that meat-eaters can be deficient in B12 too, and many are (about 40%!) Of course they're getting lots of B12 via the shortcut of eating animals that had a good supply because they ate/made their own. So why would meat-eaters have B12 problems?

Firstly, B12 can be destroyed by water, sunlight, the heat of cooking, alcohol, smoking, mercury, oestrogen in birth-control pills, and sleeping pills. And anything that upsets the balance of 'flora' in our digestive systems can negatively affect B12 absorption. Prescription antibiotics would be one example, but heavy consumption of garlic and strong spices (that have an 'antibiotic effect') could be detrimental to B12 absorption.

And what is the case with many people, on all sorts of diet, is that they are in fact ingesting sufficient B12, but their digestive systems (eg stomach, small intestine) are faulty, which means that the B12 they're ingesting is not being absorbed into the blood. This can happen in people who have followed a very poor diet in the past, who have had intestinal surgery, and in those who have generally had a history of digestive and/or bowel issues. What happens is that there is a lack of a molecule called intrinsic factor, which is needed to bind with B12 to enable it to be absorbed by the body. (By the way, 'intrinsic factor' was coined by Castle, who called B12 the 'extrinsic factor'.)

But lack of 'intrinsic factor' isn't the only thing that could negatively affect absorption of B12.

Natural Hygienist Dr Virginia Vetrano describes the process of absorption:

'The vitamin must first be separated from the materials to which it is bound before it can be combined with the intrinsic factor. In food, B12 compounds are largely protein or peptide-bound and these must be separated from the vitamin by digestive juices before B12 can be combined with the intrinsic factor.'

Now, I've recently edited the section I had written on low hydrochloric acid (HCl) in the digestive juices, because, following discussions with a nutritionist, it seems far more likely that it would be a high HCl level that's the issue, as if there is excess HCl produced in the stomach the environment in the lower intestines would be too acidic for optimum enzymatic activity sufficient to digest the peptides bound to the B12. (High HCl is most commonly found in those on poor diets, eg high in meat, alcohol, salt etc.)

Vetrano continues: 'The third stage of absorption is to transport the B12 into the cells of the gastrointestinal mucous membrane.' Some claim that damaged intestinal mucosa could inhibit absorption, that there are certain foods (eg salt, oils, isolated sugars, spices etc) that irritate the intestinal lining and cause it to secrete (extra) mucus to protect it, and that this mucus inhibits absorption of B12. Others (notably Natural Hygienist Susan Hazard writing in the Eighties) say that the mucus hardens, through inflammation as a result of condiment use. The theories seem plausible, although I haven't been able to find any scientific support for them.

The B12, if it's made it through the various minefields described above, is eventually absorbed at the far end of the small intestine - the terminal ileium.

I did have a further blood test. I don't know the details, but I was told I was OK for 'intrinsic factor'. I don't know what the state of my HCl is, nor my gastrointestinal mucus membrane (I eat very little salt, spices etc, or at least in the last couple of years). But I may well investigate these, particularly if my efforts to raise my B12 level by mouth (discussed in Pt 2) come to naught.


IS B12 MORE AN ISSUE FOR RAW VEGANS THAN THOSE ON OTHER SORTS OF DIET?

Raw food leaders disagree on this. For example, Dr Doug Graham ('80/10/10 Diet') says that rates of B12 deficiency are not higher amongst vegans or raw foodists than they are amongst meat eaters. But Gabriel Cousens MD (Tree of Life Center) says: 'There's 18 studies of vegans and live fooders, three on live eaters...in every single study, 18 out of 18 shows that, after about six years, about 80% of vegans or live fooders become B12 deficient. Please note that 39% of meat-eaters are B12 deficient. So the rate is about twice as much.' ('Live food' is virtually synonynous with 'raw'.)

I tend to go with Dr D on a lot of things, but Dr G's statement on B12 makes more sense to me. People can argue till the cows come home (vegan equivalent needed?) that there is some B12 on plant food, but the fact remains that in the vegan diet there is only a tiny fraction of the amount available in omnivorous or vegetarian (or even cooked-vegan-including-fortified-processed-foods) diets, and, as we only absorb a tiny fraction of that ingested, surely, unless vegans eat all their food with soil and insects clinging to it and drink water from a mountain stream, vegans need to look out for themselves where B12 is concerned.

