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Gabriel Cousins on B12
After reading the article, you can read more
information about the Tree
of Life if you click here.
The work at the Tree of Life and in all my nutrition books,
Spiritual Nutrition and the Rainbow Diet, Conscious Eating
and Rainbow Green Live Food Cuisine is to provide an optimal
situation for everyone to be successful vegan and live food
practitioners. To that end, we address every single issue
that is connected with being successful. The B-12 issue is
one that is critical to a successful and healthy vegan and
live food way of life.
To understand the significance of this issue, we need to
understand a little about the importance of B-12 in the
diet. The average non-vegetarian stores between 2,000
and 3,000 picograms (pg., same as micrograms) of B-12 and
loses about 3 pg. per day. About 60 percent of the total amount
of the B-12 in the body is stored in the liver and 30 percent
is stored in the muscle. The body has a special circulation
pattern between the digestive tract and the liver. Through
the bile, we secrete 1.4 pg. per day of B-12 into the small
intestine, and healthy people reabsorb about 0.7 pg. Research
suggests that if people have a low B-12 intake, the absorption
increases to even draw more B-12 into the system. However,
there is still a general potential for slow loss, depending
on the variation in this special, what is known as enterohepatic
circulation, before we develop the potential of B-12 deficiency
symptoms.
B-12 has two functions: one, methylocobalamin is used
by the enzyme methionine synthase to change homocysteine into
methionine. When this enzyme is not working, we increase the
homocysteine in our system, which recent research has associated
with the increased potentiality of heart disease and deterioration
of the arteries and nerves. When the homocysteine is high,
it appears to be a nerve toxin, as well as a blood vessel
toxin. The second function of B-12 is as a coenzyme is using
5'-deoxyadenosylcobalamin in the enzyme methyl malonyl-CoA
mutase in the conversion of methyl malonyl-coA to succinyl-CoA.
Elevated homocysteine also happens with deficiencies in B-6
or folic acid. One of the major symptoms of B-12 or folic
acid deficiency is macrocytic anemia. Folate, also called
folic acid, is needed to turn the uracil into thymidine, an
essential building block of DNA. This DNA is needed for production
of new red blood cells and for red blood cell division. B-12
is involved because it is involved in the pathway that creates
methyl cobalamin. This B-12 also produces a form of folate
needed to make DNA. So, if there is no B-12, folate can become
depleted and DNA production slows down.
Another little side part of the methyl malonyl-CoA to succinyl-CoA
conversion is that when the B-12 is not available, the methyl
malonyl-CoA levels increase and are converted to methyl malonic
acid, which accumulates in the blood and urine. Since the
B-12 is the only co-enzyme required in this pathway, methyl
malonic acid levels are considered the gold standard as an
indicator of B-12 deficiency. Other causes of high methyl
malonic acid (MMA) are genetic defects, kidney failure, low
blood volume, dysbiosis, pregnancy and hypothyroid. The MMA
test is important because the progressive medical community
no longer considers serum B-12 levels an accurate measurement
of appropriate amounts of B-12. In other words, a normal serum
B-12 may not mean that B-12 levels are healthy. We need a
urinary assay of methyl malonic acid to really determine that.
This is an important point, because when I first wrote about
this issue in Conscious Eating, the establishment of the methyl
malonic acid assay as the gold standard had not taken place
yet. I based some of my statements at that time on the world
research, which was using serum B-12. A serum B-12 of 200
pg. or less was considered deficient. As a result of the new
gold standard and what we know about MMA and homocysteine,
the B-12 serum levels should be around 450 pg. to maintain
a normal homocysteine level. Therefore, serum B-12 levels
less than 450 pg. may be considered as indicating a B-12 deficiency.
There are a variety of symptoms of B-12 deficiency,
which are important to vegans and live fooders. The first
is actually low energy. It could be a reason why some people
just don't feel well on these diets, besides not getting the
right protein/carbohydrate/fat mix for their constitutional
type. There are specific neurological symptoms, often described
as "subacute combined degeneration". Some of this
damage can be almost irreversible, if it becomes chronic.
