vegetarian, B12 deficiency and overall health

[Guest guest]

I found this discussion interesting, so I performed a Medline search

on " b12 deficiency vegetarian " and came up with a number of studies.

The ones in english with abstracts are reproduced below. Without

exception, a vegetarian diet is described as healthier but, again

without exception, vitamin and mineral deficiencies are of concern.

Can those who disagree explain why these study results are not valid?

Marjorie

Marjorie Lazoff, MD

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Ann Nutr Metab 2000;44(5-6):229-34

Metabolic vitamin B12 status on a mostly raw vegan diet with follow-

up using tablets, nutritional yeast, or probiotic supplements.

son MS.

Hallelujah Acres Foundation, Shelby, N.C., USA. michael@...

BACKGROUND: Pure vegetarian diets might cause cobalamin deficiency

due to lack of dietary intake. It was hypothesized that a population

following a vegan diet consuming mostly raw fruits and vegetables,

carrot juice, and dehydrated barley grass juice would be able to

avoid vitamin B12 deficiency naturally. METHODS: Subjects were

recruited at a health ministers' reunion based on adherence to the

Hallelujah diet for at least 2 years. Serum cobalamin and urinary

methylmalonic acid (MMA) assays were performed. Follow-up with

sublingual tablets, nutritional yeast, or probiotic supplements was

carried out on subjects with abnormal MMA results. RESULTS: 49

subjects were tested. Most subjects (10th to 90th percentile) had

followed this diet 23-49 months. 6 subjects had serum B12

concentrations <147 pmol/l (200 pg/ml). 37 subjects (76%) had serum

B12 concentrations <221 pmol/l (300 pg/ml). 23 subjects (47%) had

abnormal urinary MMA concentrations above or equal to 4.0 microg/mg

creatinine. Sublingual cyanocobalamin and nutritional yeast, but not

probiotic supplements, significantly reduced group mean MMA

concentrations (tablet p < 0.01; yeast p < 0.05, probiotic > 0.20).

CONCLUSIONS: The urinary MMA assay is effective for identifying early

metabolic cobalamin deficiency. People following the Hallelujah diet

and other raw-food vegetarian diets should regularly monitor their

urinary MMA levels, consume a sublingual cobalamin supplement, or

consume cobalamin in their food.

PMID: 11146329 [PubMed - indexed for MEDLINE]

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QJM 1999 Sep;92(9):531-44

Vegetarian diet: panacea for modern lifestyle diseases?

Segasothy M, PA.

Department of Medicine, Northern Territory Clinical School of

Medicine of Flinders University, Alice Springs, Australia.

m.segasothy@...

We review the beneficial and adverse effects of vegetarian diets in

various medical conditions. Soybean-protein diet, legumes, nuts and

soluble fibre significantly decrease total cholesterol, low-density

lipoprotein cholesterol and triglycerides. Diets rich in fibre and

complex carbohydrate, and restricted in fat, improve control of blood

glucose concentration, lower insulin requirement and aid in weight

control in diabetic patients. An inverse association has been

reported between nut, fruit, vegetable and fibre consumption, and the

risk of coronary heart disease. Patients eating a vegetarian diet,

with comprehensive lifestyle changes, have had reduced frequency,

duration and severity of angina as well as regression of coronary

atherosclerosis and improved coronary perfusion. An inverse

association between fruit and vegetable consumption and stroke has

been suggested. Consumption of fruits and vegetables, especially

spinach and collard green, was associated with a lower risk of age-

related ocular macular degeneration. There is an inverse association

between dietary fibre intake and incidence of colon and breast cancer

as well as prevalence of colonic diverticula and gallstones. A

decreased breast cancer risk has been associated with high intake of

soy bean products. The beneficial effects could be due to the diet

(monounsaturated and polyunsaturated fatty acids, minerals, fibre,

complex carbohydrate, antioxidant vitamins, flavanoids, folic acid

and phytoestrogens) as well as the associated healthy lifestyle in

vegetarians. There are few adverse effects, mainly increased

intestinal gas production and a small risk of vitamin B12 deficiency.

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J Med Assoc Thai 1999 Mar;82(3):304-11

Hematological parameters, ferritin and vitamin B12 in vegetarians.