Here's the brilliant (non-raw foodist but enthusiastic advocate of the vegan diet) Michael Klaper MD on B12:

'Vitamin B-12 is made by little microscopic plant cells called soil bacteria that live in the earth. And long ago when the earth was healthy and the soils were healthy, before we put all sorts of chemicals on them, The surface of the earth was covered with vitamin B-12, and there use to be lots of vitamin B-12 in our lives even if you were a pure vegetarian 300 years ago. You'd open up your cottage door and outside the back door would be a beautiful organic garden, and every carrot you pulled out of the ground would have little particles of vitamin B-12 sticking to it. When it came time to get your water, you'd take a bucket of water out of the stream, there would be vitamin B-12 in the stream water. There would be B-12 in the well water you brought out. There would be B-12 under your finger nails from working in the garden. There would be plenty of B-12 in your life and you needed so little of it, that it was not an issue.

We've become very isolated from the earth and we've lost our natural sources of B-12. Cows have B-12 in their muscles because they're eating grass all day and their pulling up clumps of dirt that have B-12 producing organisms clinging to the root of the grass. They eat the B-12 producing organisms who then produce the B-12, gets absorbed into their bloodstream and goes out into the muscles and is deposited into their muscles and livers. But that is bacterial B-12 in the cow's muscle. The cow did not make it, nor did the pig or chicken. It's true that you can go up to the cow, bash it's brains in, rip open it's abdomen and tear out it's liver and eat it to get your vitamin B-12. But I submit to you there is far less expensive and less violent ways to get your vitamin B-12.

(Dr Klaper then goes on to discuss B12-fortified vegan cooked foods, which is essentially supplementation.)


Everything in the garden is lovely...(well, yes it is, but...)

Please bear in mind that many raw vegans on forums insisting that B12 is no problem on a raw vegan diet 1) haven't been raw vegan for very long (so B12 levels from a previous diet may still be high) and/or 2) haven't a clue what their own B12 level is. I can understand the viewpoints of those who don't care, so haven't tested because they think the B12 thing is all scare-mongering and a fuss about nothing, but do bear in mind that their views are, in the vast majority of cases, opinions (and optimism?!) rather than conclusions based on experience.


SIGNS OF DEFICIENCY

Yes, B12 scare-mongering...is it, or isn't it?

Meat-eaters and supplement-manufacturers certainly try to scare vegans with all sorts of stories about where their diet will lead them if they don't eat corpses, buy the latest supervitamin/mineral powder etc. In most cases, I've found myself 'unbovvered' (UK joke), but, B12...hmm.

After levels of B12 in the blood drop, levels in the cells drop. It's at that stage that there is said to be a 'deficiency'. (As my tests didn't go beyond the blood, I don't know if I was simply 'low' or 'deficient'.) When there is B12 deficiency, levels of various compounds are disrupted. Fatigue is the most common problem, but, OK, are you ready? Here comes...that Really Scary List.

The Really Scary List

Breathing difficulties
Raised homocysteine increasing risk of heart attack
Numbness and pain in limbs/extremities
Irreversible damage to nerve cells, spinal chord and brain
Irreversible neurological damage, paralysis or death
In infants - permanently arrested brain and peripheral nerve development
Dementia

Yum yum, we all want some of those, don't we?

And...the doomsayers' piece de resistance...these symptoms may take up to 20-30 years to 'manifest' - aaaaaaaaaaarghhhhh!

So, if it's the case that the animal-food-eaters/medical profession are attempting to scare vegans into eating animal products (or supplementing for B12) then they've done their job rather well. The 'ah, but it can take 20-30 years for symptoms to show' has been particularly effective in the sport of Squashing the Raw Vegan. (The cynic will say, with good reason I feel, that ten years ago, the warning tended to be that it could take five years for symptoms to show, but faced with increasing numbers of healthy five-year unsupplemented vegans, those trying to discredit the diet simply upped the figure!). I'm not sure what the scientific evidence for the 20-30 years assertion is, or whether that it's that the deficiency is 'lurking' for the whole of the period, 'exploding' in a manifestation of dreadful symptoms, or whether it's simply that for eg 19 of the 20 years the vegan is in fact not deficient, and then in Year 20 s/he becomes deficient - for some reason.

