B12 Ewellness by Gabriel Cousens

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Dear Friends

 

Here is the latest eWellness letter on B12 by Gabriel Cousens. Also

look out for our eBulletin to follow.

 

Peace Prevails

 

The work at the Tree of Life and in all my nutrition books,

Spiritual Nutrition and the Rainbow Diet, Conscious Eating and

Rainbow Green Live Food Cuisine is to provide an optimal situation

for everyone to be successful vegan and live food practitioners. To

that end, we address every single issue that is connected with being

successful. The B-12 issue is one that is critical to a successful

and healthy vegan and live food way of life.

 

You can view HTML version at www.treeoflife.nu/ewellness.html

 

To understand the significance of this issue, we need to understand

a little about the importance of B-12 in the diet. The average non-

vegetarian stores between 2,000 and 3,000 picograms (pg., same as

micrograms) of B-12 and loses about 3 pg. per day. About 60 percent

of the total amount of the B-12 in the body is stored in the liver

and 30 percent is stored in the muscle. The body has a special

circulation pattern between the digestive tract and the liver.

Through the bile, we secrete 1.4 pg. per day of B-12 into the small

intestine, and healthy people reabsorb about 0.7 pg. Research

suggests that if people have a low B-12 intake, the absorption

increases to even draw more B-12 into the system. However, there is

still a general potential for slow loss, depending on the variation

in this special, what is known as enterohepatic circulation, before

we develop the potential of B-12 deficiency symptoms.

 

B-12 has two functions: one, methylocobalamin is used by the enzyme

methionine synthase to change homocysteine into methionine. When

this enzyme is not working, we increase the homocysteine in our

system, which recent research has associated with the increased

potentiality of heart disease and deterioration of the arteries and

nerves. When the homocysteine is high, it appears to be a nerve

toxin, as well as a blood vessel toxin. The second function of B-12

is as a coenzyme is using 5'-deoxyadenosylcobalamin in the enzyme

methyl malonyl-CoA mutase in the conversion of methyl malonyl-coA to

succinyl-CoA.

 

Elevated homocysteine also happens with deficiencies in B-6 or folic

acid. One of the major symptoms of B-12 or folic acid deficiency is

macrocytic anemia. Folate, also called folic acid, is needed to

turn the uracil into thymidine, an essential building block of DNA.

This DNA is needed for production of new red blood cells and for red

blood cell division. B-12 is involved because it is involved in the

pathway that creates methyl cobalamin. This B-12 also produces a

form of folate needed to make DNA. So, if there is no B-12, folate

can become depleted and DNA production slows down.

 

Another little side part of the methyl malonyl-CoA to succinyl-CoA

conversion is that when the B-12 is not available, the methyl

malonyl-CoA levels increase and are converted to methyl malonic

acid, which accumulates in the blood and urine. Since the B-12 is

the only co-enzyme required in this pathway, methyl malonic acid

levels are considered the gold standard as an indicator of B-12

deficiency. Other causes of high methyl malonic acid (MMA) are

genetic defects, kidney failure, low blood volume, dysbiosis,

pregnancy and hypothyroid. The MMA test is important because the

progressive medical community no longer considers serum B-12 levels

an accurate measurement of appropriate amounts of B-12. In other

words, a normal serum B-12 may not mean that B-12 levels are

healthy. We need a urinary assay of methyl malonic acid to really

determine that. This is an important point, because when I first

wrote about this issue in Conscious Eating, the establishment of the

methyl malonic acid assay as the gold standard had not taken place

yet. I based some of my statements at that time on the world

research, which was using serum B-12. A serum B-12 of 200 pg. or

less was considered deficient. As a result of the new gold standard

and what we know about MMA and homocysteine, the B-12 serum levels

should be around 450 pg. to maintain a normal homocysteine level.

Therefore, serum B-12 levels less than 450 pg. may be considered as

indicating a B-12 deficiency.

