Should We Supplement?
It’s always best to try and get vitamins and all other nutrients as well, from natural food sources whenever possible. Foods provide a complex network of vitamins, minerals, dietary fibre and other substances that benefit health in ways that supplements usually cannot.
Dietary supplements might help in some serious situations to alleviate a deficiency, but it’s not a good idea to rely on them solely for your nutrient needs. However, as B12 is found only in animal products or fortified vegan foods, supplementing with B12 for those on DBM programs is important, once it has been established that you are indeed deficient.
Concerns and Interactions of Vitamin B12
Vitamin B12 absorption can be hindered when someone has a history of alcoholism or heavy smoking. In addition to alcohol and nicotine, long-term antibiotic use can also reduce the ability of the stomach to absorb and use vitamin B12. For this reason, anyone who has used stomach-acid controlling drugs may want to talk to their doctor about needing vitamin B12 supplements.
Potassium supplements can also reduce absorption of vitamin B12 benefits, so if you take large amounts of potassium in supplement form, you should watch out for a possible vitamin B12 deficiency. Potassium from food sources shouldn’t cause a problem, but very high amounts may set someone up for a vitamin B12 deficiency.
If Proven To Be Deficient, Which Supplement To Choose
Research shows that people with chronic kidney failure or who are on haemodialysis should NOT take cyanocobalamin form of B12, as they do not detoxify cyanide as well as health people do.
Vegans with kidney disease, whether or not they are on dialysis, should take a non-cyanocobalamin form of B12. These patients should talk to their health professionals about how much should be taken. 1,000 µg (1 mg) of methylcobalamin or adenosylcobalamin per day might be adequate.
Cyanide Metabolism Defects
Cobalamin has a strong attraction to cyanide. While being a natural chemical produced in the body, cyanide is toxic, and the body turns it into thiocyanate in order to excrete it. If this pathway is defective or overwhelmed through ingestion of too much cyanide (such as in smokers, or people in Nigeria who eat large amounts of cassava which is high in cyanide), the body may detoxify the cyanide by attaching it to cobalamin and then excreting the cyanocobalamin.
So, to be cautious, I am suggesting that vegan smokers supplement with a non-cyanocobalamin form of B12. The amounts will have to be somewhat arbitrary because of the lack of information on the absorption rates and detoxification action of the various forms of B12 in smokers. I have not seen evidence of oral adenosylcobalamin's effectiveness in counteracting B12 deficiency. Donaldson had success with oral methylcobalamin. I would, therefore, tentatively recommend 500-1,000 µg/day of methylcobalamin. It could be that the recommendations for vegan smokers need not be any different than those for non-smokers. At this time, I do not feel that there is enough evidence one way or the other. There is no evidence that cyanocobalamin is harmful to vegan smokers; including a modest source of cyanocobalamin (e.g., 3-5 µg/day), in addition to methylcobalamin, could serve as insurance.
WE STRESS THAT supplementation is not our first choice. HOWEVER, given the poor diets, alcohol, smoking, antibiotics and other drugs, that is the "norm" for most people, it is often advisable to be tested for this deficiency. Once proven deficient, in the short-term, supplementation can be used.
Our first choice in supplementing your diet for B12 is and always will be SAUERKRAUT - read on for more information.
Vitamin B12 Supplements
B12 (also called cobalamin) is essential for your brain, nervous system, and blood cells. Deficiency leads to anemia and severe brain damage. Vegan children and elderly are especially at risk. To be safe, I take a B12 supplement. Look for the natural B12 called methyl-cobalamin. Synthetic B12 (cyano-cobalamin) does not occur in nature. Our body must convert cyano- into methyl-cobalamin. This results in cyanide byproducts.
In their book, Davis & Melina recommend 10 micrograms (mcg) of B12 a day. But in an expert interview, I heard Brenda Davis say that only 0.5 to 1% of B12 is absorbed. She said we should take 1,000 mcg a day!
Vegan Dr. Michael Klaper also said in a 2013 interview that a 1,000 mcg pill-a-day is good. That's very expensive. It's much cheaper to get 100% absorption with the B12 patch.
B12 patches are more powerful than sublingual tablets or liquid B12. You stick the patch behind your ear for a day and it goes right into your bloodstream where you want it. Each patch gives you 1,000 mcg of superior methyl-cobalamin B12. This is of course, if the patch is available in your home country.
The patch is second only to B12 shots!
Take two capsules of Super Mega-B twice a week. It's all the B vitamins with 300μg of B12 (μg = microgram). Plus I use one 1,000 mcg patch behind my ear once a month. It's expensive for me to buy patches in US dollars. I live in South Africa. If I could, I'd take it weekly.
Luckily B12 supplements are vegan. Paul Pitchford writes:
"Nearly all B12 supplements are non-synthetic and are not derived from higher animal sources; they are produced from bacteria. For convenience, one fifty-mcg supplement can be taken each week."
It's best to take your mineral supplement on a different day from B12. Pitchford reports that the combo of minerals with B12 can form B12 analogs (pseudo-B12). They fit B12 receptor sites but don't do B12's job. In fact, analogs stop B12 from doing its job — they block the receptors (parking bays) where B12 needs to park.
Spirulina (a cyanobacterium), seaweeds and some algae have pseudo-B12. No plant or animal can make B12. Only bacteria have the right enzymes to synthesize it.
The DRI (daily recommended intake) for B12 is 2.4 mcg a day, that's 72 mcg a month! Whereas Davis & Melina recommend 70 mcg a week (10μg a day) and Pitchford 50 mcg a week.
If you MUST or CHOOSE to supplement and ignore our recommendations of choosing natural sources for your B12, then, if you use a patch once a month for 1,000 mcg, and take a multi-B capsule in-between, you'll be A-okay. B vitamins work synergistically, that's why you can't take B12 alone - you might receive adequate B12.
Your liver stores enough B12 to last you several years, about 2-5 mg of B12 (2,000 - 5,000 mcg). The RDI is only 876 mcg a year.
600 mcg a week is far more B12 than the 50 to 70 mcg the nutritionists recommend. Even if you are absorbing only 1% as Davis claims, AND if you eat sufficient leafy greens high in folate, you should not become deficient..
"When sufficient folic acid is available, all known B12 related deficiency syndromes normalize, save those narrowly connected with the [two] vitamin B12-dependent enzymes."
They mean folate, not folic acid. Folic acid is the synthetic form of folate that increases your risk of cancer, especially breast, prostate & colorectal cancer. B12 is not harmful even in very large doses. On the plus side, research shows that high vitamin B12 levels in elderly individuals may protect against brain atrophy or shrinkage. I was born in 1948.
Testing for B12 Deficiency
B12 deficiency is often not recognized until it's too late, and your child's brain or nervous system may be permanently damaged.
Eating a lot of leafy greens, with all their folate, can hide the signs of B12 deficiency such as anemia. Folate is a B vitamin that functions much as B12 does. Your blood test for B12 may look normal while back at the gate your brain is deteriorating due to B12 deficiency.
The most reliable test for B12 status is the hypersegmentation index. You put blood samples under the microscope and count the number of hypersegmented nuclei. The more hypersegmented nuclei, the greater your B12 deficiency.
Also ask for urinary MMA and homocysteine levels, in addition to the standard serum B12 test. This will give you a clear picture.