Comments on Doug Graham’s B12 Statements

You might remember my August 23rd post about an article on NaturalNews.com, Response to: Vegan Vitamin B12 Deficiency is a Myth. I have been asked to respond to another article about B12 on NaturalNews.com, Dr. Doug Graham Part III: The Medical Model, the Hygienic Model and Supplements.

Some background on Dr. Doug Graham: He is a chiropractor who promotes a raw food diet that comprises of 80% carbohydrate, 10% fat, and 10% protein.

If you read the article, you might find that Dr. Graham has an unusual take on preventative medicine. He mocks the medical establishment by saying, “And so before you have B12 deficiency, let’s take those B12 supplements, prophylactically. Before you have a problem with too little salt in your diet, you better supplement with salt. Before you have high blood pressure symptoms, let’s treat you for high blood pressure now.”

People take salt supplements?

Yes, you should take B12 before you have (symptoms of) deficiency because taking B12 does no harm, while waiting until you have a deficiency of B12 could do long-term, permanent harm, possibly setting you up for a stroke or dementia (if you are mildly deficient for many years).

Later in the article, Dr. Graham is asked what someone should do if they develop B12 deficiency. He basically says that a B12 deficiency is not from a lack of dietary B12, but from people not absorbing B12. He claims that if you fast on nothing but water, your body will then be able to absorb B12. He says he has experienced people whose B12 levels return to normal three to four weeks after a fast (it’s not clear if the fast is three to four weeks, or some other length).

But where would the body get the B12 to absorb if you are not getting any in your diet?

Graham: “B12 is everywhere. It’s in the air. It’s in the mucus membranes of your nose. Every time you inhale, you’re breathing in B12; every time you swallow your own saliva, you’re swallowing B12.”

Why then, when someone has B12 deficiency, do their B12 levels increase and their deficiency symptoms go away, upon taking B12? If they cannot absorb it from swallowing their saliva or breathing, why can they absorb it when it comes in supplemental form?

One answer would be because there is so little in the air and saliva that the absorption mechanism has to be much more efficient. Perhaps. But a more elegant answer is because there is no B12 in the air or in saliva, whereas there actually is B12 in a supplement.

The idea that B12 is floating around in the air is pretty bizarre. But, I cannot say I have ever read a study where someone tested a batch of air for B12. Since B12 would settle to the ground due to its molecular weight being heavier than air, everything exposed to air should have some B12 in it, but many products tested for B12 show none. I think we can dismiss the B12-in-air theory.

What about saliva? It is possible that some people have B12-producing bacteria in their saliva. I have never seen saliva tested for vitamin B12, but it is a safe bet most people’s would have little if any. One way we can infer this is because when a person becomes vegan (without supplemental B12 or fortified foods), normally, their B12 levels start to drop, and continue to do so until they get a source of vitamin B12.

Graham: “[B12 deficiency] has been shown in every diet; there is a certain percentage of people who go B12 deficient. Whether you are vegan, vegetarian, raw fooder, or Standard American Diet, that percentage is the same.”

If you look at Table 1 in the chapter Vegan Adults of my article Vitamin B12: Are You Getting It, you will see that in the EPIC-Oxford study, 1 out of 250 omnivores had B12 deficiency, while 150 out of 250 vegans had B12 deficiency. You do the math.

Graham: “B12 deficiency was first discovered in carnivorous or what you would call “people who would eat anything” – kind of a diet. That’s where B12 was first discovered and treated.”

Yes, it is estimated that 2% of all people cannot absorb B12 in the normal way and that might account for the one omnivore in EPIC-Oxford who had B12 deficiency.

Graham: “But we do have to look at the reality that most grain products, especially those that are called “enriched grain products,” cereal, breads, and pasta, and whatnots, are typically enriched with B12.”

Most grain products are not enriched with vitamin B12. If you go to the grains section of MyPyramid.gov (and no doubt many other sources), it says “Most refined grains are enriched. This means certain B vitamins (thiamin, riboflavin, niacin, folic acid) and iron are added back after processing.” No vitamin B12. I also checked the packaging on three different brands of pasta I have here at the house and none has B12 added; I’ve never seen one that does.

Graham: “What we call the normal level of B12 is based on testing people who are supplementing with B12 at every meal. This is an abnormally high level of B12 compared to the normal population or compared to a population which isn’t supplementing.”

B12 deficiency is not defined as below the average level of B12 in the population, but rather as the level below which red blood cells stop forming properly.

Back to the idea that Graham has experienced people who cured their B12 deficiency through fasting. If a doctor I respected came to me and said that he had fasted people with B12 deficiency and their levels returned to normal even though they had not supplemented or eaten B12-containing foods, my interest would be piqued. But Dr. Graham does not have a good track record when it comes to vitamin B12 claims and so I don’t see any reason to take his claim about fasting seriously. Maybe the people fasting didn’t completely trust such methods and took vitamin B12. Who knows?

In summary, I would suggest that people not risk the dangers of long-term, mild vitamin B12 deficiency based on believing ideas that might sound good, but have little to no evidence to support them.

