Vegetarians, vegans, and sclerosis sufferers need more vitamin B12

It came as good news for vegetarians, vegans and sclerosis sufferers when Danish health authorities allowed strong vitamin B12 preparations on the market some years ago. It was also positive that the active methylated form of vitamin B12 was added to the list of approved ingredients.

All people need vitamin B12, but vegetarians and vegans are particularly prone to become deficient, as only animal food sources contain the nutrient. People suffering from sclerosis are also challenged. First of all, they have an increased need for the nutrient. Secondly, it is important that they get the active methylated form of the vitamin. It was therefore great news for these groups of people when the Danish health authorities allowed strong vitamin B12 preparations on the market and, at the same time, added the methylated form of the nutrient to the list of approved ingredients.

This is why vegetarians risk becoming deficient

Vegetarians avoid meat, fish, shellfish, and animal byproducts, all of which are good sources of vitamin B12. They typically consume a diet based on fruit, vegetables, grain, legumes, nuts, seeds etc. There are different groups of vegetarians, and the differences are based on the diet they stick with. For instance, some eat dairy products and/or eggs, while others do not. Some eat fish, although this means that they cannot consider themselves true vegetarians. Most vegetarians are at risk of becoming vitamin B12 deficient.

Vegans face the greatest risk

Vegans are far more selective than vegetarians are and avoid all foods that are even remotely linked to the animal kingdom, including fish, eggs, milk, honey etc. Their plant-based diet gives them a lot more fiber, less salt, and fewer saturated fats than the average population gets from the diet. Moreover, vegans consume smaller quantities of the unhealthy trans-fatty acids. However, vegan as well as vegetarian diets may lead to health problems because these diets contain far too little vitamin B12. Besides getting too little vitamin B12, vegans are at risk of getting too little vitamin A, iodine, and selenium. Eventually, their risk of deficiency diseases goes up.

Helps sclerosis sufferers

People with sclerosis are thought to benefit from vitamin B12, especially the active methylated form of the nutrient also known as methylcobalamin, which is absorbed more easily in the nervous system where it helps to repair the protective myelin sheaths around the nerves that get damaged by the inflammatory reactions of sclerosis. Another reason why sclerosis sufferers have an increased need for vitamin B12 is their use of interferon drugs that lower levels of vitamin B12 in the body. It is not known for sure whether this is also the case with the new generation of interferon drugs. Still, it is advisable for sclerosis patients to have their vitamin B12 levels checked. Having
vitamin B12 levels below 150 pmol/l is considered a deficiency. The optimal level is around 400-450 pmol/l.

Before year 2010, sclerosis sufferers who wanted to buy methylcobalamin (in Denmark) needed a prescription from their physician. The local pharmacy would then manufacture the preparation as a so-called magistral drug, and this was a very expensive procedure. Now, thanks to legislative changes, methylcobalamin is available over the counter.

B vitamins work in synergy

It is recommended to take vitamin B12 together with a wide selection of other B vitamins, as all the B vitamins work in synergy in the body. For instance, the combination of vitamin B12 and folic acid (previously known as vitamin B9) is able to lower levels of a harmful compound called homocysteine.

References:

Rawlak R, et al. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. Eur J Clin Nutr. 2014;68(5):541-8.
Tayebi A, et al. Effect of Vitamin B12 supplementation on serum homocysteine in patients undergoing hemodialysis: A randomized controlled trial. Saudi J Kidney Dis Transpl. 2016;27(2):256-62.