Pongstaporn W, Bunyaratavej A.

Department of Clinical Microscopy, Faculty of Medical Technology,

Rangsit University, Pathumthani, Thailand.

Hematological parameters and serum ferritin were compared between 179

vegetarians and 58 control subjects using Hematology analyzer H3 and

microparticle enzyme immunoassay, respectively. Serum Vitamin B12 was

also compared between 68 vegetarians and 30 control subjects using

microparticle enzyme immunoassay. It was found that hemoglobin,

hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin

concentration, white blood cells, neutrophils, serum ferritin and

serum vitamin B12 in vegetarian were significantly lower than control

subjects (P < 0.05). In addition, red cell distribution width and

lymphocytes in vegetarians were significantly higher than control

subjects (P < 0.05). There were 34 cases of iron deficiency in 179

vegetarians (19.%) which can be classified to iron depletion (4

cases), iron deficient erythropoiesis (12 cases) and iron deficiency

anemia (18 cases). Vitamin B12 deficiency was found in 27 cases of 68

vegetarians (40%).

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Age Ageing 1998 Jul;27(4):455-61

Nutritional status of elderly Chinese vegetarians.

Woo J, Kwok T, Ho SC, Sham A, Lau E.

Department of Medicine, The Chinese University of Hong Kong, Prince

of Wales Hospital, Shatin, NT. jeanwoowong@...

AIM: To study the nutritional status of elderly Chinese vegetarians.

SUBJECTS AND METHOD: Dietary intake (using the 24-h recall method),

anthropometric indices and some nutritional laboratory parameters

were studied in 131 elderly Chinese vegetarian women with a mean age

of 81 years. Data from age- and sex-matched omnivore subjects from

previous elderly surveys were used for comparison. RESULTS: Total

energy, fat and protein calorie, thiamine, riboflavin and niacin

intakes were lower in vegetarians than in non-vegetarians, while

carbohydrate calorie, calcium, potassium, retinol equivalent and

ascorbic acid intakes were higher. The 25th, 50th and 75th percentile

for total body fat were lower and those for corrected arm muscle area

were higher in vegetarians. Both urinary Na/Cr and K/Cr ratios were

higher but the Na/K ratio was similar to that in non-vegetarians, as

were mean systolic and diastolic blood pressures. Serum total

cholesterol was lower, while serum triglyceride concentration was

similar. The mean haemoglobin level was lower in vegetarians, the

prevalence of anaemia being 30%, with deficiencies in B12 and/or iron

accounting for 64% of the anaemia, compared with only 30% in non-

vegetarians. Serum B12 concentration below the reference range

occurred in 54% of the vegetarian subjects. Vegetarians also had a

lower prevalence of a history of ischaemic heart disease; however,

the prevalence of smoking was also lower. CONCLUSION: While the

Chinese vegetarian diet may result in a favourable risk-factor

profile for ischaemic heart disease, it is deficient in many B

vitamins and gives rise to a high frequency of nutritional anaemias.

PMID: 9884002 [PubMed - indexed for MEDLINE]

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Pediatr Clin North Am 1995 Aug;42(4):955-65

Vegetarian diets and children.

TA.

Department of Nutrition and Dietetics, King's College London, United

Kingdom.

Although the general health and development of vegan and vegetarian

children seem to be normal, there may be subtle differences compared

with omnivores. They are at increased risk of iron deficiency, and

impaired psychomotor development associated with iron deficiency has

been reported in macrobiotic infants. Fortunately, this impairment is

not permanent, and follow-up studies have reported higher-than-

average intelligence quotients among older macrobiotic children.

Several other hazards of vegetarian diets have been identified,

including vitamin B12 deficiency, rickets, and a bulky diet that can

restrict energy intake in the first few years of life; however, these

pitfalls can be avoided easily, and children can be successfully

reared on vegetarian diets.

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Eur J Pediatr 1991 Jan;150(3):205-8

Maternal vegan diet causing a serious infantile neurological disorder

due to vitamin B12 deficiency.

Kuhne T, Bubl R, Baumgartner R.

University Children's Hospital Basel, Switzerland.