62 Responses to “Comments on Doug Graham’s B12 Statements”

  1. beforewisdom Says:

    The first sign of a vitamin b-12 deficiency is crazy talk that you don’t need vitamin b-12.

  2. beforewisdom Says:

    I order daily sublingual vitamin b-12 lozenges from freeda vitamins once a year. My cost is about $25, which includes shipping.

    If you shift your perspective on this issue it is kind of amazing. People argue this much over spending less than 50 cents a week to make sure that they do not have heart attack or neurological damage.

  3. Molly Says:

    Bravo, Jack. Thank you for your sound reasoning and science. If only the people reading Doug Graham’s website would make their way over here instead.

  4. Peter Says:

    The above ideas on the website in question appear to be pretty ‘wacky’. Although I prefer to avoid supplements, as a vegan I consider supplementing with B12 as an insurance policy and as such take B12 daily.
    Does putting a B12 tablet (or a piece of a tablet) in a smoothie enhance absorbtion?

  5. Jack Norris RD Says:

    Peter,

    > Does putting a B12 tablet (or a piece of a tablet) in a smoothie enhance absorbtion?

    Not that I’m aware of.

  6. Deborah Pageau B.Sc. Says:

    That was even better than I was hoping for Jack! Thank you. I will post a link to this on Vegsource.

  7. WholeFoodsVeganMomma Says:

    Jack: Thank you, thank you for your sound reasoning. Raw foodism, and other lofty ideas, are just that–someone’s idea, rather than something actually based on solid, scientific reality. Please continue to share!

  8. Molly Says:

    Raw foods are extremely nutritious and a vital part of a healthy diet. Please do not discount them just because some people take them to the extreme. The nutrition and healthy vitality provided by raw foods ARE based in science, just as much as any other nutrition information is. For example, we know that raw apples are better for you than cooked apples because the fiber content is maintained; this isn’t “someone’s idea”, it is solid, scientific reality.

  9. gleam Says:

    I second that Molly, raw foods that are readily-edible for humans have substantial benefits on every level. Nature still does a better job of feeding its organisms than “solid, scientific reality”, which is essentially a lofty idea, haha. Science tries to measure and describe reality, and then based on abstraction and best guesses, meddles with it. Let’s not confuse reality and science please.

    Anyway, on B12, I recently read this great book “Could it be B12?”, i.m.h.o. it’s certainly worth a try if you really want to know about everything there is to know about the subject. (not linking here because I don’t intend to plug it, so just google it).

  10. Jack Norris RD Says:

    Gleam,

    I don’t know of any better way to try to describe reality than through scientific methods. Basing diets on what people think is natural has led to many health problems and very early deaths. Science has by no means perfectly described reality, there have been some mistakes along the way, and people cannot even agree on what science even says, but it’s a lot better than other alternatives (which have been praying to the gods and intuition, I guess).

  11. More B-12 Crazy Talk Debunked Says:

    […] you are taking yours, right? Link. Spread the […]

  12. Elaine Vigneault Says:

    I can see why a dietitian or a doctor is interested in getting vegans to take their B12, but personally I get a little frustrated by the controversy.

    I say just give people the facts that we know and leave it at that. If they choose to believe fantasies, who cares? Why can’t we trust adults to make their own health decisions? If they don’t want to take B12, so what?

    You know, statistically I bet you could have a greater impact on saving vegans’ lives if you worked harder on getting vegans who smoke to quit or on getting vegans who don’t exercise to start working out.

    The B12 issue is just so… trivial. And chances are – you know I’m right – many will eat cheese every now and then or eat fortified foods regularly, so it’s virtually moot. Seriously, how many raw vegans who don’t supplement with B12 are there? Really, is it that big of a deal?

  13. Meg Says:

    Thanks for writing this, Jack! Such a shame that there’s still such misinformation about B12, making this easy to avoid deficiency still a problem.

    “People take salt supplements?”

    Actually, yes, though most people certainly don’t need them. But I’ve heard of some people with POTS and Addison’s taking them and some exercise buffs do, too. I’m not sure how well they work, though.

  14. Luke Says:

    Mr. Norris,

    I’ve read accounts of 12 pioneering vegans in “Pioneers of A New Age” and most of them never took b12. All of those vegans had been vegan for at least 10 years, some for as long as 30 years +. A couple vegans described having healthy vegan children before b12 supplements were available and these children were still healthy at the time of the book (1974).
    The Taliferos over at http://www.thegardendiet.com/ have several children and they claim to never have supplemented b12. Jinjee, the mother, admitted a couple years ago that a doctor was “alarmed” at the children’s low levels but anyone can see that they are apparently thriving.
    How can these people survive without supplementing b12 if its not present in the human body or available in some other source than a supplement?
    Also, according to this study, it appears that “b12 deficiency may be more widespread than thought” – http://www.ars.usda.gov/is/pr/2000/000802.htm

  15. Jack Norris RD Says:

    Luke,

    It’s certainly possible that some people can get B12 through bacterial contamination of food, water, or their own small intestines, and it can be enough to prevent them from having overt deficiency (though they may be slowly damaging their blood vessels and neurons from elevated homocysteine). But it’s not possible to know who is going to get overt deficiency symptoms and who isn’t. I think it is terribly irresponsible for parents of vegan children not to supplement their diets with vitamin B12 in the name of some sort of dogma. There is no evidence that B12 supplements can do them any harm, whatsoever. It’s not like vaccines or something where there is at least some evidence that they could be harmful. It has not ended well for many vegan children:

    veganhealth.org/b12/infants#nob12

  16. Barry Says:

    Looks like there is scientific evidence for cooked food as a diet… not to say there is anything wrong with raw food… (I am vegetarian, but not all-raw).

