Conscious Eating Part 16

IT HAS BEEN A WELL-KEPT SECRET that a vegetarian diet increases endurance. Modern athletes are just beginning to discover what Dr. Irving Fisher first reported in the Yale Medical Journal in 1917, and what at least four more recent studies have shown: A vegetarian diet helps the body function at an endurance rate that is approximately twice that of a flesh-centered diet. He found that even sedentary vegetarians had more endurance than meat-eating athletes. In a study confirming this finding, Dr. Joteyko of the Academy of Medicine in Paris compared vegetarians and nonvegetarians from all walks of life and found that vegetarians had 2-3 times the endurance and took one-fifth the time to recover. In a Danish study in 1968, the performance of the same people on three different diets showed that on a strictly vegetarian diet they averaged 167 minutes on a bicycle endurance test as compared to 57 minutes on a high-meat and -dairy diet. In Belgian research comparing handgrip strength, vegetarians averaged 69 squeezes as compared to a weaker 38 squeezes for nonvegetarians. They also found that vegetarians had a faster recovery time. Dr. Chittenden, another researcher in this area, and Dr. Fisher surmised that one of the reasons meat-eaters had less strength and endurance is that the protein breakdown products such as uric acid, urea, and purines poison and interfere with muscle and nerve function. This immediate factor, plus all the other factors we have been discussing, make a difference when one is interested in endurance.

There are many world-cla.s.s athletes who were vegetarian at the time they won their world records and performed their greatest athletic accomplishments. Dave Scott was a lactovegetarian when he won the Hawaii Iron Man Triathlon an incredible six times! He won it three times in a row, while no one else has ever won it twice in a row. Vegetarian Edwin Moses was an Olympic Gold Medalist and top performer for eight years in the 400-meter hurdles without losing a race. Murray Rose, who as a teenager became one of the world's greatest swimmers and later starred as Tarzan, was a vegetarian. Paavo Nurmi was another vegetarian. The "Flying Finn," who set twenty world running records and won nine Olympic gold medals, found a vegetarian diet the best for endurance. Gayle Olinekova, a premier women's long-distance runner and longtime vegetarian, told me that she ran the Boston Marathon after a seven-day water fast and had one of her best times. Vegetarians have been able to develop strong bodies as well as endurance. For example, there is Andreas Cahling, a raw-food vegetarian who won the Mr. International award in 1980. Roy Hilligan won Mr. America. Stan Price, another vegetarian, set a world record in the bench press.

Population Studies Validate the Health and Longevity Effects of Vegetarianism.

OF 154 CENTENARIANS INTERVIEWED IN BULGARIA, only five ate meat regularly. It is a well-established fact that the longest-lived people throughout the world, such as the Hunza Kuts, Bulgarians, East Indian Todas, Russian Caucasians, and Yucatan Indians, are either complete vegetarians or eat meat infrequently. They eat between one-third to one-half the protein that we eat in the US.

In a study of Seventh-Day Adventists, the largest single group of vegetarians in the US, it was found that their colon cancer rate was 1.0 as compared to 2.7 for those on a flesh-centered diet. They were also found to have 40% less coronary disease than those who ate flesh. In a comparison study of strict Seventh-Day Adventists versus those of the same religion who ate meat three times per week, they found the strict vegetarians had one-half the mortality from breast cancer. The general mortality rate of Seventh-Day Adventists was 50-70% less than the US population at large.

The Journal of the American Medical a.s.sociation in 1961 estimated that 97% of heart disease could be prevented by a vegetarian diet. Research statistics show that a high-flesh-food diet causes ten times more heart attacks in the 45- to 65-year-old population than a diet of fresh vegetables, fruits, nuts, seeds, and grains. Twenty-six percent of people who eat meat have hypertension as compared to 2% of vegetarians. Flesh-eaters have 2.3 times more colon cancer, 4 times more breast cancer, 3.6 times more cancer of the prostate, and 10 times more cancer of the lungs than do vegetarians.

