Vitamin B12 Importance by Dr. Gabriel Cousens

[Guest guest]

this will help to clarify some of the issues involved with

> so-called B12 deficiency.

>

> Best,

> Elchanan

 

Elchanan,

You know I like a lot of what you say and tend to agree with you more

than disagree with you. But people can be deficient in any mineral or

vitamin. When people are tested for B12 levels and they fall

significantly short, as well as exhibit symptoms of this defiency, it

is very serious. B-12 deficiency can cause permanent damage. If you

want to call it something else, fine, but it is irresponsible, don't

you think, to say it doesn't exist.

 

I submit an article by Gabriel Cousens, who is widely respected in

the raw foods community as an expert on the diet. Through testing and

professional experience as well as education in the field, he offers

some sound information on what B12 is, what it's importance is, and

why we should supplement with it. Remember, the goal is health,

everyone, not to be a monkey again:

 

Vitamin B12 Importance

by Dr. Gabriel Cousens

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