This nerve system degeneration affects peripheral nerves and
the spinal cord. Some of the typical neurological feelings
include depression, numbness and tingling in the hands and
feet, nervousness, paranoia, hyperactive reflexes, impaired
memory and behavioral changes. With a B-12 deficiency, one
can also have diarrhea, fever, frequent upper respiratory
infections, impotence, infertility, sore tongue, enlargement
of the mucous membranes of the mouth, vagina, and stomach,
macrocytic anemia, low platelets, increased bleeding, low
white blood cell count. Some of the causes of B-12 deficiency
are low dietary intake of B-12 and/or poor absorption, which
usually comes through loss of intrinsic factor and/or a lack
of stomach acid.
Consistent research over the last decade has shown that
vegans and live food people of all ages and sexes have a much
higher risk of becoming B-12 deficient. This does not
mean that everyone becomes B-12 deficient. This deficiency
is particularly true with newborn babies, especially babies
of vegan live-food nursing mothers who are not using B-12
supplementation. In contrast to the average adult storage
of 2,000-3,000 pg. of B-12, newborns of mothers with normal
B-12 have about 25 pg. Studies have shown that the milk during
the first week of life does contain large amounts of B-12.
This means that the B-12 storage in infants at birth is normally
adequate to last the first few weeks of life. Afterwards,
they must get it from breast milk or other sources. If a vegan
or live-food mother is already B-12 deficient during pregnancy,
the baby may be born with seriously low B-12 levels and develop
clinical signs of deficiency as soon as two weeks. The general
research suggests that even among non-vegetarians, B-12 can
be insufficient in infants, and that perhaps all breastfeeding
mothers should consider B-12 supplements for themselves and
their infants during the time of breastfeeding. This lack
of B-12 in the mother's diet during pregnancy has been associated
with a lack of myelin production, which is the coating of
the nerves. It takes somewhere between one to twelve months
to develop, and manifests as failure to thrive and slow developmental
progression. The babies are often lethargic, lose their ability
to use muscle adequately, and even their sensory attunement
decreases. They also have irregular macrocytic anemia.
The good news that one major study in the United Kingdom
in 1988 showed, in studying 37 vegan children was that there
was normal growth and development in children who were breastfed
for 6 months at a minimum, when there was B-12 supplementation.
Young childrenand teenage children who were supplemented
with B-12 were found to grow normally. Adults who were vegetarian
without B-12 supplementation for greater than six years usually
had a lower B-12 than non-vegetarian adults in the general
research. In one study of adults in 1994, 81% of the vegan
adults had a B-12 lower than 200 pg. That is approximately
the percentage of adults on a live food diet who are low in
B-12. In my clinical experience, meat eaters, vegans and live-fooders
tend to have a fairly high percentage of B-12 deficiency,
although meat eaters do have less incidence. My experience
is that cooked food vegans have a higher incidence of B-12
deficiency than live fooders, but there is still a significant
occurance in live fooders. In vegetarians and vegans, there
is also a high percentage under 200 pg., about 54%. A study
in 1982 by Dunn and Scott of raw food vegans with 83 subjects
from the Natural Hygiene Society showed that 92% of the vegans
had a B-12 less than 200 pg., and in 53% it was less than
100 pg. The World Health Organization (WHO) considers B-12
deficiency to be less than 200 pg. The percentages of B-12
deficiency tend to increase over time on a natural hygiene
diet. Another study in Finland in 1995 that examined B-12
status of long-term 100% raw vegans found that 66% of the
people had a B-12 lower than 200 pg. One study done in 2000
by Donaldson at Hallelujah Acres on primarily live food diet
people, but with some B-12 supplementation via nutritional
yeast, showed only about 15% of the people were less than
200, and none of them less than 160. The supplementation with
nutritional yeast was 5 pg. of B-12 from one tablespoon of
Red Star Vegetarian Support.
Up until this time, many of us have felt that additional
supplementation for live fooders with sea vegetables or probiotic
formulas was sufficient for protection against B-12 deficiency.
