Vitamin B12 on a plant based diet

​Supplementing with vitamin B12 is an absolute necessity on a plant based diet and also recommended for vegetarians and those over age 50.

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Why do we need vitamin B12:
To support the health of our:
- neurological system, to prevent nerve damage and cognitive dysfunction
- hematological system and prevent megaloblastic anaemia,
- cardiovascular system
B12 deficiency can lead to irreversible damage

Where can we get it:
-  the most reliable way to obtain B12 in a plant based diet is via supplementation
- B12 in the form of cyanocobalamin is better utilised in our body and is the preferred supplemental choice.
- In the event of poor renal function the preferred form is methylcobalamin.
- To enhance absorption of B12:
   - use a spray supplement to ensure contact with saliva,
   - take seperate from other supplements.

How much do we need:
- 500 μg of supplemental B12 is recommended per day for adults and children over age 11 without a B12 deficiency, following a plant based diet. In the event of a deficiency, this daily dose may be increased.
- Your personalised optimal dose can be assessed via blood test, after three months of daily supplementation.
- The International Vegetarian Union (IVU) recommends a maintenance B12 dose should be determined individually by health professionals, aiming for a serum B12 level greater than 360 pmol/L (490 pg/mL). Or even better by evaluating homocysteine levels or methylmalonic acid levels, if possible, to ensure both are not elevated.
- Acidity in the stomach is required to seperate B12 from food. With age, stomach acidity reduces increasing risk of B12 deficiency. Thus all adults over age 50, regardless of diet, should consider a B12 supplement.

Regular monitoring of your serum B12 levels is sensible if following a plant based diet and should be done annually. Some medications such as proton pump inhibitors and metformin may impair vitamin B12 absorption so it's good to check with your GP.

References:
Dr Eric Slywitch, www.ivu.org
 Dr Michael Greger, www.nutritionfacts.org

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