 

There are a variety of symptoms of B-12 deficiency, which are

important to vegans and live fooders. The first is actually low

energy. It could be a reason why some people just don't feel well

on these diets, besides not getting the right

protein/carbohydrate/fat mix for their constitutional type. There

are specific neurological symptoms, often described as " subacute

combined degeneration " . Some of this damage can be almost

irreversible, if it becomes chronic. This nerve system degeneration

affects peripheral nerves and the spinal cord. Some of the typical

neurological feelings include depression, numbness and tingling in

the hands and feet, nervousness, paranoia, hyperactive reflexes,

impaired memory and behavioral changes. With a B-12 deficiency, one

can also have diarrhea, fever, frequent upper respiratory

infections, impotence, infertility, sore tongue, enlargement of the

mucous membranes of the mouth, vagina, and stomach, macrocytic

anemia, low platelets, increased bleeding, low white blood cell

count. Some of the causes of B-12 deficiency are low dietary intake

of B-12 and/or poor absorption, which usually comes through loss of

intrinsic factor and/or a lack of stomach acid.

 

Consistent research over the last decade has shown that vegans and

live food people of all ages and sexes have a much higher risk of

becoming B-12 deficient. This does not mean that everyone becomes B-

12 deficient. This deficiency is particularly true with newborn

babies, especially babies of vegan live-food nursing mothers who are

not using B-12 supplementation. In contrast to the average adult

storage of 2,000-3,000 pg. of B-12, newborns of mothers with normal

B-12 have about 25 pg. Studies have shown that the milk during the

first week of life does contain large amounts of B-12. This means

that the B-12 storage in infants at birth is normally adequate to

last the first few weeks of life. Afterwards, they must get it from

breast milk or other sources. If a vegan or live-food mother is

already B-12 deficient during pregnancy, the baby may be born with

seriously low B-12 levels and develop clinical signs of deficiency

as soon as two weeks. The general research suggests that even among

non-vegetarians, B-12 can be insufficient in infants, and that

perhaps all breastfeeding mothers should consider B-12 supplements

for themselves and their infants during the time of breastfeeding.

This lack of B-12 in the mother's diet during pregnancy has been

associated with a lack of myelin production, which is the coating of

the nerves. It takes somewhere between one to twelve months to

develop, and manifests as failure to thrive and slow developmental

progression. The babies are often lethargic, lose their ability to

use muscle adequately, and even their sensory attunement decreases.

They also have irregular macrocytic anemia.

 

The good news that one major study in the United Kingdom in 1988

showed, in studying 37 vegan children was that there was normal

growth and development in children who were breastfed for 6 months

at a minimum, when there was B-12 supplementation.

 

Young childrenand teenage children who were supplemented with B-12

were found to grow normally. Adults who were vegetarian without B-

12 supplementation for greater than six years usually had a lower B-

12 than non-vegetarian adults in the general research. In one study

of adults in 1994, 81% of the vegan adults had a B-12 lower than 200

pg. That is approximately the percentage of adults on a live food

diet who are low in B-12. In my clinical experience, meat eaters,

vegans and live-fooders tend to have a fairly high percentage of B-

12 deficiency, although meat eaters do have less incidence. My

experience is that cooked food vegans have a higher incidence of B-

12 deficiency than live fooders, but there is still a significant

occurance in live fooders. In vegetarians and vegans, there is also

a high percentage under 200 pg., about 54%. A study in 1982 by Dunn

and Scott of raw food vegans with 83 subjects from the Natural

Hygiene Society showed that 92% of the vegans had a B-12 less than

200 pg., and in 53% it was less than 100 pg. The World Health

Organization (WHO) considers B-12 deficiency to be less than 200

pg. The percentages of B-12 deficiency tend to increase over time

on a natural hygiene diet. Another study in Finland in 1995 that

examined B-12 status of long-term 100% raw vegans found that 66% of

the people had a B-12 lower than 200 pg. One study done in 2000 by

Donaldson at Hallelujah Acres on primarily live food diet people,

but with some B-12 supplementation via nutritional yeast, showed

only about 15% of the people were less than 200, and none of them

less than 160. The supplementation with nutritional yeast was 5 pg.

of B-12 from one tablespoon of Red Star Vegetarian Support.

 

Up until this time, many of us have felt that additional

supplementation for live fooders with sea vegetables or probiotic

formulas was sufficient for protection against B-12 deficiency.