Because the animals whose flesh is eaten are higher on the ecological chain, there is a higher concentration of radioactive materials from fallout as well as higher amounts of pesticides, fungicides, and many other environmental toxins. This undoubtedly adds to a decrease in vitality and quality of health. Vegetarian women have been found to have between one-third to one-half the pesticides in their tissues as compared to meat-eaters. There are approximately fourteen times more pesticides in flesh foods than in vegetarian produce. Flesh-eaters have to face the threat of the disease toxo-plasmosis in pigs and cattle and trichinosis in pigs, as well as the threat of salmonella poisoning, especially from chickens. It is estimated that approximately one-third of commercial chickens carry salmonella. Most of the one million cases of food poisoning reported yearly are salmonella.

The social costs of these self-induced, dietary-related illnesses are enormous. The National Heart, Lung, and Blood Inst.i.tutes estimate that the cost of heart attacks alone in 1983 was sixty billion dollars in medical bills, lost wages, and productivity. Mordecai Ben-Porat once introduced a bill in the Israeli parliament to outlaw flesh-eating because it was estimated it would save 4,266 billion British pounds from the improved health that would result from a vegetarian diet. The bill did not pa.s.s, however.

Wartime epidemiological population studies of vegetarian diets have brought some fascinating results. In 1917-1918, when little meat was available in Denmark due to the war, the death rate of civilians dropped 34% as compared to the yearly average for the previous 18 years. In the same sort of wartime situation during World War II in Norway, with little meat available, the death rate from circulatory disease dropped significantly. The effect of the nonflesh diet was confirmed when, after the war, the meat consumption rose and the death rate also rose correspondingly. In Great Britain, where there was also a decrease in flesh food in the diet, infant and postnatal deaths dropped to their lowest rates ever. Dental health improved in children. The amount of anemia decreased as did the rate of cardiovascular diseases. In general, overall quality-of-health statistics improved in England with less meat in the diet.

A Cornell-China-Oxford Project on Nutrition, Health, and Environment, which began in 1983 to track the health of 6,500 Chinese in sixty-five provinces throughout China, has provided some interesting preliminary results. This study offers some particularly potent epidemiological evidence of the superior health benefits of a primarily vegetarian diet. According to Nathaniel Mead of the East-West Journal, some scientists are calling this study the "Grand Prix of epidemiology." Although this study may go on for decades, a preliminary release of data available in 1990 has already made several important points.

Preliminary Data.

Cornell-China-Oxford Project on Nutrition, Health, and Environment.

Diets for children that are high in protein, fats, calcium, and calories promote early growth, but higher breast cancer rates among women.

A vegetable-based diet is more healthy than an animal-based diet.

The healthiest percentage of fat intake is 15-20%, which is easy to achieve on a vegetarian diet.

The body gets adequate amounts of calcium from plant sources and does not need dairy to prevent osteoporosis.

A vegetarian diet reduces the risk of nutritionally related diseases.

The study suggests that if flesh-centered societies were to switch to a vegetable-centered diet, it might be a greater factor in improving world health than all the doctors, health insurance programs, and pharmaceuticals that are present approaches to improving world health.

There is an overwhelming amount of evidence, from the microcosmic cellular level to the macrocosmic global cultural level of research, that makes a single point: a vegetarian diet is superior for one's health in almost every way as compared to a flesh-centered diet. A vegetarian diet is a way of loving yourself and your body

The Need for B12 Supplementation.

NEW INFORMATION HAS ARISEN SINCE the first edition of Conscious Eating, based on recent studies and techniques that call for a new a.s.sessment of the role of B12 in the vegetarian diet.

The progressive medical community no longer considers serum B12 levels the most accurate measurement of healthy B12 levels. In other words, a normal serum B12 may not mean that B12 levels are healthy. It is now agreed that we need a urinary a.s.say of methyl malonic acid (MMA) to most accurately determine healthy B12 levels. When I first wrote about B12 in Conscious Eating, the establishment of the methyl malonic acid a.s.say as the "gold standard" had not yet taken place. Some of my statements at that time were based on the world research which was using serum B12. A serum B12 of 200 pg. or less was considered a deficiency. As a result of the new gold standard and what we know about MMA and h.o.m.ocysteine, the B12 serum levels should be around 340405 pg. Therefore, serum B12 levels less than 340405 pg, and in some cases less than 450 pg. may be considered as indicating a B12 deficiency.

