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Thread: Help and advice needed

  1. #1

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    Default Help and advice needed

    Im really hoping someone can give me some advice. I have been a vegetarian since 2008 and I vegan since the start of this year. When I had my b12 levels checked last march it was 512 but by this march it had dropped to 246. I saw my doctor earlier this week regarding the drop and she wants to send of to see a dietician. Has anyone here seen a dietician regarding their veganism and if so was it any help? And also has anyone experienced a large drop in b12 levels like I have? I am a bit unsure about seeing a dietician as its not a case of not knowing what food b12 is in, its just that most of it is not vegan and the things that are vegan and contain b12 are things I dont like and have never really eaten, such as marmite and cereal. The added problem I have is that I find it difficult to swallow tablets so I take a childrens multivitamin which doesnt contain b12 but at least by taking that I am making sure I get other vitamins and calcium. To be honest I dont mind if I end up having b12 injections as it seems like a small to do for something I strongly believe in especially if I cant swallow tablets easily. Does anyone here get the injections and if so how bad are they (because I have heard that they hurt a lot) and how often do you have them? I dont thing it would really bother me but I just need a bit more info about everything. And there is also I family history of b12 deficiency due to not being able to absorb it. Any advice or help will be greatly appreciated.

  2. #2
    Abe Froman Risker's Avatar
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    Default Re: Help and advice needed

    You could get chewable tablets (veg1 from the Vegan Society for instance) or break regular pills up to make them easier to swallow or crush them to a powder and add them to other foods.

  3. #3
    patientia
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    Default Re: Help and advice needed

    Now chewable B12 2000mcg is vegan.

  4. #4
    Johnstuff's Avatar
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    Default Re: Help and advice needed

    A lot of soya milk has added B12, do you drink any soya? Maybe switch to one with B12 if you do?

    I have never checked my B12 but I assume it's ok because of all the soya milk I have in tea, coffee and hot chocolate!

  5. #5

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    Default Re: Help and advice needed

    Does your doctor know about the family history of B12 malabsorption? i.e. it may not be a question of adjusting what you are eating but you may require supplementation and/or injections regardless of your diet? Has your B12 level fluctuated in the past? Is it possible that the change in your B12 levels is just coincidental with your decision to eat more healthily this year?

  6. #6

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    Default Re: Help and advice needed

    I haven't really tried soya milk because i use a milk substitute made from water and oats instead. I remember trying soya milk a few years back and didn't like it but I may give it another go. I did tell the doctor about my family history but she seemed to think that it was only due to my diet, but i'm not convinced as even though I don't really like marmite and cereal, I do often eat them purely for my b12 levels, so It world be interesting to see how low they would be he I didn't eat them, and this is the reason I don't think a dietician is going to really help me. And the other thing is for most of the year between the two times I had my levels checked, I was a vegetarian not a vegan so i was eating dairy products so its not as though my b12 intake has been low for long as I had only been vegan for 3 months of that year, Which is another reason I think something else other than my diet may be causing it.

  7. #7

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    Default Re: Help and advice needed

    It's up to you, of course, but if it were me, I think I'd go to a different GP for a second opinion and emphasise the family history of malabsorption rather than you having been vegan for a few months - which I think may be a bit of a red-herring for less vegan-aware GPs. If it is your underlying medical condition which is affecting your B12, a trip to the dietician isn't going to solve that.

    If you want to move into using fortified soya milks, you might need to try a whole range to find the ones you like - they all taste so different to me. Maybe try them in porridge or something first, then hot chocolate, then coffee etc.

  8. #8
    Ex-admin Korn's Avatar
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    Default Re: Help and advice needed

    Hi Mooncat,

    if you need oral B12 supplements, you can either find someone that you can disssolve in some liquid and drink it, or just get some strong tablet and break it down in really small pieces.

    Have you seen this thread: Is oral B12 as effective as intramuscular injections? I'm not keeping myself updated on studies about the effectiveness of B12 injections vs. oral B12, but the earlier, everybody seemed to agree that if someone has a problem with B12 absorption, they should take injections. Since you last March recently had B12 levels which seem to be just above the average of what most people have, you may not - at least in theory - not have a serious problem with B12 absorption, but don't take this as an advice about not following up your B12 situation!