    Link goes to TED talk.

  17. Molly Says:

    Hey Barry,
    Perhaps I missed something, but what does cooked food have to do with a B-12 deficiency? I think, in Jack’s post, the vegans that are showing low B-12 are not doing so because of raw food, but due to lack of supplementation. If one supplements with B-12, whether raw or not, one will have an adequate level of B-12. As far as I know, cooked or raw has nothing to do with it. I speak up on this because I’m semi-to-mostly-raw and I supplement with B-12. I’ve been tested several times and my levels are ideal.

  18. Johanna Says:

    Elaine,

    According to Jack’s report (under “myths”), someone who eats cheese every now and then but otherwise eats a vegan diet is not getting nearly enough B12 to avoid deficiency. Not unless “every now and then” is multiple times per day.

    I would love to see this fact given more attention. For years, when I was in college and grad school, I probably ate less than one serving of animal foods per day on average, not because I was trying to be veg*n, but because I was trying to eat tasty and healthy foods on a budget. It would never have occurred to me that I was at any kind of risk for B12 deficiency. (I have since started taking supplements, I’ve had my blood tested, and I’m fine.)

    For even the most trustworthy adults to make their own health decisions, they need to have accurate information.

  19. gleam Says:

    @ Elaine

    “And chances are – you know I’m right – many will eat cheese every now and then or eat fortified foods regularly, so it’s virtually moot. … Really, is it that big of a deal?”

    Even people who eat cheese of “fortified” food may have near total deficiencies, so well, you’re not entirely right it seems. And yes, it’s a big deal, costing healthcare and people billions each year, not to say ruining their lives to some extent. Many physical and mental ailments that run rampant are due to B12 deficiency, which really is dangerous.

    There’s a whole spectrum of serious and permanent damage your body can develop (virtually overnight in some cases), most of these look like and are diagnosed as something else, and treated with the incorrect medication as a result, because nobody suspects an innocent little vitamin.

    I completely understand the “what’s the big deal” attitude, I used to be like that. Please read “Could it be B12?” it will wake you up and want yourself to get tested asap, especially if you’re in any risk-category due to your diet for example. (Sorry Mr. Norris to mention the book again on your blog, if it’s any comfort, it’s very scientific 😉 Btw has anyone here read it? I’m curious)

  20. Elaine Vigneault Says:

    I think it is terribly irresponsible for any parent to ignore sound nutritional advice and to not follow basic nutritional guidelines for any dietary choice, be it vegan or nonvegan. Every parent should make certain their child gets enough B12, but also vitamin D, vitamin A, protein, iron, fiber, etc.

    Jack suggested that “many vegan children” have suffered as a result of parents who did not supplement with B12. In actuality, following Jack’s link, only 30 vegan infants in the past 30 years have been recorded as deficient of B12. That’s one infant per year.

    To put that in perspective, UNICEF says “An estimated 33 per cent (190 million) of pre-school age children and 15 per cent (19 million) pregnant women do not have enough vitamin A in their daily diet, and can be classified as vitamin A deficient.”

    It doesn’t do much good to narrowly hone in on one nutrient, B12, and act as though vegans need to pay closer attention to their diets than nonvegans. Everyone needs to pay attention to their diet. And supplements can be useful for all sorts of populations and all sorts of dietary habits.

    I hardly think there is a growing number of dogmatic anti-B12 vegans that we should be concerned about. I think the problems with the health of the vegan community at large are similar to the problems with the health of the nonvegan community…

    As Jack wrote at Vegan Health:
    “In summary, not enough is yet known about vegan mortality to draw any conclusions other than that vegans do not have unusually high rates of mortality and they probably do better than the average person due either to diet or a healthier lifestyle.”
    http://www.veganhealth.org/articles/dxrates

    To reiterate, anyone interested in saving vegans’ lives ought to be more concerned with the more common unhealthy habits amongst vegans (and nonvegans) such as smoking and lack of regular exercise. Focusing on these issues would greatly reduce the number of preventable deaths of vegans.

  21. Jack Norris RD Says:

    Hi Elaine,

    Are you saying I should not have written a response to what Doug Graham was saying about B12? That article came out in 2009 and I heard nothing about it until recently, so I didn’t know if it was worth bothering with but some people on the International Vegetarian Union Science email list asked me to write a response and thought it would be helpful, so I did. Much of what he is saying is rather preposterous, the only question is whether enough people believe him to make it worth talking about.

    In your responses, you have not acknowledged the link between lower B12 intakes of vegans and the risk of chronic disease, or perhaps you are saying that the risks are not that great, and that smoking is much more of a risk. I fully agree that smoking is a greater risk to one’s health than is elevated homocysteine (from B12 insufficiency), but smoking has nothing to do with nutritional implications of the vegan diet, or even nutrition, which is what my website is about. And what good would it do for me to tell vegans not to smoke? They already know smoking is bad for their health.