Using the methyl malonic acid test as the gold standard, elevated MMA was found in subjects with a B12 up to 486 pg. Up until this time, most of the studies in world health basically say that 200 pg. and above is not considered deficient. That was somewhat why my earlier edition of Conscious Eating suggested that B12 in many vegans and live-food pract.i.tioners was low normal, but still within normal. Using the gold standard methyl malonic acid test, studies show that without B12 supplementation vegans have higher h.o.m.ocysteine levels than lacto-ovo vegetarians and non-vegetarians, which means they are deficient in B12. High h.o.m.ocysteine levels are connected with the potential for heart disease, arterial destruction, neurological pathologies, Alzheimer's, age-related hearing loss, neural tube defects, recurrent loss of pregnancy, and increased mortality.

Consistent research over the last decade has shown that vegans and live-food pract.i.tioners of all ages and s.e.xes have a much higher risk of becoming B12 deficient. There are more than fifteen studies on vegans and an additional three studies on live-food vegans that have substantiated this point. The most dramatic was a study done by Dong and Scott on eighty-three subjects at a Natural Hygiene Society conference. Ninety-two percent of the non-B12 supplementing, primarily live-food vegans were B12 deficient. This seemed to increase with the amount of time as a vegan. There are no studies that show that vegans do not get Bu deficient over time.

The conclusion from the present research is that: it is a reasonably safe bet that about 80% of the vegan and live-food population, within six to ten years, runs the risk of a subclinical or clinical B12 deficiency and increased h.o.m.ocysteine levels. Perhaps over a thirty- to fifty-year span it may reach 100%. An even higher percentage of newborns run this risk, as they have a B12 reserve of 25 ng versus 20003000 ng for an adult. There are a variety of symptoms of B12 deficiency. The first is low energy. This 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 const.i.tutional type.

Out of concern for all of my clients, for my fellow live-food pract.i.tioners, vegans, and their children, I strongly advise supplementation with an actual B12 human active supplement, especially during pregnancy and while breast feeding. My general recommendation is that if you already have symptoms of B12 deficiency, you can start with a 1,000 pg. injection, or according to the recent research, an oral administration of 1,000 pg. per day for two to four weeks. The safest and healthiest approach to B12 supplementation is a food concentrate or extracted B12 supplement. The Tree of Life carries a liquid B complex extracted from yeast that gives a minimum of 12 ng of B12 per one-half teaspoon, which is easy for babies, children, and adults to take. My opinion is that it is best to take B12 on a daily basis at 10100 ng per day to prevent a potential B12 deficiency. More research is necessary to be sure of the exact minimal amount.

Do Vegetarians Get Enough Vitamin B12?

THE OFTEN-HEARD HEALTH QUESTION raised by nonvegetarians and vegetarians alike is whether vegetarians get enough B12. The answer is an important one because B12 deficiency can cause nerve degeneration and even death. I will speak more about the symptoms of B12 deficiency later. The B12 question is not one that can be answered merely by a simple recounting of the results of one or two laboratory studies or theoretical discussions. In order to answer this question to my own satisfaction I had to look at my clinical experience and review a lot of the clinical studies on lactovegetarians and vegans. Vegans are those who do not consume any animal products, including dairy.

As pointed out by Dr. Alan Immerman in his review of vitamin B12 status on a vegetarian diet, many studies of vegans have appeared in the literature in the last 35 years. Of those studies suggesting an apparent B12 deficiency in vegans, none fulfilled the full scientific criteria for a legitimate B12 deficiency diagnosis. According to Dr. Immerman, all of the scientifically complete studies on vegans showed no evidence of B12 deficiency. Such studies include: 1. Harding and Stare in 1954, who examined 26 vegans and found no B12 deficiencies and general good health; 2. Ellis and Montegriffo, who also studied 26 vegans and found no evidence of B12 deficiency-four of the vegans had been on the diet for more than 13 years with no supplements and had normal B12 levels; and 3. A study by Sanders in 1978 on 34 vegans, all of whom had normal blood and physical exams. Sanders divided the subjects into two groups: one group who had been taking some sort of B12 supplement (six people were taking regular B12 supplements) and one group who had absolutely no supplements. The average B12 serum level was higher in vegans who were taking some sort of food or vitamin B12 supplements. Their serum level was 421 picograms/cc (pg/ml) as compared to 253 pg/ml for the vegans not taking any supplements. No subject had a serum B12 less than the 80 pg/ml defined as indicative of deficiency by the World Health Organization in 1968. Some private laboratories now use 115 pg/ml as the indicator of deficiency. These major studies, plus other studies, suggest that dietary B12 deficiency is rare among healthy vegans and all other types of vegetarians, whether they be lactovegetarians or lacto-ovovegetarians.