We present a 9-month-old exclusively breast-fed baby of a strict

vegetarian mother who had excluded all animal proteins from her diet.

The patient's symptoms included dystrophy, weakness, muscular

atrophy, loss of tendon reflexes, psychomotor regression and

haematological abnormalities. Biochemical investigations revealed

severe methylmalonic aciduria and homocystinuria in the patient,

slight methylmalonic aciduria in the mother and low concentrations of

serum vitamin B12 in both patient and mother.

PMID: 2044594 [PubMed - indexed for MEDLINE]

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J Am Coll Nutr 1990 Dec;9(6):600-9

Long-term effects of a vegetarian diet on the nutritional status of

elderly people (Dutch Nutrition Surveillance System).

Lowik MR, Schrijver J, Odink J, van den Berg H, Wedel M.

Department of Human Nutrition, TNO-CIVO Toxicology and Nutrition

Institute, Zeist, The Netherlands.

The health and nutritional status (anthropometry, and blood and urine

biochemistry) of 44 Dutch apparently healthy vegetarians, aged 65-97

years, refraining from meat, fish, and poultry consumption, was

assessed for insight into long-term consequences of ovo-lacto- or

lacto-vegetarianism. The results indicate that in comparison to

omnivorous elderly the vegetarian elderly (especially men) have aged

successfully with respect to cardiovascular risk factors. In

contrast, vegetarian elderly are at a higher risk for a marginal

iron, zinc, and vitamin B12 status. Although several vegetarian

elderly showed low levels of 25-hydroxyvitamin D in plasma and many

had low values of 24-hr urine volume (per kg body weight), these

values are not likely the result of a vegetarian diet per se. It is

concluded that, although some nutrition-related risks are prevalent

among vegetarian elderly, these risks can probably be prevented by

lifestyle changes.

PMID: 2273194 [PubMed - indexed for MEDLINE]

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Clin Pediatr (Phila) 1987 Dec;26(12):662-3

Vitamin B12 deficiency due to a strictly vegetarian diet in

adolescence.

Ashkenazi S, Weitz R, Varsano I, Mimouni M.

Department of Pediatrics B, Beilinson Medical Center, Petah Tiqva,

Israel.

A 14-year-old white girl suffered from severe neurologic disturbances

caused by vitamin B12 deficiency, due to failure to provide vitamin

B12 supplementation to a strictly vegetarian diet. The disturbances

resolved completely following treatment with vitamin B12. Physicians

should be alert to the necessity for vitamin B12 supplementation for

strict vegetarians, who eat no meat, fish, eggs, or dairy products.

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Eur J Pediatr 1986 Dec;145(6):570-1

Megaloblastic anaemia in one of monozygous twins breast fed by their

vegetarian mother.

Gambon RC, Lentze MJ, Rossi E.

Megaloblastic anaemia in infancy is uncommon in western countries. We

describe a case of an exclusively breast-fed monozygous twin with

severe vitamin B12 deficiency with haematologic and neurologic

abnormalities. Treatment with vitamin B12 resulted in a rapid

haematological and clinical improvement.

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Clin Pediatr (Phila) 1986 Apr;25(4):219-21

Nutritional vitamin B12 deficiency in a breast-fed infant of a vegan-

diet mother.

Sklar R.

A 7-month-old male presented with lethargy and failure to thrive. The

child was exclusively breast-fed from birth by a mother who was a

strict vegetarian. Laboratory data revealed macrocytic anemia and

methylmalonic acid in the urine, consistent with vitamin B12

deficient anemia. The patient responded well to supplementation with

B12 alone and was developmentally normal by 11 months of age. This

study emphasizes the need for assuring maternal dietary adequacy

during pregnancy and after birth.

PMID: 3948463 [PubMed - indexed for MEDLINE]

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Acta Paediatr Scand 1985 Mar;74(2):191-5

Vitamin D deficiency rickets and vitamin B12 deficiency in vegetarian

children.

Hellebostad M, Markestad T, Seeger Halvorsen K.