    I don’t find the comparison between vegan kids who have been harmed by vitamin B12 deficiency with children suffering from malnutrition to be relevant. I fully realize children are dying of malnutrition in large numbers, every year, much more than vegan kids are getting B12 deficiency. The difference is that I’m in a position to possibly prevent the B12 deficiency of vegan kids. If I can keep one vegan kid from being mentally impaired for their entire life, it is worth a little bit of annoyance this might cause the vegans who are tired of hearing about B12.

    Those 30 cases of infants with B12 deficiency are not the only cases, they just happen to be the ones documented in the scientific literature. When one of these cases hits the news, which they do from time to time, it can do damage to veganism.

    The studies you quoted me on do not account for children who get permanent damage from B12 deficiency. Only healthy (at baseline) adults are put in those studies. But since you bring them up, and as most readers probably know, a vegetarian diet has been touted as a cure for heart disease and stroke, yet the mortality rates have not indicated that we have lower rates of stroke than non-vegetarians. This could possibly be due to sub-optimal B12 deficiency over many years. Another study has shown vegetarians to have higher rates of neurological problems, possibly also due to B12 (or DHA) deficiency. This latter finding was only in one study, and may be an anomaly, but is something we need to be concerned about and which I’m trying my best to prevent from seeing again.

    > It doesn’t do much good to narrowly hone in on one nutrient, B12, and act as though vegans need to pay closer attention to their diets than nonvegans.

    I also recommend vegans pay attention to vitamin D, calcium, iodine, and omega-3s. But I disagree that it doesn’t do much good to hone in on B12. The fact of the matter is that plant foods do not naturally contain vitamin B12, whereas there is no such nutrient like that in omnivorous diets. This does make B12 and veganism a special case.

    I am not alone in thinking vitamin B12 is very important for vegans. You can see a list of other vegan health professionals and organizations who agree in this open letter, What Every Vegan Should Know about Vitamin B12.

    Jack

  22. Elaine Vigneault Says:

    Jack, I simply think that instead of “What Every Vegan Should Know about Vitamin B12” it should be “What Every ONE Should Know about Vitamin B12”.

    Eating animals does not necessarily mean someone will obtain adequate vitamin B12 and thus the issue is not “nutritional implications of the vegan diet” as though there were one vegan diet. B12 is simply a nutritional issue, of importance to all people eating any diet.

    I definitely think you should write about it, as an RD and as someone interested in the topic. I just don’t think it should be framed as a huge vegan problem. It’s nothing of the sort.

    I find some of your articles to be alarmist sounding. It almost feels like you’re scaring people away from veganism.

    If 60% of vegans really aren’t getting enough B12 AND that had serious consequences, then why do vegans have similar mortality rates as nonvegans and they aren’t just dropping dead all over the place?
    Either that study was wrong, or vegans need less B12, or deficiencies aren’t that big of a deal.

    I vote for the first option: the study was wrong and most vegans do get plenty of B12. It makes sense to me: most of us vegans are very mainstream, we eat fortified foods and/or take vitamins. We’re not at risk of developing a deficiency. We’re not in a freaking cult or living on a commune or in the groups most at risk (or sadly, the groups most studied by nutrition experts).

  23. Jack Norris RD Says:

    Elaine,

    > I find some of your articles to be alarmist sounding. It almost feels like you’re scaring people away from veganism.

    It’s a hard line to walk. I want to be alarmist for the vegans who are not getting a regular source of vitamin B12. And I want to counter misinformation on the subject because too many vegans do not know the truth about B12. But if someone is getting a reliable source, then there is nothing to be alarmed about. I’m the first person to say that there is no reason for vegans to get their B12 levels tested (unless they have reason to think they are in the 2% of people who cannot absorb it properly).

    > If 60% of vegans really aren’t getting enough B12 AND that had serious consequences, then why do vegans have similar mortality rates as nonvegans and they aren’t just dropping dead all over the place? Either that study was wrong, or vegans need less B12, or deficiencies aren’t that big of a deal.

    That’s a good point. If all we want is for vegans to have similar mortality rates as non-vegetarians, then it appears we are already there. On the other hand, some people who become B12 deficient stop being vegan. Rhys Southan of LetThemEatMeat.com is a good example – he didn’t pay attention to B12, probably wasn’t getting much if any, felt very fatigued, gave up the diet, and now dedicates his time to criticizing veganism.

    If all vegans ate lots of fortified foods, then there would be no worries, but many vegans shun processed foods (and, really, there aren’t that many vegan products fortified with B12, it’s mainly soymilk and some fake meats), and a lot of them don’t drink soymilk. But, I don’t mean to be alarmist for people who are making sure they get a regular source of B12.

    Jack

  24. Molly Says:

    I don’t think Jack’s articles are alarmist at all. I think they are very fair and realistic, and I find them to be extremely helpful, both to me and to the friends and family I recommend them to (who are vegan and non-vegan).