Like the "high protein" myth, the B12 scare aimed at vegetarians also dissolves in the face of scientific studies of population subgroups. In studies of villagers in southern India who are vegetarian, B12 deficiency was also found to be a rare occurrence. Dr. Baker, who studied some populations in southern India, found people with serum levels below 140 pg/ml who were what he considered healthy subjects with no clinical evidence of B12 deficiency. This suggests that a low serum level, without neurological, hema-tological, or any other clinical evidence of B12 deficiency, is not necessarily an accurate way to diagnose B12 deficiency. If serum B12 were used as the sole criteria, it would be necessary to categorize much of the population of India and other developing countries as deficient in B12.

My observation, however, is that the serum B12 level in vegetarians and in vegans in particular is lower than that of people on a flesh-centered diet. Instead of thinking of these levels as inadequate, it seems more accurate to broaden the range of acceptable normals based primarily on serum levels of nonvegetarians to include averages for vegetarians, which do run lower.

In general, I have begun to find that the physiological profiles for vegetarians, and particularly vegans, are different than those of nonvegetarians. For example, vegans will have lower cholesterols and triglycerides than flesh-eaters. If we used vegan physiology as the standard, more flesh-eaters would be considered to have high cholesterols rather than just high normal cholesterols. Broadening the range of normals for B12 levels to include healthy vegans gives us a much clearer framework from which to a.s.sess health. It also forces us to look at our cultural biases.

Live-food vegetarians exhibit different baseline normals of nutrient levels compared with other dietary sub-groups, including cooked-food vegetarians. Raw-food people will have less enzymes in their digestive secretions because their bodies have adjusted to the high enzyme concentrations that come in the raw foods. If large amounts of cooked food were added to their diets, we could expect that within a week the enzyme contents of their secretions would shift back to that of the regular cooked-food population. I have also observed that as the health of a person improves and their diet includes more live food and less protein, they seem to need less food and have more vitality. This positive physiological shift is a fairly consistent observation. This may also explain why the cultural studies of those primarily vegetarian populations which abound in good health and longevity find that the subjects are able to live healthily on between one-third to one-half the protein and calorie intake.

The question that needs to be asked is: "Why do healthy vegans routinely not suffer from B12 deficiency, despite fears, mythologies, and some 'scientific' prognostications to the contrary?" To answer this, it is helpful to understand a little about the physiology of B12.

Physiology of B12.

1. B12 is only available from bacterial production. B12 is not made by plants or animals. All B12 found in plants and animals is from bacteria growing in or on them. Animals are a better source of B12 than plants because they have more bacteria growing in them. Not all the B12 produced by bacteria are the same. Some are very useful to humans and others are called a.n.a.logs, which are similar to B12 in chemical structure but are not utilizable by human vitamin metabolism. Some theorize that these a.n.a.logs may even block the utilizable B12 uptake by occupying some of a limited number of B12 uptake sites. For example, in a human's stool there are approximately 100 micrograms of B12; 95% are a.n.a.logs, which are not utilizable, and 5% are the true B12 that is active for humans.

2. Humans have B12-producing bacteria throughout the body. It is estimated by Doctors Thrash and Thrash that the microorganisms between the teeth and gums, around the tonsils, in the tissue at the base of the tongue, and in the nasopharyngeal pa.s.sages produce about .5 microgram per day. Dr. Baker and his a.s.sociates have shown that there are bacteria in the small intestine which produce utilizable B12 which is a.s.similated into the system through the lower end of the small intestine (the ileum). Colon bacteria also produce 5 micrograms of utilizable B12 daily, but B12 doesn't seem to be absorbed from the colon.