During the years 1978-83 four vegetarian children have been admitted

to the pediatric departments of Ullevaal and Aker Hospitals in Oslo

and Haukeland Hospital, Bergen, with the diagnosis of vitamin D

deficiency rickets. One had vitamin B12 deficiency as well. All had

been fed a vegetarian diet with some cows' milk, but without vitamin

supplementation. All had marked hypocalcemia, and three had tetany or

convulsions. All responded well to conventional doses of vitamin D

therapy. Two of the mothers had vitamin D deficiency, and one of them

also had vitamin B12 deficiency. This report describes the case

histories of these children, and also discusses predisposing factors

of vegetarian diets for the development of nutritional rickets.

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Clin Lab Haematol 1984;6(1):1-7

Megaloblastic anaemia in vegetarian Asians.

s JH, Wood JK.

Of 27 Asians with a megaloblastic bone marrow, 22 (81%) had

nutritional deficiency of vitamin B12 (NMA), while five (19%) had

true pernicious anaemia (PA). All the patients were Hindu vegetarians

except for a single Muslim who had PA. Dietary intakes of calories,

protein, iron, vitamin B12 and folate were below the recommended

level in both groups. The PA group had lower levels of serum B12 and

higher levels of serum folate than the NMA group. Despite low levels

of red cell folate (RCF) in the NMA patients, the abnormality in

deoxyuridine (dU) suppression was always corrected by vitamin B12.

The dU suppressed value showed a significant inverse relationship to

the RCF level. Nutritional deficiency of vitamin B12 is the most

common cause of megaloblastic anaemia in Hindu vegetarians but the

incidence of true PA is higher than previously thought and may

approximate to that of the white population.

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Pediatrics 1982 Oct;70(4):582-6

Totally vegetarian diets and infant nutrition.

Shinwell ED, Gorodischer R.

Observations on the deleterious effects of a totally vegetarian diet

in infancy are reported and the difficulties encountered in the

prevention of nutritional deficiencies in a vegan religious community

are discussed. Twenty-five infants of this community who were seen at

the hospital showed evidence of protein-calorie malnutrition, iron-

and vitamin B12-deficient anemia, rickets, zinc deficiency, and

multiple recurrent infections. Evidence of growth retardation was

also found in 47 infants seen at the local mother-child health (well-

baby) clinic. Samples of breast milk showed low levels of

carbohydrate (1.6 to 3.5 gm/100 ml), protein (0.8 to 1.4 gm/100 ml),

and fat (2.4 to 4.1 gm/100 ml). The main constituent of the infants'

diet after the age of 3 months (a " soya milk " prepared at the

community's central kitchen) was extremely dilute with a very low

calorific value (13.7 kcal/100 ml). Persistent attempts to find

dietary modifications that would satisfy both the vegan philosophy

and also the recommended dietary allowances failed. This problem

represents a scientific and medicosocial challenge to pediatricians

and nutritionists.

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Am J Clin Nutr 1982 Feb;35(2):204-16

Nutritional status of vegetarian children.

Dwyer JT, Dietz WH Jr, s EM, Suskind RM.

Thirty-nine preschool children consuming different types of

vegetarian diets were studied. Type and amount of carbohydrate, fat,

protein, and amount of sodium and cholesterol provided by their diets

were more like intakes suggested in the proposed Dietary Goals for

the United States than to levels in usual diets of nonvegetarian

children. Macrobiotic vegetarian children consumed less animal food

than did other vegetarian children. The mean intake of vitamin D of

macrobiotics was an eighth of the Recommended Dietary Allowance and

mean serum alkaline phosphatase values were elevated. The mean intake

of vitamin B12 levels were normal. Vegan macrobiotic children had the

lowest intakes of vitamins B12 and D. Other vegetarians' mean intakes

of these vitamins met the Recommended Dietary Allowance. Mean iron

intakes of the vegetarians approximated the Recommended Dietary

Allowance. Hematological indices were suggestive of mild iron

deficiency anemia in a quarter of subjects. Serum cholesterol values

were low for the group. Physical measurements were within normal

limits and macrobiotic vegetarians were not smaller or leaner than

other vegetarian children. The nutritional difficulties discovered

could be corrected by careful planning of vegetarian children's diets

while preserving the beneficial qualities of the diet in other

respects.