    Jack is doing nothing to scare people away from veganism. He is working to ensure that people who choose to be vegan are healthy, happy and armed with accurate information. He is doing the best job he possibly can do.

    As a vegan who does NOT eat fortified foods and who must take supplements, I sincerely appreciate all of Jack’s efforts, and I think that we, the vegan community, would do well to work on the same side as he is – all of us, working together to strengthen the vegan message, to encourage vegan health and activism, to ensure that all vegans are happy, healthy and strong – so that we present the best face of veganism to the omnivorous world, and so that we can lead fulfilling, productive lives. Criticizing Jack and others like him is worse than a waste of time – it is a detriment to the larger vegan community. We need people like him. Let’s work together to strengthen his message, not tear it down.

  25. Ginny Messina Says:

    Thanks for this great article and excellent responses, Jack. I agree that we need to stay on top of refuting these unsupported claims about vitamin B12. Vitamin B12 is *the* issue in vegan diets and that’s why there continues to be resistance among some vegans to the idea that supplements are essential. Some of it comes from people outside of the scientific community, but not all of it. I continue to hear claims about B12—that you can get enough from unwashed produce or that you don’t need to supplement until after you’ve been vegan for 3 years—even from health professionals who position themselves as experts on vegan nutrition. That suggests to me that we still have a bit of a battle in getting the word out about B12.

    The B12 issue matters not just to the health of individual vegans but also to the image of veganism as a health-supporting choice. While it’s true that anyone on any kind of diet needs to pay attention to meeting nutrient needs, vegan diets have unique issues. And if we care about the health of vegans, those are the issues we focus on! As long as people go around saying crazy things about B12, we need to counter with the facts.

  26. beforewisdom Says:

    About two weeks ago I read the First Amendment on wikipedia. At first I had the same thoughts that brought self imposed public humiliation to Christine O’Donnel. However, one thing separated me from being a TEA party candidate. My common sense kicked in, telling me that lawyers, law professors and constitution scholars having spent years studying the document know more than I do having only read it for 5 minutes.

    Vitamin B-12 and a few other things turn some vegans into the TEA party candidates of the nutrition world.

    People, someone who has gone to school, who has studied, who devotes their waking hours to working on a subject is going to know more than you do reading 1 – 2 pop diet folklore books.

    Please stop making vegans look foolish. Engage your common sense.

    Jack, keep writing your articles. Every time you do I post them and get flack from morons but the debate usually convinces 1 -3 people to start taking b-12.
    It is worth it

  27. Jeremy Says:

    Can someone enlighten me on a few B12 questions? How come Vegetarian species of animals can thrive without B12 supplements? I don’t have a problem with taking a Vitamin B12 supplement, but I have also read that most B12 supplements are garbage and that there are only a few good ones that will even properly absorb. Is it true that the majority of B12 supplements are derived from animal products? I was told that improper B12 absorption was due to a lack of the intrinsic factor working rather than not getting enough B12 in the diet. It just seems odd to me that we would need something like that. I don’t think God would make a mistake in creating us to be deficient in something like B12. Like I said before, I am not against B12, I just wonder what the true motives are. Are the studies just being published so B12 supplement makers can rake in more dough? I know Raw Vegans that don’t take B12 supplements and haven’t for 20+ years and they are healthy and their minds are as sharp as a tack.

    So in conclusion I suppose my biggest question is, if we do have to take a B12 supplement for some odd reason, which one is the most bio available and not made from animal or sewage derived sources? I am just looking at this from both sides.

  28. Jack Norris RD Says:

    Jeremy,

    > How come Vegetarian species of animals can thrive without B12 supplements?

    Either through b12-producing bacteria in their gut somewhere that it can be absorbed, eating insects, or eating feces. More info here.

    > I have also read that most B12 supplements are garbage and that there are only a few good ones that will even properly absorb.

    That’s another myth about B12. Unless there is something wrong with a particular batch which is highly unlikely, all B12 supplements are effective. If someone doesn’t have much stomach acid, they need to chew the supplement up or let it dissolve under their tongue. There are a few rare exceptions of people who need a type of B12 other than cyanocobalamin, and those people usually take methylcobalamin.

    > I was told that improper B12 absorption was due to a lack of the intrinsic factor working rather than not getting enough B12 in the diet.

    I address this in my article above, which started this thread.

    > Are the studies just being published so B12 supplement makers can rake in more dough?

    I’ve never seen a study on B12 that was funded by a supplement manufacturer.

    > I know Raw Vegans that don’t take B12 supplements and haven’t for 20+ years and they are healthy and their minds are as sharp as a tack.

    Yep, that’s what I hear and most seem to be healthy (and they would until developing B12 deficiency at which point they would do something about it; I know of a raw foodist who waits until B12 deficiency symptoms show up and then takes some B12). But some raw foodists do develop deficiency (see here).

    > not made from animal or sewage derived sources?

    B12 supplements do not come from animal or sewage sources, they come from bacteria cultures.

