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Vitamin B12 Deficiency

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Living a Vegan lifestyle? How to ensure you don’t get to stage four Vitamin B12 Deficency.

If you just switched to a 100% vegan based diet, you can relax for now. Your liver can store enough vitamin B12 to last one to five years. After that, however your health could suffer serious and irreversible damage if you have vitamin B12 deficiency.

In 2013, researchers described the case of a 25-year-old man with low Vitamin B12 and myelopathy. Myelopathy is degeneration of the spinal cord, and is the a common neurological syndrome of vitamin B12 deficiency and is a sign of early stage four vitamin b12 deficiency. If detected in time, the condition is fully reversible they discovered. The subject of the study  sought medical help for a tingling sensation in both hands that was spreading. He was known as a strict vegetarian, he was treated immediately with B12 injections, which led to a cure for his symptoms.

You will only become aware of any physical symptoms when you hit stage 4.

Stage 1 Vitamin B12 deficiency

This is when “serum depletion” becomes evident. It is possible to detect low levels of the B12 carrier protein TCII. TCII levels drop within just a few days of absence of the vitamin. This is only discovered through a blood test as no physical symptoms are present.

Stage 2 Vitamin B12 deficiency

As stage one progresses to stage 2, low vitamin B12 can be detected at a cellular level. Like stage 1, there are no discernible symptoms and are only discovered through having bloodwork done.

Stage 3 Vitamin B12 deficiency

In Stage 3, there is another detectable change in your blood. Amino Acid Levels begin to rise above normal, creating a condition sometimes called ‘hyperhomocysteinuria’. As B12 levels rise, homocysteine Amino Acid levels fall, and vice versa. Elevated homocysteine in the blood is an indication of B12 deficiency.

Researchers have observed stage 3 Vitamin B12 deficiency in over 60% of vegetarians.

Stage 4 Vitamin B12 deficiency

This is where physical symptoms start to appear. Some of these are more serious than others, and some are more obvious than others.

Early, mild symptoms of stage 4 vitamin B12 deficiency include:

  • Fatigue
  • Depression
  • Memory Loss
  • Anxiety
  • Loss of appetite
  • Hair loss
  • Numbness or tingling in the hands and feet

Memory loss and slower mental processes are the most reported cognitive problems associated with Vitamin B12 deficiency. In older people, cognitive function may decline, and dementia arise. Senior citizens whether omnivore or vegetarian are vulnerable to B12 deficiency, a factor that can be easily overlooked when symptoms of dementia arise. It is estimated that 10%–15% of people over the age of 60 have vitamin B12 deficiency. If alzheimers or dementia runs in your family it may be wise to take a Vitamin B12 supplement no matter if you are a vegan or not.

Both your blood and the central nervous system are the most probable to be affected at this stage. Megaloblastic anaemia is not uncommon in Stage 4. This is a condition in which abnormal red blood cells are produced by bone marrow. The first neurological symptoms may be tingling or numbness in your hands or feet. Other symptoms develop over time including balance or walking problems, vision loss due to degeneration of the optic nerve and dementia or memory loss.

Peripheral neuropathy (damage to nerves in the arms and legs is seen in 25% of patients with vitamin B12 deficiency.

Another indication of stage 4 Vitamin b12 deficiency is depression.

One study compared vitamin B12 levels in 100 vegetarians with 100 omnivores. Vitamin B12 was significantly higher in the omnivore group and lower in the vegetarian group, and the frequency of depression was 12% in the omnivore group compared to 31% in the vegan group. Psychosis was found in 3% of the omnivore group campared to 11% of the vegetarians.

If left untreated, stage four Vitamin B12 deficiency will progress to irreversible damage to your central nervous system.

How to continue a Vegan Based Lifestyle

vegan food pyramid

Despite the physical and mental problems of untreated vitamin B12 deficiency, it is possible to continue on a vegan-based lifestyle diet. This means being knowlegedable of alternative sources of Vitamin B12, and making sure you have enough of those sources.

For people leading a vegan lifestyle and not eating any animal products, yeast extract (like Vegemite/Marmite) and other fortified/supplemented foods such as breakfast cereals, soya milks, soya/veggie burgers, shitake mushrooms and vegetable margarines are all good sources.

While algae, seaweed, and certain mushrooms all contain vitamin B-12, they are not very reliable sources because they do not act the same way in the human body. Studies have found that consuming these foods does not significantly impact a person’s vitamin B-12 levels and can still lead to Vitamin B12 deficiency.

Who else is at risk

Besides Vegans people who have celiac disease, gastritus and ulcerative colitis disease and chronic alcoolics may lead to a Vitamin B12 deficiency because these conditions cause the absorption of many nutrients to be reduced.

Individuals treating their diabetes with metformin are advised to monitor their levels of vitamin B-12. Metformin might reduce the absorption of vitamin B-12. This is a standard test done by endochronologists.

Older people are also at high risk for developing Vitamin B12 deficiency. Up to 30% of people age 50 and over suffer from atrophic gastritis, a thinning of the stomach lining. Gastritus reduces the amount of B12 absorbed by the small intestine.

Tests to check for Vitamin B12 Deficiency

HoloTC test is a early and reliable marker of vitamin B12 deficiency. In contrast to the serum test, it only measures the vitamin B12 form, which can actually be utilized by the body.

MMA Test

Is a very simple, yet meaningful variant is the MMA urine test. In this method, the methylmalonic acid is measured – an increased MMA value indicates a vitamin B12 deficiency. Just as with the Holo TC test, only the actual active vitamin B12 is measured in this variant.

Vitamin B12 Supplements


If you eat a healthy and balanced diet, there is no need to take extra vitamin B12 supplements unless you are in one of the at risk groups. However, if you do not get enough vitamin B12 from your diet, you should take alternative vitamin B12 sources. Supplementation of Vitamin B12 of 25-100 mcg per day has been used to maintain vitamin B12 levels in older people.

For vitamin B12 deficiency in other people such as those following a vegan lifestyle: Vitamin B12 doses of 300-10,000 mcg daily have been used. Some evidence suggests the most effective oral dose is between 647-1032 mcg daily.

Here are 3 recomended Vitamin B12 supplements:

Vitafusion B12: 1000 mcg

Vitafusion Vitamin B-12 1000 mcg Gummy Supple…

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DESCRIPTION: Vitamin B12 deficiency is common among those eating vegetarian and particularly vegan diets because of failure to take B12 supplements or eat B12-fortifed foods. Have a question about this video? Leave it in the comment section at and I’ll try to answer it! Check out my blog post Vegan B12 Deficiency: Putting It into Perspective ( to put this subject into context.

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