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Am J Clin Nutr 1981 Nov;34(11):2464-77

Nutrient intake and health status of vegans. Chemical analyses of

diets using the duplicate portion sampling technique.

Abdulla M, Andersson I, Asp NG, Berthelsen K, Birkhed D, Dencker I,

Johansson CG, Jagerstad M, Kolar K, Nair BM, Nilsson-Ehle P, Norden

A, Rassner S, Akesson B, Ockerman PA.

A strict vegetarian diet [vegan diet (VD)] was investigated. Six

middle-aged vegans (three men and three women) collected copies of 24-

h diets using the duplicate portion sampling technique. By chemical

analyses, the nutrient composition was determined in detail and

compared with corresponding figures of a normal mixed Swedish diet.

In the VD 30% of the energy originated from fat compared with 40% in

normal Swedish mixed diet (MD). Linoleic acid was the dominant fatty

acid (60% of total fat in VD versus 8% in MD). The VD contained 24 g

protein/1000 kcal compared to 30 g/1000 kcal in MD, but the intake of

essential amino acids by the vegans exceeded the recommendations.

Dietary fiber was about 5 times higher in the vegan diet (29 versus 6

g/1000 kcal) and sucrose similar to MD (18 versus 21 g/1000 kcal).

Among the inorganic nutrients the concentration of calcium (351

versus 391 mg/1000 kcal) and sodium (53 versus 49 mmol/1000 kcal)

were similar in both types of diets but the amount of potassium (56

versus 30 mmol/1000 kcal, magnesium (300 versus 110 mg/1000 kcal),

iron (9 versus 6.5 mg/1000 kcal), zinc (6.5 versus 4.7 mg/1000 kcal),

and copper (2 versus 0.7 mg/1000 kcal) were nearly doubled. Iodine

(39 versus 156 micrograms/1000 kcal and selenium (5 versus 17

micrograms/1000 kcal) were much lower in the VD, selenium even being

undetectable in several 24-h diets. The VD was rich in folic acid

(301 versus 90 micrograms/1000 kcal in MD) but the intake of vitamin

B12 was only 0.3 to 0.4 microgram/day (MD: 3 to 4 micrograms/day). No

clinical signs of nutritional deficiency were observed in the vegans.

Serum protein levels of the vegans as well as their serum

lipoproteins were near the lower range of the reference group. In

addition, none of the vegans was overweight and their blood pressures

were low for their age.

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N Engl J Med 1978 Aug 17;299(7):317-23

A syndrome of methylmalonic aciduria, homocystinuria, megaloblastic

anemia and neurologic abnormalities in a vitamin B12-deficient breast-

fed infant of a strict vegetarian.

Higginbottom MC, Sweetman L, Nyhan WL.

We studied a six-month-old infant with severe megaloblastic anemia,

coma and hyperpigmentation of the extremities. He was found to have

methylmalonic aciduria (79 mumol per milligram of creatinine) and

homocystinuria (0.85 mumol per milligram of creatinine). Additional

biochemical abnormalities included cystathioninuria, glycinuria,

methylcitric aciduria, 3-hydroxypropionic aciduria and formic

aciduria. The concentration of vitamin B12 in the serum was 20 pg per

milliliter. This severe nutritional deficiency was a consequence of

inadequate intake, for the infant was exclusively breast-fed by a

strictly vegetarian mother who manifested methylmalonic aciduria. Our

observations emphasize the importance of educating strict vegetarians

about the deficiency of vitamin B12 in their diets and the importance

of vitamin B12 supplementation.

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Prim Care 1975 Jun;2(2):309-15

Vegetarian diets.

Sutnick MR.

A growing number of Americans are choosing to follow vegetarian

diets. These diets can meet the nutritional needs of individuals of

all ages. Vegetarians who eat eggs and/or milk and dairy products

have no special problems in obtaining adequate nutrients. Pure

vegetarians, who avoid all animal products, should pay particular

attention to sources of protein, calcium, and riboflavin.

Supplementation of vitamin B12 is indicated in these individuals.

Guidelines for both good normal nutrition and therapeutic diets can

be adapted for use with a vegetarian diet.

PMID: 1046253 [PubMed - indexed for MEDLINE]