  29. Kate Says:

    I wanted to post about the realities of needing B12: 1 year ago my son and I both suffered from not having enough B12. As a vegan, I have always been very careful about vitamins etc and never thought that this could happen. I found myself in a nightmare situation with my son hospitalized and being tested for a lot of disesases. I live in Spain, not a big vegan country and it took them a couple of days to work it out. I was breastfeeding him one day and they worked out the connection.I should point out that the docotrs believe that it was more down to him being born premature and probably not having enough vitamins to start with. But the guilt was incredible. Thank God, the difference after the B12 was corrected in us both was immediate, I didn´t realize how “fuzzy” my head had become- I thought it was having a young child! My son immediately picked up and has continued to thrive since that day. We have continued with regular check ups and are now ok. I now supplement us both without fail.
    Yes, it is unfair as vegans that we have this “weak point” and that our natural diet can not provide this BUT it is the way it is.
    Please take care of your B12 levels and don´t end up as being one of the “bad” examples of veganism, like myself!!

  30. beforewisdom Says:

    Yes, it is unfair as vegans that we have this “weak point” and that our natural diet can not provide this BUT it is the way it is.

    I respectfully disagree. Vitamin b-12 can be had from some unpasteurized, fermented products. So, that is “natural”. Pasteurization isn’t natural ( neither if factory farming ), but it is something we do to avoid getting sick and we see that as good even though artificially not getting sick is not “natural”.

    Kate, I’m glad you told your story.

    Many packaged foods have been fortified with small amounts of b-12 ( it is a problem for omnivores too ) and a vitamin b-12 deficiency takes years to become visible.

    This leads to many people who have been vegan for a few years, who are not educated in these issues and who have not yet gotten sick from foolishly proclaiming that experts are wrong, that we don’t need vitamin b-12 supplements.

    I’ve read accounts from doctors and nutritionists who have consulted with patients with a b-12 deficiency.

    It isn’t something people brag about, but it is useful for them to speak about it to convince others that it is a real issue, even if they themselves have not seen it personally.

    So, thanks for posting your account.

  31. Jack Norris RD Says:

    Before Wisdom,

    > Vitamin b-12 can be had from some unpasteurized, fermented products.

    I am not aware of any fermented products that require b12 producing bacteria for their fermentation. So if some happen to be in the batch, it’s simply by luck and cannot be relied on.

  32. beforewisdom Says:

    Jeremy;

    Americans eat pasteurized and otherwise sanitized food for our safety. That process destroys vitamin b-12 we might have otherwise gotten. Animals don’t eat diets that have been processed to food safety standards.

    Regarding the non-sick raw vegans you know, it takes years for the symptoms of a b-12 deficiency to be visible.

    Jack has an incredible article about everything related to b-12. You can answer many of your own questions by reading it:
    http://veganhealth.org/articles/vitaminb12

  33. Jeremy Says:

    Wow,

    Thanks for the speedy responses! Well, I have been a raw vegan for about a year now and I was just concerned and wanted to make sure I was doing the right thing for me. I do take some supplements occasionally that contain B12 but was wondering if it was better to find an entire B complex multivitamin. I know this thread isn’t about which supplements are recommended but would I be wise to get B12 by itself or mixed with other B vitamins, also is liquid or tablet/pill forms better? Just wondering because I have seen some B12 supplements with a very low cost and some with a very high cost and wondered what the differences were. I will read the B12 articles listed on this thread again to get more knowledge and insight. I guess If I can’t overdose on B12 then it couldn’t hurt to take it daily. Thanks again for everyone’s advise!

  34. Jack Norris RD Says:

    Jeremy,

    Here are my recommendations for how much B12 someone should take. Taking it with other B vitamins will not harm the B12, but B complexes are typically not very palatable and it’s best to chew the B12 tablet. If you are fairly certain your stomach acid is normal and you easily digest tablets, then swallowing them whole is probably fine.

  35. beforewisdom Says:

    I know of a raw foodist who waits until B12 deficiency symptoms show up and then takes some B12). But some raw foodists do develop deficiency

    Is that dangerous? Do all cases of a vitamin b-12 deficiency develop with the same progression of symptoms. Visible, rersable symptoms followed by irreversible damage?

    I’m just trying to imagine how that guy knows when he “running low” and how he bails out in time before he gets stuck with a permanent problem.

  36. Jack Norris RD Says:

    >> I know of a raw foodist who waits until B12 deficiency symptoms show up and then takes some B12). But some raw foodists do develop deficiency

    > Is that dangerous?

    I would assume his homocysteine levels are typically pretty high and that can be dangerous over the long term.

  37. Tracy Says:

    I know Doug personally, and find him to be among the most rational, intelligent and FIT people on the planet. He doesn’t just say stuff. He lives what he preaches. He’s practically super human.

    As for him saying that B12 is in enriched grain products, it seems like an honest mistake. My mom said that Dr. Oz says you can get folic acid from enriched cereal. She hasn’t found it in any of her cereals.

    Scientific research is awesome, but one report always usurps the last based on new study methods. And recommendations for what is healthy change with the times; maximum cholesterol levels have risen to accommodate increasingly unhealthy Americans.

    Doug’s claim that B12 is in the air, etc. sounds far-fetched, but also sounds like one of those things that we discover later, then look back on and wonder why we didn’t know it.

