Avoid B12 Deficiency; Get Heart Disease
and Cancer

Vitamin B12 is involved in the metabolism
of all cells in the body; but the effects
of deficiencies are first seen in the blood
and then the nervous system. An anemia,
called megaloblastic anemia, because it is
characterized by large red blood cells, is
a common manifestation of deficiency. The
low red blood cell count is very well
tolerated by the patient even when severe,
and is always cured by the taking of small
amounts of B12. Mild problems with the
nervous system characterized by numbness
and tingling in the hands and feet also
develop. These sensations are reversible in
early stages; however, damage to the
nervous system can become much more severe
and irreversible after prolonged
deficiency.

Take a moment to compare the possible
consequences of your dietary decisions. You
could choose to eat lots of B12-rich animal
foods and avoid the one-in-a-million chance
of developing a reversible anemia and/or
even less common, damage to your nervous
system. However, this decision puts you at
a one-in-two chance of dying prematurely
from a heart attack or stroke; a
one-in-seven chance of Breast Cancer or a
one-in-six chance of prostate cancer. The
same thinking results in obesity, diabetes,
osteoporosis, constipation, indigestion,
and arthritis. All these conditions caused
by a B12-sufficient diet are found in the
people you live and work with daily. How
many vegans have you met with B12
deficiency anemia or nervous system damage?
I bet not one! Furthermore, you have never
even heard of such a problem unless you
have read the attention-seeking headlines
of newspapers or medical journals.

Sensationalism Surrounds B12-Deficient
Vegetarians

Rare cases of B12 deficiency suspected to
be caused by following a vegetarian diet
make media-selling banners, because "people
love to hear good news about their bad
habits." However, in depth research reveals
that many of these "vegetarians" also
suffer from generalized malnutrition—not
just isolated B12 deficiency from a diet
based on plant foods. For example, the
March 23, 2000 issue of the New England
Journal of Medicine published a letter (not
a scientific article) with the provocative
title, "Blindness in a Strict Vegan."1 The
letter described a 33-year old man who was
found to have severe loss of vision
(bilateral optic neuropathy). He had
started a strict vegetarian diet at age 20.
Tests showed he suffered from deficiencies
of vitamins A, C, D, E, B1, B12 and folic
acid, as well as zinc and selenium. All
combined, these deficiencies clearly
indicate severe malnutrition. B12
injections corrected his anemia, but not
his visual loss.

Do you see the disconnection between the
case history and the headlines? Starches,
vegetables, and fruits are very rich
sources of folic acid and vitamin C (as
well as A, E, B1, zinc and selenium). His
malnourished condition most likely was
caused by an intestinal disease and/or an
unhealthy "vegetarian" diet.2 The headlines
published worldwide that followed this
letter reassured meat- and dairy-lovers
that becoming a vegetarian was an unwise
decision. Examination of many reported
cases of B12 deficiency connected to a
vegetarian diet in both children and adults
reveals similar confounding factors. ^1-6 The patients may have subtle
malabsorption and often come from
conditions of poverty and/or live an
eccentric lifestyle—their health problems
are not simply due to avoiding animal
foods. However, I do believe there are very
rare patients with diseases due to lack of
B12 from following a strict vegetarian diet
for years—while others have disagreed with
me and believe that all cases have
confounding factors.⁷

Germs for Good Health

Although vitamin B12 is found in animal
foods it is not synthesized by plants or
animals. Only bacteria make biologically
active vitamin B12—animal tissues store
"bacteria-synthesized B12," which can then
be passed along the food chain by animals
eating another animal's tissues. Ruminants
(like cows, goats, sheep, giraffes, llamas,
buffalo, and deer) are unique in that
bacteria in their rumens (stomachs)
synthesize vitamin B12, which is then
passed down and absorbed by their small
intestines. Lions and tigers get their B12
from eating these grazers.

The human gut also contains
B12-synthesizing bacteria, living from the
mouth to the anus.⁸ The presence
of these bacteria is an important reason
that disease from vitamin B12 deficiency
occurs very rarely in people, even those
who have been strict vegetarians (vegans)
all of their lives. The colon contains the
greatest number of bacteria (4 trillion/cc
of feces), and here most of our intestinal
B12 is produced. However, because B12 is
absorbed in the ileum, which lies upstream
of the colon, this plentiful source of B12
is not immediately available for
absorption—unless people eat feces (don't
gasp). Feces of cows, chickens, sheep and
people contain large amounts of active B12.
Until recently most people lived in close
contact with their farm animals, and all
people consumed B12 left as residues by
bacteria living on their un-sanitized
vegetable foods.

