Reminder from Italy: Get B12!

The good news is that we rarely hear reports such as this coming from the United States these days, so the word seems to have reached most vegans here. But a case report from Italy of a 36-year old vegan was just released. I have added it to Individual Cases of Deficiency of Vitamin B12: Are You Getting It? and reproduced here:

A 36-year-old woman developed numbness, tingling and sensory loss in her hands and feet, weakness in the lower limbs, and disequilibrium, with difficulty in writing, gait, walking up and down stairs, driving. She was a dance-master, and after 3 months she was not able to work. The patient was treated with intramuscular injections of cyanocobalamin. Oral vitamin D3 and calcium were also given. After 3 months, the patient reported paresthesias and gait improvement. Six months later, weakness, sensory disorders, and paresthesias had fully disappeared, and she reported that her skin got clearer and hair loss stopped. After 1 year, spinal cord MRI, nerve conduction studies, and somatosensory evoked potentials were normal. Neurological examination, 2 years from the onset, showed reduced vibration sense in the lower limbs and normal tendon reflexes.

I should add that it can be difficult to get the message about vegans and B12 to non-English speakers. Anyone should feel free to translate posts such as this and send them to vegetarian societies in non-English-speaking countries. You don’t even need to ask me for permission.

B12 Recommendations


De Rosa A, Rossi F, Lieto M, Bruno R, De Renzo A, Palma V, Quarantelli M, De Michele G. Subacute combined degeneration of the spinal cord in a vegan. Clin Neurol Neurosurg. 2012 Feb 6. | link

13 Responses to “Reminder from Italy: Get B12!”

  1. Jona Says:

    Yikes. I’m on a steady intake of B12 now but wasn’t for years. Exposure to clear information that drive home both the importance of B12 intake and how easy and inexpensive it is to supplement with B12 made a difference in my case.

    Have you considered a drive of some kind to get at least certain portions of vegan health translated to as many languagues as possible. There are risks with that of course – an inaccuracy in the translation can reflect badly back onto the main site – but I’d wager the benefits outweigh. You could set up an quick contact page for translator applications and then filter submitters based on academic merits. I’m sure there are people out there with sufficient pedigree to offer reliable translations for many languages. Though i’m not one of those people I know of some who might be good candidates.

  2. Mark Says:

    I’ve been vegan for about 15 years. My meat-eating father was diagnosed with low levels of B12. He said the doctor told him this could be a hereditary thing. So I boosted my B12 supplement to include a few B12-specific pills a week in addition to the one-a-day I was taking. Then I had my blood tested. The doctor said my B12 levels were sky high — after fasting for 18 hours — and if I was taking a supplement, I needed to cut way back. Just an observation.

  3. Jona Says:

    Mark, let me reply though keep in mind I’m writing as just an ordinary reader of the blog with no special medical/nutritional expertize.

    I have the impression that it is in general very hard to get negative effects from B12 overintake. currently recommends 2 Doses per Week @ 1000 micrograms and also states “Amounts much larger than these are considered safe, but it’s probably best not to take more than twice the recommended amounts.” That is in line with what my own physician rather bluntly told me: you poop out the excess intake.

    I don’t know how many and how solid studies there are on overintake. I think it would be useful if veganhealth adressed the topic a bit more since it is a quite common question I’ve encountered in conversations with people. Speaking generally it would be bad if some vegans stay under the recommendation out of overintake worries that are unfounded.

  4. Jack Norris RD Says:


    There is no known toxicity to large amounts of B12 except that some people can develop acne-like symptoms:

  5. Sascha Says:

    I’m a dutch medical student, and as a vegan I think it is very important to tell people the truth about B12. But the dutch recommended dosis are a little higher sometimes then in the U.S. I’ve noticed that you calculated the dosis with their absorption rates in mind so they do exceed a little. But still they do not account for the RD in the Netherlands at some ages. If I would want to translate them, should I change the ones that are to low for our recommendations? And is it also possible to translate other recommendations to Dutch?

  6. Jack Norris RD Says:


    You may translate all my recommendations. And I would not make changes based on recommendations in the Netherlands – I’ve carefully vetted my recommendations and cannot imagine there is any benefit to be had by higher amounts than I recommend. Thank you!

  7. Sascha Says:

    Jack Norris, thank you! I’ve also noticed that you have translations on your website. Would you like me to send the Dutch translations to you (as soon as I’ve translated them), so you can also place them on your website?

  8. Jack Norris RD Says:


    You can send me the link and I can put it on my site. Thanks!

  9. Christina Says:

    Oh, my. Thank you for posting this reminder. I’ve been vegan for over eight years and have been taking B12 supplements on and off. I’m 25, active, and healthy (knock on wood), and I try my best to eat a balanced diet, but I’m glad to have received this kick in the pants to get my act together and be sure that I’m never lacking this vitamin.

    (Also, conversely, if you ever needed translations from Italian to English, I’d be delighted to help.)

    Thank you again!

  10. Claire Harris Says:

    Jack, why do you say not to rely on Red Star Nutritional Yeast as a B12 supplement? I’ve been vegan for over 8 years and I take one tablespoon daily in a smoothie. My yearly blood test has never shown a B12 insufficiency. Doesn’t that mean that the supplement is working?

  11. Jack Norris RD Says:


    Here is what I say and why:

    The key word is do not “solely” rely on nutritional yeast. In addition to what I write above, I know one vegan who got B12 deficiency thinking he was getting B12 from nutritional yeast.

  12. Sandra Says:

    I thought that it was better to take B-12 as methylcobalamin because the body is better to absorb it.

  13. Jack Norris RD Says:


    The body is not better able to absorb methylcobalamin and because methyl- is less stable than cyano- you might need to take much larger amounts. It hasn’t been studied well, but here is what I know:

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