3. B12 absorption begins in the stomach, where gastric secretions of proteases and hydrochloric acid split off the B12 from the peptide bonds that attach it to the food. Proteases from the pancreas later disconnect from the food whatever B12 has not yet been separated out. A healthy pancreas, as well as strong gastric secretions, are needed for maximal B12 absorption. Once the B12 is disconnected from the food, it binds to the intrinsic factor. It then goes to specific receptor sites in the ileum part of the small intestine, where it is absorbed into the system. About one percent of the B12 absorption is directly through the ileum via the basic diffusion process. It is this one percent which is probably the basis for the use of the extremely high B12 tablets we see in the health food stores.

4. An additional mechanism for maintaining a high B12 level in the system is the high quant.i.ties secreted by the liver into the bile. Dr. Herbert, a national expert on B12, estimates that anywhere between 1 to 10 micrograms of B12 are secreted into the bile, and therefore into the small intestine, each day. Normally we absorb much of the human-active B12 back into our system through the ileum. In this process unwanted a.n.a.logs are excreted. Dr. Herbert feels that vegetarians may be getting more B12 from the reabsorption of the bile B12 than from the foods they eat. Since humans need less than 0.5 micrograms per day, this bile secretion is indeed significant.

5. Louis Sullivan, a researcher at Harvard, showed that only 0.1 micro-gram of B12 is needed to get a physiological response in B12-deficient people. Dr. Herbert estimates that between 0.2 and 0.25 micrograms per day is probably adequate for any individual. Dr. Herbert claims there is no objective published data that show any larger amounts of B12 have any additional value for greater health or longevity. Other leading experts state that 0.5 microgram per day is sufficient. Dr. Baker reports that the daily B12 intake of healthy South Indian vegetarian villagers, who had no signs of B12 deficiency fell in the range of 0.3 to 0.5 microgram per day. This estimate did not factor in B12 loss from cooking their food. This range of .25-5 microgram per day as the minimum needed for adequate B12 is approximately 250 to 500 times less than the 50- to 100-microgram tablets offered in health food stores for daily doses. It is estimated that about 1-3% of these B12 tablet megadoses will cross the intestinal barrier directly; the rest will not be utilized.

Vegetarians have also been shown to have better absorption rates than meat-eaters. Meat-eaters, who might ingest 10 micrograms of B12 per day, are estimated to absorb 16%, while vegans, who may be ingesting 1 microgram per day from their food, are estimated to absorb up to 70%. This is another example of how the adaptive physiology of the human organism changes as a function of the quality of the diet. Dr. Thrash suggests that those on low-fat and low-protein vegetarian diets with good health habits may need only 0.05 microgram of B12 per day, and that nonsmoking vegans may not need any external source of B12 in their diets or through supplements because their own friendly bacteria living in the nasopharynx, teeth, gums, and small intestine would produce enough B12.

6. Vitamin B12 is heat-sensitive but not entirely destroyed by cooking. Research shows that between 23.7% and 96.4% of B12 is destroyed by boiling or baking, depending on the food type and the length of heat processing. Boiling milk for two to five minutes decreases the active B12 amount by 30%. Another study of longer boiling time showed a 50% loss. Sterilization of milk in sealed containers for 13 minutes caused a 77% loss. Milk pasteurization has been reported to have as low a loss as 10%. In condensed milk, the B12 loss is between 40% and 90%.

7. B12, when isolated as a single factor, is highly mutable. When it is put in a multivitamin, for example, B12 often mutates into an a.n.a.log state and is no longer utilizable for body consumption. Because B12 breaks down to a.n.a.logs when in a multivitamin, it is advisable that if one is to take a B12 supplement, it should be taken as a single, separate supplement rather than in a multivitamin.

Why Vegetarians Do Not Become B12-Deficient.

NOW THAT WE UNDERSTAND some of the B12 physiology, the reasons why vegetarians, and particularly vegans, do not normally develop B12 deficiencies give some insight into the subtleties of the B12 question. There is enough B12 in dairy products alone to supply adequate B12 for lac-tovegetarians, so they are considered less at risk for B12 deficiency.

