2013 Review of B12 Status of Vegetarians & Vegans

[Breaking news: A paper was released today showing vegetarians to have a lower risk of heart disease – I will write about that next week. Update: Click here.]

It’s raining B12 this week!

Yet another paper was released on vegetarians and vitamin B12, this time reviewing all the studies that have measured B12 status using methylmalonic acid (MMA) or holo-transcobalamin II levels (1).

Holo-transcobalamin II is thought to be a better predictor of vitamin B12 deficiency than blood B12 levels because it is the last refuge of B12 being transported to cells, while MMA levels are the best way to know that the cells are not getting enough vitamin B12 to function normally.

The review included 18 studies, eight of which were done on German vegetarians. The authors did not combine results from the studies, but rather provided a handy chart to see what each study found.

They concluded that all vegetarians – not just vegans – are at a significant risk of B12 deficiency and recommend a B12 supplement of 250 µg per day.

This is higher than what I recommend on a daily basis, which is 25 to 100 µg. I do not think this review provides enough evidence to change my recommendations, but I would not discourage anyone from taking 250 µg per day.

The authors state:

“Supplements, when taken in an adequate dose, are very effective in both the prevention and treatment of B12 deficiency and are very cost effective. However, many vegetarians, for different reasons, refuse to take B12 supplements. This is largely due to various misconceptions, including the belief that it takes many years for B12 deficiency to develop.”

The authors also noted a connection between low vitamin B12 status in vegetarians and low bone mineral density, citing a paper from 2009. Upon reading this, I thought “Ha, I remember that paper,” only to find out that the study I had written about in Bones, Vitamin D, and Calcium, was a different one from 2009! (2) The paper they cited (3) had flown under my radar, but never fear, I intend to review it for an upcoming post.

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1. Pawlak R, Parrott SJ, Raj S, Cullum-Dugan D, Lucus D. How prevalent is vitamin B(12) deficiency among vegetarians? Nutr Rev. 2013 Feb;71(2):110-7. Epub 2013 Jan 2. | link

2. Krivosikova Z, Krajcovicova-Kudlackova M, Spustova V, Stefikova K, Valachovicova M, Blazicek P, Nemcova T. The association between high plasma homocysteine levels and lower bone mineral density in Slovak women: the impact of vegetarian diet. Eur J Nutr. 2009 Oct 7. | link

3. Herrmann W, Obeid R, Schorr H, Hübner U, Geisel J, Sand-Hill M, Ali N, Herrmann M. Enhanced bone metabolism in vegetarians–the role of vitamin B12 deficiency. Clin Chem Lab Med. 2009;47(11):1381-7 (Abstract only) | link

5 Responses to “2013 Review of B12 Status of Vegetarians & Vegans”

  1. Bertrand Russell Says:

    Hope the heart disease is corrected for all factors, and compared not just to general meat-eaters….

  2. Nadine Says:

    Yet another example of the importance of B12! I can’t believe that I still have to “fight” people on this issue. I see people jeopardizing their health over their refusal to supplement. I don’t understand the supplement phobia. I would rather take supplemental B12 than partake directly in animal exploitation.

  3. Ava Odoémena Says:

    True, I’ve been fighting B12-ignorance for almost a decade (mostly in Germany, with the help of all the info from Jack), and I am also flabberghasted because of the almost delusional contradictions the natural crowd condones.

    They apply a stone-age paradigm while shopping for organic greeneries under electric light, almost all of which was harvested by machines!

    On top of it, NO ONE is free from supplemental B12, ESPECIALLY people who eat animal products. B12 is routinely added to the fodder or animal feed, actually in any sort of agricultural foodstuff used specifically to feed domesticated livestock.

    The fodder industry is one of the main purchasers of fermented B12. I stumbled over this stunning fact while reviewing an evaluation of scientific literature done by Michel Post:

    (Dutch, but Google can help)

    Basically what he discovered in the chapter “markets”, is, that if you subtract the B12-market of sport nutrition an its use as a placebo in scientific studies, and compare only direct use as a supplement with what the fodder industry is buying, they are the main consumers of supplemental B12.

    So while most eaters of eggs/milk/meat gently believe that their “food” contains natural B12, it’s all supplements having been added to the feed of livestock.

    The reason they are doing this, is because the soy/corn, well, the so called high protein diet for e.g. cows is changing something in the gut, disturbing the bacterial balance. Ruminants who are fed with mainly grains apparently grow B12-deficient quickly.

  4. Priscilla Says:

    I am lost. I have known many people who have been raw vegan for 6 years+, they get their blood checked and have never been deficient of b12. Are they lucky or liars? I thought b12 comes from organic, wild, nutrient rich soil grown produce.

  5. Jack Norris RD Says:


    Here is the scientific literature on raw foodist vegans and vitamin B12:


    My guess is that they are lucky (so far).

    Produce grown in manure can possibly have miniscule amounts of vitamin B12. Certainly not enough for optimal health.

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