    Doug has fasted hundreds of people – it may be his legacy along with 80/10/10 Raw Vegan – so if he says something about fasting, I tend to believe him.

  38. gleam Says:

    (beforewisdom) “it takes years for the symptoms of a b-12 deficiency to be visible”

    Doesn’t have to, a deficiency can happen in days and symptoms can manifest in little more. For ecample, people who are borderline-deficient (lots of them about, maybe even you or me, and no way only vegans) can take a hit on their B12 levels from which the body doesn’t recover (for instance, can happen when you visit the dentist or elsewhere where you get a mild aneasthetic), and then start having serious, irreversible, issues within days. (the “permanent” damage flag is what makes underestimating B12 so dangerous, when you know what’s at stake, doing a few tests doesn’t sound so bad as compared to, let’s say early dementia or a string of miscarriages, or being mistakenly diagnosed with autism where B12 shots can get you back to normal, to name but a few of the pitfalls that could be easily avoided)

    Okay, sometimes the doctor orders a B12 test when symptoms are bad, most times not as they are mistaken for something else and ineffectual medication is prescribed, and in probably far the most cases the symptoms are so mild that people do not regard them as “something wrong” in the first place. The older you get, the riskier. Even if you “feel fine” about the only thing that works is get some proper tests (make sure to include a urinary MMA), then see if supplementation makes any difference. (test first, then supplement after, to rule out skewing your test results) You might be surprised at the difference it makes compared to the old you, the one that was “feeling fine” and posting on the internet that this B12 stuff is exaggerated. This is one that won’t “blow over”, better to get educated, get tested, and get healthy. (fun fact: in japan the level of B12 that is considered normal for proper body function is about 3 times as high as in the US, go figure)

  39. Jeremy Says:

    Thanks again for all the help! I will make sure I get my Vitamin B12 regularly…Now the next thing I need to do is read the articles about Vitamin D, my only other worry since here in Utah we don’t get too much sun in the winter.

  40. beforewisdom Says:

    Good for your Jeremy!

    Jack’s site, veganhealth.org is basically a free vegan nutrition book. If you follow his advice you will be and stay healthy.

  41. John Says:

    Jack:

    I’m assuming the B-12 recommendation are based on cyanocobalamin…

    Are the B-12 recommendations the same whether one supplements with methylcobalamin or cyanocobalamin?

    Thanks!

  42. Jack Norris RD Says:

    Because methylcobalamin is considered less stable than cyano-, it is usually taken in larger doses of 1,000 µg per day. I have not seen much research on it, but here is something I wrote awhile ago: veganhealth.org/b12/noncyanob12

  43. The B12 Myth, a blog post Says:

    […] […]

  44. Amy Says:

    Thanks Jack. It makes me really annoyed to read that there are some people who say B12 supplements or fortified foods are not important for vegans, when we know they are. There are meat eaters that develop B12 deficiencies as well, so this is not just a vegan issue but it is definitely something we need to watch out for.

  45. Alice Says:

    Thanks for the article on B12 Jack! It was just linked on a popular raw food site. I think most of us rawfoodists are getting the message these days, and your articles are a big part of the reason!

    Thanks again!

  46. Sarah Says:

    Hello everyone,

    Just wanted to add my two cents. I followed Doug Graham’s advice (and diet) for years and didn’t supplement with B12. This summer, I started getting strange neurological sensations. This wasn’t the first time in the past few years. Was tested and found deficient in a number of ways, including B12. I started supplementing with high doses, according to my doctor. The bulk of the symptoms went away within 3 weeks, but I still have residual neurological sensations in my feet. It’s been almost two months at 5000 mcg of B12 per day (yes, you read that right…so 5 mg per day) in methylcobalamin form. I imagine these symptoms will slowly heal and fade away as well.

    I know it’s controversial…the amount, but apparently large doses have been found successful for a number of neuropathies. Not all, but enough to warrant this decision by my doctor. I don’t think a high dose is necessary for all cases, though. Everyone is different.

    Anyway, I wanted to share this website: http://animalliberation.org.au/blog/98-vitamin-b12-fuss.html

    It describes why some vegan societies have been able to live without supplementation, and why we can’t do the same.n I disagree with the amounts of B12 that the site suggests, but only because my case is a bit extreme (I’ve been very deficient for a few years).

    Thanks Jack, for all of your great work, and for keeping this subject alive in vegan nutrition. I was a vegan harmed by the wacky advice out there and it’s great to know that more level headed vegan advice is available.

  47. Chad Says:

    Im vegetarian, but this article makes me think that, if vegan is truly the correct way, but it brings b12 deficiency then there are several explanations:

    1: We are not meant to be vegan.
    2: There IS an absorption issue that may be due to overeating.
    3: The stomach has been weakened from years of overeating causing an eventual inability for the stomach to use intrinsic factor to digest B12.
    4: We don’t know what we are talking about when we all think we do, or we have lost touch with basic physiology and functioning of the human organism.
    5: We are OVERDOING it and living in a society where we need to take supplements and eat meat to thrive in such a faced paced atmosphere, full time work, promotions, stress, un-natural environments filled with metal and buildings.
    6: We are not exercising enough, getting lazy and the body is weakened and more exposed to stresses.