One of the major sources of B12 for vegans is their own bacteria. As mentioned above, bacteria growing in the nasopharyngeal areas, as well as the teeth and gums, supplies .5 microgram of B12 a day, alone covering one's daily needs. There is also some absorption from the bacterial production in the small intestine, as well as reabsorption from bile. Additional research has found that there is actually more B12 produced by the bacteria in the small intestine of a vegetarian than in that of a meat-eater. This fits perfectly with the aforesaid principle that different dietary and lifestyle patterns produce different physiologies, which reveal different normal baseline readings. A study of South Indian immigrants who had no B12 deficiencies in India, but who developed some deficiencies when they migrated away from India, sheds some additional insight into the importance of small-intestinal bacteria. Researchers found that the bacteria in the stomach of the South Indians while in India had higher amounts of B12-producing bacteria than that of Britishers. It was hypothesized that the move to England changed the types of bacteria colonizing the small intestine. This new and less dense strain of bacteria did not produce sufficient B12 to meet the B12 needs of the emigrating South Indians. Some studies of the well water of these same South Indians also showed that in India there was considerably more B12-producing bacteria in the water, thus meeting more of their B12 needs.

The B12 bacteria growing in water and found on vegetables that we eat are another way vegetarians get B12. One unusual study focused on a vegetarian community that grew their food with fertilizing methods used in the Orient for thousands of years, namely using fertilizer that has composted human feces mixed in. It was found that the foods had an ample quant.i.ty of B12 because of this. The point is that the B12 is not in the food, but on the food. It is produced by the local bacteria, and those bacteria are commonly abundant in our environment and on our food. B12 intake can come from multiple sources.

B12 is found more often in root vegetables because of their contact with the soil bacteria. This means that if we are too scrupulous in washing off our food we may actually be washing away part of our B12 intake. Researchers have found high concentrations of B12 in and on mung beans, bean sprouts, comfrey leaves, fermented soybeans, peas, peanuts, lettuce, alfalfa, rice pol-ishings, turnip greens, legume root nodules, and whole wheat. Each harvest seems to have variable amounts of B12 so that sometimes the same food may not have any B12 on it.

Research in the late '80s financed by the Maine Coast Sea Vegetables company at my suggestion has found that kelp, alaria (like wakambe), dulse, and laver (like nori) all have high amounts of human- utilizable B12. Their sea vegetables were sent to an independent lab that tests for human-active B12. Alaria had 15.4 micrograms (g) of B12 per 100 grams. Laver had 5.3 g of B12 per 100 grams. Kelp had 3.4 g of B12 per 100 grams. Dulse had 2.05 g of human-active B12 per 100 grams. What this means is that one-half ounce of alaria, which is a large single portion, will supply ten times the daily amount needed. One-half ounce of dulse, which has the lowest amount of human-active B12 of the sea vegetables, will also meet the daily requirement.

A Vegan Diet Supplies Enough B12.

BLOOD AND TISSUE LEVELS OF B12 are lower but adequate in healthy vegans. In lactovegetarians and flesh-eaters the B12 level is higher. There is some speculation that after 20 years on a vegan diet one might run into B12 deficiencies because of a very slow and gradual B12 depletion. Unfortunately almost no research is available on vegans of more than 20 years who have never taken any B12 tablets or food supplements containing B12. Sanders' research, for example, included only three vegans of greater than 20 years' duration, but two were taking food supplements-food concentrates such as spirulina which are high in B12-and one was taking a B12 tablet. The longer-than-20-year vegan who has never taken a food supplement of B12 may be a rare find. It is only theoretical speculation as to whether they might, in fact, be B12-deficient. The practical reality is that many vegans, either thoughtfully or inadvertently, have taken some B12-containing food supplement. My own serum B12, after more than 20 years vegetarian and 8 years on primarily live foods, was a surprisingly high 500 micrograms. This 500-microgram value is about double what most vegans have and equal to or greater than that of most meat-eaters. Most vegans, however, do not eat primarily live foods, a dietary approach which conserves the B12 in the food because there is no loss from cooking. During this time I was not taking any B12 supplements but I was regularly taking a blue-green algae from Klamath Lake, called Aphanizomenonon Flos-aquae, which I discovered through an independent laboratory a.n.a.lysis to be high in human-active B12. The laboratory report showed that one gram of the blue-green algae powder contained .279 microgram of active B12. This is equal to approximately the daily dose needed of active B12. Although I did not take the algae from Klamath Lake for this reason, it has obviously been a perfect vegetarian source of B12 for me. This high human-active B12 algae may not be the same as green or other blue-green algaes which have been noted to have high concentrations of the inactive B12 a.n.a.logs.