Why would a plant-food-based diet, heralded
as a preventative and cure for our most
common chronic diseases be deficient in any
way? Such a diet appears to be the proper,
intended, diet for humans, except for this
one blemish. The reason for this apparent
inconsistency is we now live in unnatural
conditions—our surroundings have been
sanitized by fanatical washing, powerful
cleansers, antiseptics, and Antibiotics .
Since the germ theory of disease was
developed by Louis Pasteur in 1877 our
society has waged an all-out war on these
tiny creatures—most of them extremely
beneficial with only a very few acting as
pathogens. The rare case of B12 deficiency
may be one important consequence of too
much cleanliness.

Efficiency Is the Other Reason
Deficiency Is Rare

The human body has evolved with highly
efficient and unique mechanisms to absorb,
utilize, and conserve this vitamin. Our
daily requirement is less than 3 micrograms
a day—one microgram is one-millionth of a
gram (1/1,000,000 gram).⁹ Which
means, by design, people are expected to be
exposed to only miniscule amounts of this
essential nutrient.

Vitamin B12 is the only nutrient that
requires a cofactor for efficient
absorption. The cells of the stomach
produce a substance, called intrinsic
factor, which combines—after the acidic
digestion of the food in the stomach—with
the B12 released from food. This "intrinsic
factor-B12 complex" then travels to the end
of the small intestine (the ileum) where it
is actively absorbed.

There is a second, much less efficient
process, called "the passive absorption of
B12" which also occurs in the intestine.
This mechanism does not use intrinsic
factor and as a result it is 1/1000 as
efficient. But by consuming very large
doses of oral B12, passive absorption will
correct B12 deficiency even for patients
with diseases of the stomach and small
intestine.

On average, for someone raised on the
Western diet, about 2 to 5 milligrams of
B12 are stored, mostly in the liver. This
means most people have at least a three
year reserve of this vital nutrient.
Conservation of B12 by the body boosts the
time this supply lasts by 10-fold. After
excretion through the bile into the
intestines most of the B12 is reabsorbed by
the ileum for future use. As a result of
this recirculation it actually takes, on
average, 20 to 30 years to become deficient
after becoming a strict vegan. That is if
no vitamin B12 were consumed—which is
impossible, even on a strict vegan diet,
because of bacterial sources of B12 from
the person's bowel, contaminated vegetable
foods, and the environment.

There is evidence that suggests that during
pregnancy and nursing a mother is more
dependent on B12 from her diet, because B12
stored in the woman's body is less
available for the baby.¹⁰
Therefore, during these important times,
B12 supplementation should be used by a
vegan mother.

Biochemical Changes Occur with Low B12

Blood levels of B12 can be measured
directly in the blood and are a means to
help diagnose deficiency. Values above 150
pg/ml (picograms per milliliter) are
considered normal, and levels below 80
pg/ml represent unequivocal B12 deficiency. ¹¹

Within the body, biochemical reactions
require B12. A deficiency can cause an
interruption of normal metabolism and
result in the accumulation of substances
like methylmalonic acid and the amino acid,
homocysteine. Tests showing increases in
these metabolic products are used to
diagnose "early B12 deficiency"—before any
actual disease occurs.

Elevated homocysteine has been associated
with an increased risk of common Western
diseases (heart attacks, strokes, etc.).
However, this amino acid itself does not
cause disease—it serves as a marker for
identifying people who consume large
amounts of animal foods. Eating meat,
poultry, fish, and cheese raises levels of
homocysteine—as well as these same foods
making people fat and sick. Efforts to
lower homocysteine with supplements of
folic acid and/or B12 have produced no
reduction in heart disease or stroke ¹²—and in fact the use of folic
acid supplements increases the risk of
cancer, heart disease, and overall death. ¹³

The long-term consequences of B12
supplementation are unknown; so far this
vitamin appears to be non-toxic and
beneficial. As a result, I currently have
no hesitation recommending supplements to
strict vegetarians in order to prevent the
rare chance of a deficiency occuring.

Intestinal Diseases, Not Dietary
Deficiency, Cause Most B12 Problems

Almost all cases of vitamin B12 deficiency
seen in patients today and in the past are
due to diseases of the intestine, and are
not due to a lack of B12 in their diet.
Damage to the stomach (parietal cells)
usually from an autoimmune disease or
surgery halts the production of intrinsic
factor. Damage to the ileum, preventing
reabsorption and interrupting
recirculation, causes the loss of B12. Over
a period of 3 to 6 years the body's stores
of vitamin B12 are depleted. The disease
that results is called pernicious anemia.
(The word pernicious refers to a tendency
to cause death or serious injury.) Prior to
the development of a treatment with liver
extracts in 1926 this condition was fatal. ^14-15