Metabolic Vitamin B12 Status on a Mostly Raw Vegan Diet with Follow-Up Using Tablets, Nutritional Yeast, or Probiotic SupplementsDonaldson M.S.
Hallelujah Acres Foundation, Shelby, N.C., USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
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 µg/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.
© 2000 S. Karger AG, Basel
Herbert V, Das KC: Folic acid and vitamin B12; in Shils ME, Olson JA, Shike M (eds): Modern Nutrition in Health and Disease. Philadelphia, Lea & Febiger, 1994, pp 402–425.
- Norman EJ, Morrison JA: Screening elderly populations for cobalamin (vitamin B12) deficiency using the urinary methylmalonic acid assay by gas chromatography mass spectrometry. Am J Med 1993;94:589–594.
- Herbert V: Vitamin B12: Plant sources, requirements, and assay. Am J Clin Nutr 1988;48:852–858.
- Albert MJ, Mathan VI, Baker SJ: Vitamin B12 synthesis by human small intestinal bacteria. Nature 1980;283:781–782.
Malkmus GH: God’s Way to Ultimate Health. Shelby, Hallelujah Acres, 1995.
Crane MG, Sample C, Patchett S, Register DU: Vitamin B12 studies in total vegetarians (vegans). J Nutr Med 1994;4:419–430.
- Miller DR, Specker BL, Ho ML, Norman EJ: Vitamin B12 status in a macrobiotic community. Am J Clin Nutr 1991;53:524–529.
- Matchar DB, McCrory DC, Millington DS, Feussner JR: Performance of the serum cobalamin assay for diagnosis of cobalamin deficiency. Am J Med Sci 1994;308:276–283.
- Matchar DB, Feussner JR, Millington DS, Wilkinson RH Jr, Watson DJ, Gale D: Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency: A prospective clinical evaluation. Ann Intern Med 1987;106:707–710.
- Allen RH, Stabler SP, Savage DG, Lindenbaum J: Diagnosis of cobalamin deficiency. I. Usefulness of serum methylmalonic acid and total homocysteine concentrations. Am J Hematol 1990;34:90–98.
- Moelby L, Rasmussen K, Jensen MK, Pedersen KO: The relationship between clinically confirmed cobalamin deficiency and serum methylmalonic acid. J Intern Med 1990;228:373–378.
- Pennypacker LC, Allen RH, Kelly JP, Matthews LM, Grigsby J, Kaye K, Lindenbaum J, Stabler SP: High prevalence of cobalamin deficiency in elderly outpatients. J Am Geriatr Soc 1992;40:1197–1204.
- Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J: Effective treatment of cobalamin deficiency with oral cobalamin. Blood 1998;92:1191–1198.
Glantz S: Primer of Biostatistics. New York, McGraw-Hill, 1997.
- Dong A, Scott SC: Serum vitamin B12 and blood cell values in vegetarians. Ann Nutr Metab 1982;26:209–216.
- Rauma AL, Torronen R, Hanninen O, Mykkanen H: Vitamin B12 status of long-term adherents of a strict uncooked vegan diet (‘living food diet’) is compromised. J Nutr 1995;125:2511–2515.
Chanarin I, Malkowska V, O’Hea AM, Rinsler MG, Price AB: Megaloblastic anaemia in a vegetarian Hindu community. Lancet 1985;ii:1168–1172.
- Dagnelie PC, van Staveren WA, van den Berg H: Vitamin B12 from algae appears not to be bioavailable. Am J Clin Nutr 1991;53:695–697.
- Methylcobalamin. Altern Med Rev 1998;3:461–463.
- Mayer G, Kroger M, Meier-Ewert K: Effects of vitamin B12 on performance and circadian rhythm in normal subjects. Neuropsychopharmacology 1996;15:456–464.
Herbert V: Staging vitamin B12 (cobalamin) status in vegetarians. Am J Clin Nutr 1994;59(suppl):1213–1222.
Crane MG, Register DU, Lukens RH, Gregory R: Cobalamin (CBL) studies on two total vegetarian (vegan) families. Veg Nutr 1998;2–3:87–92.
Hokin BD, Butler T: Cyanocobalamin (vitamin B12) status in Seventh-Day Adventist ministers in Australia. Am J Clin Nutr 1999;70(suppl):576–578.
- Bar-Sella P, Rakover Y, Ratner D: Vitamin B12 and folate levels in long-term vegans. Isr J Med Sci 1990;26:309–312.
Haddad EH, Berk LS, Kettering JD, Hubbard RW, Peters WR: Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Am J Clin Nutr 1999;70(suppl):586–593.
- Helman AD, Darnton-Hill I: Vitamin and iron status in new vegetarians. Am J Clin Nutr 1987;45:785–789.
- Schneede J, Dagnelie PC, van Staveren WA, Vollset SE, Refsum H, Ueland PM: Methylmalonic acid and homocysteine in plasma as indicators of functional cobalamin deficiency in infants on macrobiotic diets. Pediatr Res 1994;36:194–201.
- Specker BL, Miller D, Norman EJ, Greene H, Hayes KC: Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B12. Am J Clin Nutr 1988;47:89–92.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.