I have also observed in my clinical practice that there is a certain percentage of both meat-eaters and vegetarians who seem to need B12 supplements. One patient who was a meat-eater came to me with a history of becoming ill after contracting hepat.i.tis, and for 20 years he needed B12 shots on alternate days in order not to feel sick or become constipated. As I worked with him to move his diet in the direction of vegetarianism, his overall health got stronger and he then only needed to get a B12 shot once every two to six months. I have observed other patients who, under mental or physical stress, become B12-depleted and are helped considerably by a B12 shot. In my earlier work as an orth.o.m.olecular psychiatrist (use of vitamins and minerals to improve mental imbalances), I observed certain patients with psychosis or borderline mental states whose minds became normal after a B12 shot and who were able to be maintained on regular B12 shots. There is a lot we do not understand about B12 and human function. Even the editorial of the June 1988 edition of the New England Journal of Medicineby William Beck, a prominent B12 researcher at the Ma.s.sachusetts General Hospital, suggested that newer research may ultimately justify previously judged "indiscriminate" use of B12 injections. This comment applied mostly to particular subpopulations of people who are not primarily vegetarians and yet still need B12 because of certain pathological conditions. Dr. John Domissee, a prominent orth.o.m.olecular psychiatrist from Virginia, uses B12 for post-traumatic stress disorders with great success. So, whether vegetarian or not, there are groups of people who need B12 supplementation.

Causes of B12 Deficiency.

THE MAIN CAUSES OF A B12 DEFICIENCY are poor absorption, not enough B12 intake, or physical or mental stress. It is my experience that the following causes are far more responsible for B12 deficiencies than general type of diet: A disruption of the normal B12 mechanism of absorption may be caused by such things as: low hydrochloric acid in the stomach, insufficient pancreatic digestive secretions, inadequate intrinsic factor production in the body, and disrupted small intestine function. Some of these things happen with a lowered quality of health and vitality, such as in older people who are not making efforts to maximize their vitality with good health habits. Some of the chief causes of poor absorption are: intestinal parasites, such as fish-tapeworm; malaria; liver disease; chronic pancreatic disease; chronic infections, such as systemic mucocutaneous candidiasis; cancer; specific diseases of the gastrointestinal tract, such as regional ileitis, chronic atrophic gastritis, tropical sprue, and celiac disease; and poor digestion in general. Putrefaction in the small intestine from a high-protein diet or contaminated meat, chicken, or fish may stimulate the overgrowth of pathogenic bacteria that may also block the B12 uptake.

Surgery can compromise intrinsic-factor secretions of the small intestine or even remove the B12-absorbing segments of the small intestine.

Excess fat or protein may increase B12 needs.

Cooking our foods rather than eating them live depletes available active B12.

Drug intake-such as alcohol, tobacco, coffee, para-amino salicylic acid, colchicine, birth control pills, and antibiotics-increases the body needs for B12.

Megadoses of vitamin C seem to lower serum B12 levels. Studies show that people who take two or more grams per day create a depletion in the B12. Some have estimated that a high vitamin C intake increases the B12 needs tenfold. Others feel that anyone taking more than 500 mg of vitamin C per day for a long time should check their B12 status.

Foods with a high amount of B12 a.n.a.logs, such as multiple vitamins, might cause a depletion because the a.n.a.logs and active B12 compete for B12 receptor sites. I believe further research is needed to confirm this.

Low B6 and iron may also cause B12 depletion.

Raw soy products increase the excretion of B12 from the system.

Thyroid disease has been implicated in B12 depletion.

One of the most important causes of B12 depletion is pregnancy and lactation. Pregnancy causes an increased requirement of B12 due to the fetal drain on the maternal stores. The fetus requires about 50 micrograms of B12 per day. Under normal conditions, including that of healthy vegan mothers, there is enough stored B12 to meet the needs of both the mother and the fetus. One Indian researcher concluded that vegetarians have lived for ages giving birth to healthy children and having healthy mothers who have never eaten flesh foods. This researcher felt there was no evidence to suggest that a vegetarian population consuming adequate lactovegetarian food is at any more risk than nonvegetarian mothers and babies.

