THE TROUBLE WITH B12

Because reliable sources of B12 are found only in animal foods, or in foods fortified with the vitamin , attention to obtaining this nutrient is critical for vegans, and even for vegetarians who consume few dairy foods. Deficiencies of B12 can lead to pernicious (megaloblastic) anemia, loss of appetite, fatigue, pallor, dizziness, numbness or tingling in the extremities, and impairment of brain and nerve tissue that may result in permanent neurological damage. A ma jor concern with B12 deficiency is that it is not easily recognized before it has already caused physiological damage.

One reason why B12 deficiency is difficult to diagnose may be due to folic acid consumption. Folic acid is a B vitamin that functions much as B12 does. Symptoms of folic acid deficiency are similar to those of B12 deficiency, and both give rise to megaloblastic anemia, although only B12 deficiency results in neurological damage. High folic acid intake , as found in many vegetarians and others who eat large amounts of green leafy vegetables, can mask the clinical signs of anemia. This means that blood assays of B12 may appear normal while neurological damage due to B12 deficiency may be progressing undiscovered.

Alternative practitioners such as Rudolph Ballentine, M.D., medical director of the Himalayan Institute for Yoga Science in Honesdale, Pennsylvania, are finding that unrecognized B12 deficiency in their vegetarian patients is more common than they

had thought. When I was in medical school, Ballentine says, I was taught that what you get with B12 deficiency was pernicious anemia. Then, if it goes on too long, you get degeneration of the nervous system. But now we know that this is not necessarily true. Neurological symptoms can precede hematological ones.

To find a more reliable indicator of B12 status, Ballentine scoured the literature and found that the most reliable test was one called the hypersegmentation index , a test of where you put blood samples under the microscope and count the number of hypersegmented nuclei - the more hypersegmented nuclei, the greater the B12 deficiency. We now examine people for hypersegmented nuclei and have found it in a suprising number of people, even vegetarians who eat dairy products, and even in a few people who are not vegetarian. Ballentine says. It is alarming.

William Doell, M.D. medical director of Metagenics, a San Clemente, California based formulator of dietary supplements, has had similar experience. Doell was a family practioner and nutritional consultant in Denver, Colorado, for 25 years and had many vegetarian patients. I had patients who would have high serum B12 levels, Doell says. But when he visually examined the blood cells, as Ballentine did, he would see signs of B12 deficiency. At the time, he says, I didn't know why that was.

Doell points out that people have different abilities to absorb B12. Some people cannot produce intrinsic factor, a protein secreted by the stomach that allows B12 to be absorbed by the intestinal wall. Others lack the transport mechanism to get

B12 from the intestinal wall into the blood. And different factors may inhibit some people from getting B12 from the blood serum into the cells.

Ballentine believes that this malabsorption question is the most serious issue in the field of vegetarianism. We must caefully watch B12 status in people who tend toward a vegan diet.

- Dan Seamens

Reprinted from East West Natural Health Magazine (Nov/Dec 1992)