But one reason the '20-30 years' thing is so effective in wiping the smile off the happy vegan is that there aren't enough raw unsupplemented vegans of 20-30 years' standing to form any sort of statistically significant pool to say 'look at us, we're doing fine!' Raw vegans who have had any cooked vegan B12-fortified food (eg spreads, soya milk etc) in that time won't do, as certainly if it's in the last few years, B12 could still be relatively high due to recycling. Raw vegans who've used non-food supplementation at any time in that period won't do either, as non-food supplementation, eg tablets, contain extremely high doses of B12. And raw vegans who call themselves vegan, or who people think of as vegan, but have in fact had a small amount of dairy in those years won't do either. I'd long cherished the idea that Dr Virginia Vetrano, thriving in her 80s, and a vociferous advocate of not supplementing for B12, had been vegan, but recently heard that, like many of the classic Natural Hygienists, she has included dairy in her diet.

In fact, if there is anyone who has been 100% raw (or virtually?) and 100% vegan and unsupplemented (in any form) for 20+ years and has had their B12 level tested recently and it's in the 'normal' range, I've never come across them, nor heard of them, nor have met anyone who has. I'm thinking they might be as rare as hens' teeth.

The only person I can think of who gets anywhere near that is Dr Doug Graham, who has been raw vegan unsupplemented for twelve years. I'm not sure whether he's had his B12 tested recently, but assume he's probably on top of it, as he did supplement twelve years ago when he'd had symptoms, the cessation of which on supplementation suggested to him that he had probably had a B12 deficiency.

Unfortunately, there are no lifetime (let alone 'generations') vegan communities/cultures to say that, even if we do eat all our food straight from the ground, unwashed, that B12 won't be an issue. It may well be that it isn't, but obviously it would be helpful if there were vegan cultures that could be an example for us all. But I haven't come across any. This of course doesn't diminish the vegan diet in any way. Just because it's 'normal' for cultures to eat animals, to damage their food, to drink alcohol, to inhale smoke, to kill members of other societies, etc, and that we haven't yet found a culture free of all those things, doesn't mean that a way of living that excludes those things isn't the right way to go. It's just that, where B12 is concerned, it would be useful to have a helpful prop in the argument for raw vegan unsupplemented, but...we don't (at least yet) have that.

As, over the years, whenever anyone has claimed that X or Y culture/community is (lifetime) vegan, on researching, I've always found a bit of dairy creeping in somewhere (or if not dairy, meat/fish)! Over and over again I've found that reportedly vegan cultures - on closer examination - have a little (just a little) dairy, usually in the form of goats' or sheeps' milk or cheese (unpasteurised, ie with all bacteria present, of course).

*****

So do I CARE about my 'low' B12? Yes I do.

That word 'irreversible' certainly chills the bones, doesn't it? And sure, again, when that word is used, it's not generally used in conjunction with any statistics that might back the claim. It could mean 'one in a million cases', and we all know that if that unfortunate person has been following a vegan diet, as opposed to an omnivorous diet, the newspapers will fall over themselves in their stampede to attribute the dreadful occurrence to the 'extreme' vegan diet whilst neatly overlooking the millions that are getting all sorts of horrible diseases and dying prematurely from the conventional cooked omnivorous diet!

But on the other hand, the magnitude, the severity of the symptoms (together with seeing a few too many posts from vegans complaining about tingling/pain in their extremities) has had me thinking that I'd hate to find myself in 20 years' time with something nasty and be saying 'Well, blow me down, seems they were right after all...', as I have lots left I want to do in the next 50+ years! Not sure if I want to take the risk.

Here's an account from someone who did appear to have classic B12 symptoms. Brother Nazariah (Essene Church of Christ): 'For seven years I followed a vegetarian diet. I then became a raw vegan and after five years lost the ability to walk. All of my extremities - hands, fingers and feet - were in such pain that I couldn't move. I had central nervous system problems and was B12 anaemic.' (He switched from raw vegan back to raw vegetarian (the Essene diet), attributing cessation of his symptoms to eggs.)

In Part Two here I'll be describing how, having decided that I did care about my low B12 figure, I considered the various options available to me for increasing it. I'll discuss these options then let you know which one I (eventually) decided to take.