    I'm not a doctor/dietitian, so I can't give you any professional advice anyway, but are your B12 levels measured in pmol/l or pg/ml? There's no world wide agreed-upon "normal" level of B12 that everybody agrees upon, but several sources list 200 - 900 pg/ml as "normal". (Breast milk contains 180 - 300 pg/ml.) According to this site, "the normal blood level of vitamin B12 ranges between 200 and 600 picogram/milliliter (148-443 picomol/liter)." Don't be surprised if these references numbers will be updated/increased in the future.


    The B12 levels in someones blood is, however, only part of the story here, because these tests usually don't differentiate between active B12 and inactive B12 "analogues". Read about MMA and homocysteine tests. And to make it even more confusing, it's also possible to have good tissue B12 levels even if the B12 leves in blood aren't looking so good. But again; please don't use this as an excuse for ignoring a drop in B12 levels...


    A large study performed by Tuft University found that 39 % of the studied group had B12 values in the "low normal" range. This wasn't a study on vegans. Their threshold for "low normal" was levels below 258 pmol/350 pg. Depending on a lot of factors, people need to adjust their B12 intake based on their exposure to "B12 killers" like coffee, tobacco, alcohol and much more, so there's no "fixed" value which applies to all people. Age also plays a role here.

    Here's a comment about the Tuft study:

    While this is well above the currently accepted deficiency level of 148 pmol/L, some people exhibit neurological symptoms at the upper level of the deficiency range, explains study leader Katherine L. Tucker. She is a nutritional epidemiologist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.

    "I think there’s a lot of undetected vitamin B12 deficiency out there," says Tucker. She noted that nearly 9 percent of the study population fell below the current deficiency level. And more than 16 percent fell below 185 pmol/L. "Many people may be deficient at this level," she says. "There is some question as to what the clinical cutoff for deficiency should be."

    Deficiency can cause a type of anemia marked by fewer but larger red blood cells. It can also cause walking and balance disturbances, a loss of vibration sensation, confusion, and, in advanced cases, dementia. The body requires B12 to make the protective coating surrounding the nerves. So inadequate B12 can expose nerves to damage.

    Tucker and colleagues wanted to get a sense of B12 levels spanning the adult population because most previous studies have focused on the elderly. That age group was thought to be at higher risk for deficiency. The researchers also expected to find some connection between dietary intake and plasma levels, even though other studies found no association.

    Some of the results were surprising. The youngest group—the 26 to 49 year olds—had about the same B12 status as the oldest group—65 and up. "We thought that low concentrations of B12 would increase with age," says Tucker. "But we saw a high prevalence of low B12 even among the youngest group."

    Since you have stopped using animal products, you should expect the B12 levels to drop, since animal blood and muscles (which is what meat is) contains B12; both naturally occuring B12 and also B12 from supplements given to animals.

    I wouldn't be worried about seeing a dietitian/nutritionist, just remember that what they'll tell you to large extent will depend on who you talk to. One common mistake is that a lot of doctors and health professionals often use B12 levels in blood (alone) to evaluate the real level of B12 in a person...

    Anyway, here's what The American Dietetic Association sayd about vegans and supplements:

    It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods. This article reviews the current data related to key nutrients for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. A vegetarian diet can meet current recommendations for all of these nutrients. In some cases, supplements or fortified foods can provide useful amounts of important nutrients. An evidence-based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes. The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals. The variability of dietary practices among vegetarians makes individual assessment of dietary adequacy essential. In addition to assessing dietary adequacy, food and nutrition professionals can also play key roles in educating vegetarians about sources of specific nutrients, food purchase and preparation, and dietary modifications to meet their needs.
    IMHO, they should have emphaized B12 more - because of all the B12 killers out there.
    Last edited by Korn; May 29th, 2010 at 09:22 AM.
    I will not eat anything that walks, swims, flies, runs, skips, hops or crawls.

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