Wellness Wednesday: To B12 or Not B12

African American woman taking vitamins and supplements at home in her kitchen
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Years ago a patient came to my office for the first time with the following symptoms. Follow me now. She felt weak and sluggish and depressed. Occasionally she had heart palpitations. She had numbness of her feet and a feeling of pins and needles in both her legs. She had loss of appetite and occasionally diarrhea. On physical exam the only abnormal finding I found was an abnormally smooth tongue.

I could not immediately think of a diagnosis that would explain all of these symptoms but I remembered in medical school that a smooth tongue and leg numbness were linked to a vitamin deficiency. When I asked her about her diet, I got the answer and knew what was the most probable diagnosis. So I ordered a number of lab tests including vitamin B12.  When the labs came back they were diagnostic. She was anemic and had vitamin B12 deficiency.

Vitamin B12, also called cobalamin, is a water-soluble vitamin that has a key role in the normal functioning of the brain, nervous system and is essential in the formation of red blood cells. No fungi, plants, or animals (including humans) are capable of producing vitamin B12.  Only bacteria have the enzymes needed for its synthesis.  Animal sources of B12 include dairy products, eggs, fish, clean meats, and poultry.

As we get older it can become harder to absorb this vitamin through our gastrointestinal system. It can also happen if you have had weight loss surgery (Bariatric surgery) or if you’ve taken acid-reducing medications for a long time.  Other diagnoses that can cause B12 deficiency include atrophic gastritis, pernicious anemia, Crohn’s disease, Graves disease and Lupus. So if you have had any of these diagnosis, your health care provider may prescribe supplements  for you.

The question that I asked the patient at her initial visit was what her diet consisted of.  She said that she had become a vegan vegetarian eight months before.

Let me just take a few lines to review with you the different types of vegetarian diets.  There are three types of vegetarians.

  • Lacto Ovo vegetarians do not eat animals including fish.  They do eat the products of animals like eggs, butter, milk and cheese.
  • A Vegan vegetarian, on the other hand, does not eat animals, or the products of animals. If it had a mother or came from a mother they do not eat it.
  • There is also a vegetarian called a Pescatarian.  This is a “vegtarian” who is plant-based, except for fish (“clean fish”).

Due to their diet choices, a Vegan and some Lacto Ovo vegetarians can develop a B12 deficiency.  Now some Vegans believe that the bacteria in their gut produce sufficient vitamin B12 to supply their needs. My research shows this is not the case. A vegan should be taking B12 supplements in a pill form or IM injections and whose who have had gastric surgery should take the B12 under their tongue for better absorption.

For most people, treatment resolves the problem. But, any nerve damage that happened due to the deficiency could be permanent.  So see your doctor, FNP or PA and have that blood test done especially if you are a vegan vegetarian.

So in conclusion, you are really what you eat.  I do believe and research has shown, that a meatless diet is best for us all. My counsel is for you to chose  carefully and intelligently which diet is best for you.

Bon appetit.

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