This does not seem to be the case. In macrobiotics, who
primarily cook their food, we see a very high percentage of
children actually having growth retardation due to low B-12
intake. Many of us have felt that spirulina, Klamath Lake
Algae, all the sea vegetables had enough active B-12 to avoid
a B-12 deficiency. Although the research is not fully in,
we do know that, as I pointed out in Conscious Eating, these
substances do have human active B-12. The problem is they
also have a significant amount of analog B-12 that competes
with the human active B-12. This analog amount was not
measured in my studies. Using the methyl malonic acid reduction
approach, which is now the gold standard, research showed
that when people used dry and raw nori from Japan, the dried
nori actually made the methyl malonic acid (MMA) status worse,
which means it actually reduced the B-12 status. Therefore
it could possibly worsen a B-12 deficiency. Raw nori seemed
to keep the methyl malonic acid at the same level, meaning
it did not harm the B-12 status, but the research showed it
did not particularly help it either. No food in Europe or
the U.S. has been tested for lowering methyl malonic acid.
Research absolutely has to be done to answer this question
fully.
There is one exception to this lack of vegetarian B-12 active
food, which is that we do produce B-12 from bacteria in our
large intestine, but since this B-12 is produced in the area
below where B-12 is reabsorbed, it is really not available
for absorption. Some people have argued that a lot of species
of lower mammals do not need B-12. The reason why this is
true is that a lot of species that are primarily vegetarian
animals eat their feces. Human research also has shown if
you eat your feces, you will get enough B-12. Dr. Herbert
sponsored research in England where vegan volunteers with
a documented B-12 deficiency were fed B-12 extractions made
from their own feces. It cured their B-12 deficiency. So,
there is a natural vegan way to do it. It may not be the most
tasteful way, however.
Some have theorized that organic foods, in various regions,
would improve the B-12 tests by lowering the serum malonic
acid, but again, the research has not shown that washed or
unwashed organic food has made a difference. Many animals,
aside from eating their own feces, will ingest a variety of
eggs, insects, small vertebrates or soils. For example, gorillas,
who are the closest to vegan of all the species, will eat
insects and sometimes their feces. So there are ways to do
this for vegans, but again, they may not be the most aesthetic
or tasteful. I would love, at this point, to come up with
an alternative to this, however it doesn't seem to be the
case.
There are many ideas of vegan foods that have active B-12,
but few are proving to actually raise B-12 or prevent its
loss. The research has shown, for example, that tempeh
does not supply human active B-12. Research in both the
U.S. and the Netherlands has confirmed this. There was one
paper that showed that tempeh from one particular source in
Thailand did have some B-12, but what they basically found
was that fermented soybean did not contain B-12. Other
foods such as barley, malted syrup, sourdough bread, parsley,
shitake mushrooms, tofu, and soybean paste, had some B-12
in them. Amazake rice, barley miso, miso, natto, rice miso,
shoyu, tamari, umeboshi, and a variety of nuts, seeds and
grains did not contain any elements or even any detectable
B-12 analog. My study using the earlier gold standard test
for B-12 active bacteria did show indeed that arame, dulse,
kelp, kombu and wakame had significant human active B-12.
Other studies have shown that dulse did have a certain
amount of B-12 analog per serving. Until research is done
to see if it actually lowers the methyl malonic acid levels,
the question has to be raised that we can't assume that because
a food has human active B-12 it will help avoid a B-12 deficiency,
because the actual non-human active analogs may be blocking
the human active B-12. The same question arises now with the
aphanizomenon flos-aqua and spirulina, as well as chlorella.
So, until we actually do the gold standard test of these,
through the methyl malonic test, to see if it actually lowers
the methyl malonic acid, I think it is reasonable to eat these
foods, but not expect that they are actually going to raise
your human active B-12. My serum B-12 of 600 pg. may have
thrown off my conclusions when I wrote my summary in 1990.
I may have been in that 20% of vegans and live food people
that don't seem to be affected. But I am more concerned about
the other 80% that are B-12 deficient and that 50% whose B-12
levels go down to less than 100 pg. A study done in 1991 by
Miller found that serum B-12 appeared to be unrelated to consumption
of wakame, kombu, and other sea vegetables or tempeh in macrobiotic
children. Other researchers feel that it is possible that
raw nori, not dried nori, is a source of active B-12. Some
of these conclusions are not finalized. This brings me to
the next issue, which is, what is a normal level of B-12?
Now the next question really is, what is a healthy level
of B-12 in the serum? The answer is that a serum level of
450 pg. keeps the homocysteine level within normal levels.