This does not seem to be the case. In macrobiotics, who primarily

cook their food, we see a very high percentage of children actually

having growth retardation due to low B-12 intake. Many of us have

felt that spirulina, Klamath Lake Algae, all the sea vegetables had

enough active B-12 to avoid a B-12 deficiency. Although the

research is not fully in, we do know that, as I pointed out in

Conscious Eating, these substances do have human active B-12. The

problem is they also have a significant amount of analog B-12 that

competes with the human active B-12. This analog amount was not

measured in my studies. Using the methyl malonic acid reduction

approach, which is now the gold standard, research showed that when

people used dry and raw nori from Japan, the dried nori actually

made the methyl malonic acid (MMA) status worse, which means it

actually reduced the B-12 status. Therefore it could possibly

worsen a B-12 deficiency. Raw nori seemed to keep the methyl

malonic acid at the same level, meaning it did not harm the B-12

status, but the research showed it did not particularly help it

either. No food in Europe or the U.S. has been tested for lowering

methyl malonic acid. Research absolutely has to be done to answer

this question fully.

 

There is one exception to this lack of vegetarian B-12 active food,

which is that we do produce B-12 from bacteria in our large

intestine, but since this B-12 is produced in the area below where B-

12 is reabsorbed, it is really not available for absorption. Some

people have argued that a lot of species of lower mammals do not

need B-12. The reason why this is true is that a lot of species

that are primarily vegetarian animals eat their feces. Human

research also has shown if you eat your feces, you will get enough B-

12. Dr. Herbert sponsored research in England where vegan

volunteers with a documented B-12 deficiency were fed B-12

extractions made from their own feces. It cured their B-12

deficiency. So, there is a natural vegan way to do it. It may not

be the most tasteful way, however.

 

Some have theorized that organic foods, in various regions, would

improve the B-12 tests by lowering the serum malonic acid, but

again, the research has not shown that washed or unwashed organic

food has made a difference. Many animals, aside from eating their

own feces, will ingest a variety of eggs, insects, small vertebrates

or soils. For example, gorillas, who are the closest to vegan of

all the species, will eat insects and sometimes their feces. So

there are ways to do this for vegans, but again, they may not be the

most aesthetic or tasteful. I would love, at this point, to come up

with an alternative to this, however it doesn't seem to be the

case.

 

There are many ideas of vegan foods that have active B-12, but few

are proving to actually raise B-12 or prevent its loss. The

research has shown, for example, that tempeh does not supply human

active B-12. Research in both the U.S. and the Netherlands has

confirmed this. There was one paper that showed that tempeh from

one particular source in Thailand did have some B-12, but what they

basically found was that fermented soybean did not contain B-12.

Other foods such as barley, malted syrup, sourdough bread, parsley,

shitake mushrooms, tofu, and soybean paste, had some B-12 in them.

Amazake rice, barley miso, miso, natto, rice miso, shoyu, tamari,

umeboshi, and a variety of nuts, seeds and grains did not contain

any elements or even any detectable B-12 analog. My study using the

earlier gold standard test for B-12 active bacteria did show indeed

that arame, dulse, kelp, kombu and wakame had significant human

active B-12. Other studies have shown that dulse did have a certain

amount of B-12 analog per serving. Until research is done to see if

it actually lowers the methyl malonic acid levels, the question has

to be raised that we can't assume that because a food has human

active B-12 it will help avoid a B-12 deficiency, because the actual

non-human active analogs may be blocking the human active B-12. The

same question arises now with the aphanizomenon flos-aqua and

spirulina, as well as chlorella. So, until we actually do the gold

standard test of these, through the methyl malonic test, to see if

it actually lowers the methyl malonic acid, I think it is reasonable

to eat these foods, but not expect that they are actually going to

raise your human active B-12. My serum B-12 of 600 pg. may have

thrown off my conclusions when I wrote my summary in 1990. I may

have been in that 20% of vegans and live food people that don't seem

to be affected. But I am more concerned about the other 80% that

are B-12 deficient and that 50% whose B-12 levels go down to less

than 100 pg. A study done in 1991 by Miller found that serum B-12

appeared to be unrelated to consumption of wakame, kombu, and other

sea vegetables or tempeh in macrobiotic children. Other researchers

feel that it is possible that raw nori, not dried nori, is a source

of active B-12. Some of these conclusions are not finalized. This

brings me to the next issue, which is, what is a normal level of B-

12?