    Whatever it is, something definately doesn’t smell right

  48. Jack Norris RD Says:

    Chad,

    I discuss that here:

    http://veganhealth.org/b12/natural

  49. gleam Says:

    Chad,
    => “take supplements and eat meat to thrive”

    correction: thrive = survive, as opposed to thrive 😉

    Real health feels vastly different from stuffing yourself with supplements and meat, doing that will actually destroy your health in the long run.

    Your points are some good food for thought though!

  50. Chad Says:

    Thanks Jack and Gleam 🙂

    Just had my B12 blood analysis done and came back normal, but according to the book “Could it be B12” my 222pmol/L is on the low side….and seems to marry up with borderline RBC….I’ll either try fast or diet remod to improve absorption or get acupuncture to strengthen digestive function 🙂 along with eating more blood nourishing foods of course!

  51. Sintija Says:

    What about B6 which is in my B12 liquid formula..B6 is dangerous taken long term..but B12 is longterm supplement..

  52. Jack Norris RD Says:

    Sintija,

    I’m not aware of B6 being harmful long term (I take B6 in my B complex every day), but if you’re worried about it there are plenty of inexpensive, B12-only supplements available.

  53. Dan Says:

    I hope you can debunk more of Graham’s pseudoscience. He’s done a lot of damage in the last decade and I’ve witnessed a lot of people lose their health to 80/10/10.

  54. Jack Norris RD Says:

    Dan,

    Just curious, do those people believe they suffered from it, or was it merely your observation?

  55. Dan Says:

    I’ve spoken directly to several people who developed health problems while on 80/10/10, ranging from missed periods to dental issues (receding gums are downplayed by Dr. Graham as merely being inflamed gums returning to normal), digestive complaints, mental issues (depression, mood changes, spacyness or feeling high), severe weight loss and more.

    Many anecdotes can be found on support forums, blogs,etc.

    I also had a negative experience on 80/10/10 between 6-8 months into the diet, which have since resolved themselves after moving to a MCDougall style way of eating.

  56. Vesanto Says:

    I would not treat someone for chiropractics as I am not trained in that field. In a similar way, it seems Doug Graham should maybe stick to his field of expertise and avoid nutrition, where clearly he is out of his depth.

  57. Nick Says:

    Doug Graham is at it again spreading nonsense about B12:

    http://www.youtube.com/watch?v=M_0GcpVahr8

    Many of the same claims made in his NaturalNews interview, but some new ones like apple stems being a source of B12. He also claims there are 5 tests for vitamin B12 deficiency, all of which are inaccurate due to B12 analogs. I’m aware of 9 different tests for B12 deficiency:

    1. Serum/plasma B12 test
    2. Holotranscobalamin II
    3. Methylmalonic acid
    4. Homocysteine
    5. Formiminoglutamic acid
    6. Full blood count (for detecting macrocytic anemia)
    7. Deoxyuridine suppression
    8. Methylcitrate
    9. Carbon 13 breath test

    Only numbers 1 and 2 actually measure vitamin B12. The others measure metabolic disturbances associated with B12 deficiency. B12 is typically assayed using intrinsic factor, which has a low affinity for B12 analogs. My understanding is that analogs should only compromise the accuracy of B12 blood tests in algae consumers or people with small intestinal bacterial overgrowth. A much bigger problem with B12 blood tests is that the serum/plasma B12 test measures both the B12 bound to transcobalamin II (available for cellular delivery) and haptocorrin (not available for cellular delivery) but that’s another story. Graham then goes on to say that B12 deficiency is no more common among veg*ans than among meat eaters. If all tests for B12 deficiency are unreliable, how can he say that with certainty?

  58. Jack Norris RD Says:

    Nick,

    I’d be interested to know how many micrograms of vitamin B12 Doug Graham thinks there is on the stem area of the average unwashed apple.

  59. Arcadio Says:

    Doug Graham’s apple stem theory is not new. I attended several of his lectures in 2001 and 2003 in London (UK). Each time he claimed the area around the stem of an apple was not completely clean and therefore a good source of B12.

    Many vegans have suffered because of misinformation like this.

  60. Sterre Says:

    Dear Jack Norris,

    I would just like to point out that you start you’re article stating that 80/10/10 stands for eating 80% carbohydrate, 10% fat, and 10% protein. I’m afraid that is a gross misrepresentation.
    In actual fact 80/10/10 stands for eating at least 80% of calories from carbohydrates, at most 10% of calories out from proteins and at most 10% of calories from fats.
    That makes a world of a difference.

    With kind regards,
    Sterre.

  61. Hillary Says:

    I have gone to a lecture given by Dr Graham. He sounded like a [edited]! i heard him say b-12 is in the air. What a disappointment. I missed my sons football game for that!

  62. Leland Says:

    This is really too bad there is so much misinformation regarding B12. The problem is, people get this emotional and identity attachment to their diets which gets in the way of real “science.”

    This is particularly true when raw vegan or similar diets have many positive effects, which makes the negatives easier to ignore.

    However, over the long run, we must be cleared of such rubbish confirmation bias and cult-like psychology if we truly care about our health.

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