Some might just say that dulse and raw nori and an algae called
cocolithophorid algae, also known as pleurochritias cartera,
may provide sufficient human active B-12. They have not been
fully tested with the gold standard. The normal serum homocysteine
level is 2.2 - 13.2 micromoles/liter. The normal adult urine
MMA is .58 - 3.56 micromoles/mmol/cr. The normal level of
B-12 for breast milk is 180 - 300 pg. per ml. The normal urine
level for children is 820 - 11,200 micromoles/mmol/cr of MMA.
The normal serum B-12 level of children is 160 - 1300 pg.
per ml.
Using the methyl malonic acid study as the gold standard,
elevated methyl malonic acid was found in subjects with a
B-12 up to 486 pg. This is a really important statement, because
up 'til this time, most of the studies in the world health
basically say that 200 pg. and above is not considered deficient.
That was somewhat how I based my ideas that B-12 in many vegans
and raw foodists was low normal, but still within normal.
Using the gold standard methyl malonic acid test, studies
show that without supplementing with B-12, vegans have higher
homocysteine levels than lacto-ovo vegetarians and non-vegetarians,
which means they are deficient in B-12. The good news,
of course, is that B-12 supplementation will decrease these
high homocysteine levels back to normal range. High homocysteine
levels are connected with the potential for heart disease,
arterial destruction and neurological pathologies. Other diseases
associated with an elevated homocysteine are: Alzheimer's,
age related hearing loss, neural tube defects, recurrent loss
of pregnancy, increased mortality. Many non-vegetarians also
have a poor B-12 status because there are many factors that
can cause B-12 deficiency. They include malabsorption or inadequate
intake of protein or calories or B-12, radiation exposure,
drugs, and a variety of toxins, paraminosalicylic acid, alcohol,
pancreatic tumors, failure of the small intestine to contract
and move food associated with bacterial overgrowth, oral contraceptives,
fungal infections, liver and kidney disease, tobacco smoking
and B-6 or iron deficiency.
The research conclusion is that: it is a reasonably
safe bet that about 80% of the vegan and live food population,
over time, runs the risk of a subclinical or clinical B-12
deficiency and increased homocysteine levels.
An even higher percentage of newborns run this risk. My
suggestion, out of my concern for all of my clients, for my
fellow live fooders and vegans is that it is well advised
to supplement with an actual B-12 human active supplement.
There are vegan B-12 supplements, which allow us to be totally
successful vegan live fooders.
My general recommendation is that if you have symptoms
of B-12 deficiency, you can even start with a 100 pg. injection,
or according to the research, an oral administration of 1,000
pg. per day for two to four weeks is equal to repeated monthly
injections. After about a month of the oral, the dose
can be cut in half. One can even cut that in half again. I
don't really recommend nutritional red star yeast, because
of the fungal potential; I think that the safest and healthiest
approach is via supplementation.
Some people eat according to their philosophy and belief of
what is natural, and this may be an impediment. For example,
the black Hebrews, a group of African-Americans who have migrated
to Israel, have horrendously high levels of infant B-12 deficiency,
as well as adult B-12 deficiency. They did not believe in
taking supplements. Data in a 1982 study showed that of the
infants who were breastfed for three months, and then were
given diluted homemade soymilk for three months to one year,
25 of them (a significant percentage) had protein deficiency,
iron and B-12 anemia, as well as zinc deficiency. In the 1982
study, three of the infants were dead on arrival, five more
died within a few hours of hospital admission, despite treatment.
Serum levels were low in 9 of 15 cases and undetectable in
three of them. I don't feel this is a very good example of
what we want to show to the world in the way we want to treat
our children. We can make those choices. We have a theory
of natural, and we also have a theory of what it means to
be healthy.
This is the first time in history that we can be completely
successful live food vegans. What I mean by being successful
is completely healthy, including no B-12 deficiency and no
elevated homocysteine levels. It is my medical opinion, as
a vegan since 1973 and live fooder since 1983, and as a person
committed to supporting all those who choose to become healthy
live food vegans, that it would be wise to incorporate some
B-12 supplementation in your diet. I believe it is more natural
to be healthy than it is to be anything less than that.