 

Now the next question really is, what is a healthy level of B-12 in

the serum? The answer is that a serum level of 450 pg. keeps the

homocysteine level within normal levels. Some might just say that

dulse and raw nori and an algae called cocolithophorid algae, also

known as pleurochritias cartera, may provide sufficient human active

B-12. They have not been fully tested with the gold standard. The

normal serum homocysteine level is 2.2 - 13.2 micromoles/liter. The

normal adult urine MMA is .58 - 3.56 micromoles/mmol/cr. The normal

level of B-12 for breast milk is 180 - 300 pg. per ml. The normal

urine level for children is 820 - 11,200 micromoles/mmol/cr of MMA.

The normal serum B-12 level of children is 160 - 1300 pg. per ml.

 

Using the methyl malonic acid study as the gold standard, elevated

methyl malonic acid was found in subjects with a B-12 up to 486 pg.

This is a really important statement, because up 'til this time,

most of the studies in the world health basically say that 200 pg.

and above is not considered deficient. That was somewhat how I

based my ideas that B-12 in many vegans and raw foodists was low

normal, but still within normal. Using the gold standard methyl

malonic acid test, studies show that without supplementing with B-

12, vegans have higher homocysteine levels than lacto-ovo

vegetarians and non-vegetarians, which means they are deficient in B-

12. The good news, of course, is that B-12 supplementation will

decrease these high homocysteine levels back to normal range. High

homocysteine levels are connected with the potential for heart

disease, arterial destruction and neurological pathologies. Other

diseases associated with an elevated homocysteine are: Alzheimer's,

age related hearing loss, neural tube defects, recurrent loss of

pregnancy, increased mortality. Many non-vegetarians also have a

poor B-12 status because there are many factors that can cause B-12

deficiency. They include malabsorption or inadequate intake of

protein or calories or B-12, radiation exposure, drugs, and a

variety of toxins, paraminosalicylic acid, alcohol, pancreatic

tumors, failure of the small intestine to contract and move food

associated with bacterial overgrowth, oral contraceptives, fungal

infections, liver and kidney disease, tobacco smoking and B-6 or

iron deficiency. The research conclusion is that: it is a

reasonably safe bet that about 80% of the vegan and live food

population, over time, runs the risk of a subclinical or clinical B-

12 deficiency and increased homocysteine levels. An even higher

percentage of newborns run this risk. My suggestion, out of my

concern for all of my clients, for my fellow live fooders and vegans

is that it is well advised to supplement with an actual B-12 human

active supplement. There are vegan B-12 supplements, which allow us

to be totally successful vegan live fooders.

 

My general recommendation is that if you have symptoms of B-12

deficiency, you can even start with a 100 pg. injection, or

according to the research, an oral administration of 1,000 pg. per

day for two to four weeks is equal to repeated monthly injections.

After about a month of the oral, the dose can be cut in half. One

can even cut that in half again. I don't really recommend

nutritional red star yeast, because of the fungal potential; I think

that the safest and healthiest approach is via supplementation.

 

Some people eat according to their philosophy and belief of what is

natural, and this may be an impediment. For example, the black

Hebrews, a group of African-Americans who have migrated to Israel,

have horrendously high levels of infant B-12 deficiency, as well as

adult B-12 deficiency. They did not believe in taking supplements.

Data in a 1982 study showed that of the infants who were breastfed

for three months, and then were given diluted homemade soymilk for

three months to one year, 25 of them (a significant percentage) had

protein deficiency, iron and B-12 anemia, as well as zinc

deficiency. In the 1982 study, three of the infants were dead on

arrival, five more died within a few hours of hospital admission,

despite treatment. Serum levels were low in 9 of 15 cases and

undetectable in three of them. I don't feel this is a very good

example of what we want to show to the world in the way we want to

treat our children. We can make those choices. We have a theory of

natural, and we also have a theory of what it means to be healthy.

 

This is the first time in history that we can be completely

successful live food vegans. What I mean by being successful is

completely healthy, including no B-12 deficiency and no elevated

homocysteine levels. It is my medical opinion, as a vegan since

1973 and live fooder since 1983, and as a person committed to

supporting all those who choose to become healthy live food vegans,

that it would be wise to incorporate some B-12 supplementation in

your diet. I believe it is more natural to be healthy than it is to

be anything less than that.

 

Gabriel Cousens, M.D., M.D.(H), Dip. Ayurveda