While this may be true, there is one relatively small study of 17 macrobiotic babies and mothers reported in the American Journal of Clinical Nutrition which is of concern to me. It indicated that 56% of the macrobiotic mothers had a lower B12 than the study's nonvegetarian control group. Their infants also had a lower B12 level. According to what we know, this lower serum B12 would be expected. It is significant that none of the mothers showed any clinical signs of a B12 deficiency. My concern was that at least one of the 17 macrobiotic babies had mild symptoms suggestive of a B12 deficiency which went away when the mother was given B12 supplementation in the form of food sources which contained active B12. One out of 17 in such a small study is not a highly significant finding or even suggestive that a macrobiotic diet is B12-deficient in the actual B12 taken into the body. One possibility for these findings is that there is something detrimental in the macrobiotic diet that leads to B12 deficiencies from poor a.s.similation or poor health that it creates.

There are other individual reports, as well as a Dutch study of macrobiotic mothers and infants reported in the East-West JournalMay 1988 issue, showing infants of mothers on a macrobiotic diet who have developed B12 deficiencies, with some macrobiotic children actually developing blood changes and physical symptoms that were reversed with B12 supplementation. This tendency may also be true for mothers and infants on fruitarian diets. Again, a possible explanation for these results is that the health of these mothers and infants was compromised in a way that led to poor B12 a.s.similation or retention.

I have observed in my practice that a variety of women who have come to me, both vegetarian and meat-eaters, have become B12-deficient during pregnancy and lactation. My impression is that B12 deficiency with symptoms, not simply a lower serum B12 as compared to nonvegetarians, is due more to poor health resulting in poor a.s.similation of Bn or accelerated loss of B12 from the system rather than not enough B12 in the diet. It is possible that this may happen more easily on a macrobiotic or fruitarian diet than for other types of vegetarian diets. Cooking the food also contributes to the problem because it may destroy up to 90% of the B12.

My recommendations for preventing B12 deficiencies stemming from certain diets and pregnancy are: follow Dr. Paavo Airolas suggestion of three tablespoons daily of brewer's yeast or yeast that has been grown on a B12-supplemented medium; eat sea vegetables; and take one gram (approximately four capsules or one-half teaspoon) of algae from Klamath Lake. This approach has been most helpful in preventing this problem, as well as meeting the increased need for protein during pregnancy. I have often found that one B12 injection for a chronically depleted, postpartum woman brings tremendous relief almost immediately. Oral B12 supplementation often works, but not as well. Because of the general compromised health level of our total population, both vegetarians and flesh-food-eating mothers would do well to pay careful attention to their B12 levels during pregnancy and lactation. For more information on nutrition during pregnancy, see Chapter 30.

Signs of B12 Deficiency.

AB12 DEFICIENCY MAY INITIALLY BE SUGGESTED by symptoms of general fatigue and tiredness. Symptoms may manifest first through the blood system with anemia-caused fatigue and other blood cell changes. B12 is important in DNA synthesis, which affects the ability of all cells to reproduce and function properly. Over time, all the cells may be affected. The nerve cells are one of the primary targets. Onset of symptoms of nerve degeneration is suggested by loss of feeling in one's fingers and toes and loss of feeling in the spine. Other symptoms may be a progressively poor sense of balance, clumsiness, loss of the sense of joint position orientation, cutaneous pain upon light touching, and decreased reflexes.

Another set of symptoms that might first manifest is mental in origin. Increased irritability is often the first symptom. There may also be memory loss, inability to concentrate, depression, and other subtle symptoms that may mirror senile dementia. There may be personality changes or even hallucinations. These neuropsychiatric changes in certain people, according to Lindenbaum's studies at Columbia Presbyterian Medical Center, may occur without accompanying changes in the blood picture in about 30% of people. Deficiency symptoms in infants manifest as lethargy, loss of appet.i.te, speech impairment, and other signs of slow physical and mental development.