Gabriel Cousens, M.D., M.D.(H), Dip. Ayurveda
B12 UPDATE March 2004
Dear Brothers and Sisters,
I was pleased by the general positive response to the B12
article. It was nice that so many people understood the integrity
of my intent, which is to create the understanding and support
for everyone to be successful on a live food diet. The ethics
of live food lifestyle are wonderful, but we need to remember
that we are still in the first few generations of a worldwide
live food movement. We need to give honest feedback so we
can attain the highest level of health and make this a truly
successful worldwide movement.
Contrary to what a few people wanted to interpret from my
article, there was more than one study that showed live food
people were B12 deficient. There were at least three studies
on adults and two on children. All five of these published
live food studies showed the participants had serious deficiencies.
These are no studies that show live food vegans do not get
B12 deficient overtime. There are at least fifteen vegan studies
on adults that have shown identical results. Cooked food and
live food vegans show the same results…approximately 80% of
those who do not use B12 supplements or B12 fortified foods
sooner or later develop symptoms of B12 deficiency. These
may include physical symptoms such as the inability to walk,
tremors, weakness, fatigue, diarrhea, fever, upper respiratory
infections, impotence, infertility, anemia as well as neurological
symptoms such as depression, anxiety, panic attacks, hyperactive
reflexes, numbness and tingling in the hands and feet, impaired
memory, and paranoid delusions. These appear in children as
well, but in children if they are not caught in time, they
often result in death. Sickness and death due to B12 deficiency
do not support the expansion of the vegan live food movement.
These symptoms are not just “a misunderstood healing crises
or poorly functioning colon or a poor live food diet.”
Although bacteria in the colon do produce B12, it is not
reabsorbed into the system. Published research has shown that
if people eat an extract of their feces they will not get
a B12 deficiency. Although this may be considered natural,
it is not something that I recommend. There are far easier
and tasteful ways to build the B12 such as taking a supplement
or eating B12 fortified foods. Whether one’s colon is clean
or not, B12 does not get absorbed from the colon. A reasonable
dose is 10-100 micrograms per day. Research shows that a daily
intake best approximates the natural intake pattern. Vegan
tablets are available from a variety of companies; Twin Labs
has gelatin in its tablet and therefore is not vegan. There
are three forms of B12: cyanocobalamin, methylcobalamin, and
hydroxycobalamin. Although all three forms work, but cyanocobalamin
probably should not be used in people with kidney problems
or who smoke. In some studies with people with severe B12
deficiencies oral doses of 1000 micrograms per day for two
months worked as well as 1000 microgram injections repeatedly
given.
A published report cites a man in his eighties who had been
in excellent health as a vegan for 38 years, when suddenly
he began to suffer from mental disturbances, developed confusion
and sadness, lost bowel control, and lost motor control skill
to the point where he could marginally stand up. After one
shot of B12 his physical and mental health began to rapidly
return and by one week many of his symptoms had disappeared.
A personal communication with Nazariah Owen who developed
weakness, fatigue and impaired motor and nervous system symptoms
including the loss of the ability to walk following a seven
year history of lacto-vegetarian diet followed by a five year
history of a pure raw vegan diet tells of a too common story.
His symptoms disappeared after starting B12 supplementation
and eating B12 fortified foods. He found many people who had
similar B12 deficiency symptoms, but who were afraid to share
publicly. An additional health problem associated with a low
B12 is elevated homocysteine which is associated with an increased
incidence of heart attacks, neurological problems, neural
tube defects in children especially if the folic acid is low,
increased incidence of hearing loss with age. In one study
women with higher homocysteine levels had 170% chance of two
or more pregnancy losses in the first trimester.
If the live food movement is to mature, it requires that
we do not suppress honest feedback so we can solve the problems
that do arise in this young mass movement. Yes…there are 20%
who may not get an immediate or even a deficiency after 20
years. There are one million four hundred thousand genetic
variations in our DNA. Some people are going to get B12 deficient
sooner than others or not at all because of their particular
enzyme systems and metabolic patterns. For some it may be
like the man in his eighties who took thirty-eight years before
becoming deficient.
For those who do not want to risk the eighty percent chance
of becoming deficient, oral supplementation is the simplest
way to avoid a B12 deficiency and elevated homocysteine levels.
The personal physical, moral and spiritual reasons for succeeding
at live food vegan diet, the shift in world consciousness
and healing of the planetary ecology brings is a far greater
gift than the ego gratification of holding on to a concept
of naturalness.
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