Having been vegan for so many years, I’m aware of the significance in getting enough Vitamin B12. But if you have Inflammatory Bowel Disease or an ostomy, did you know that B12 deficiency is also a concern for you too?

Here’s the lowdown on this vitamin!

Disclaimer: B12 deficiency can result in neurological problems, so play it safe and always ask your doctor to make sure your B12 levels are good.

An Intro to Vitamin B12

First, I should probably explain what B12 does, but I’ll keep this short and sweet!

B12 is needed for proper nerve function, the production of DNA, and it also plays a part in preventing anemia.

What’s important to know is that B12 is an essential nutrient, and must be obtained either through diet or supplementation.

And while we don’t need a whole hell of a lot of B12, getting enough is crucial to staying healthy.

So Where You Find This B12?

Most people get B12 through the consumption of animal products, but it’s important to realize that B12 is produced by microorganisms, not animals.

People who are not eating animals usually get B12 through fortified foods or supplements that are made using a bacterial process without harming animals.

But, there’s a catch…

If you have ileitis (inflammation of the ileium), Crohn’s Disease affecting your stomach or small intestine, or have had a bowel resection, chances are that you might be deficient in B12 because you aren’t able to properly absorb it through your gut (SOURCE).

This means that no matter how much you EAT, you’ll always be deficient unless you find another way to get B12 – and there are plenty!

Because B12 doesn’t have to pass through your digestive system, it can be obtained through any of the following:

• Sublingual supplements (can come in a pill, spray, drops or strips)
• Injections (common among people with IBD).
• Nasal sprays.
• Mouth sprays.
• Skin patches.
• Liquid drops (if you don’t have absorption issues)
• Pills (if you don’t have absorption issues)

Whoa, we’re pretty lucky, aren’t we? The good news is that even if you’re vegan and/or have IBD, using thse alternative forms of B12 can usually correct deficiencies and keep your levels up!

If you’re vegan, you should ALWAYS find a reliable source of B12.

Eric, VeganOstomy

You should still have regular blood tests to find out what your level of B12 is, but because B12 deficiency is often masked by other factors, it’s best to speak to your doctor about getting the most accurate test possible for your circumstance.

The test that seems to be common and reliable is an “MMA test”.

How Much Do You Need?

You’ll often find that the recommended daily intake (RDI) for B12 listed as 2.4 mcg (SOURCE, SOURCE) for most men, and women over the age of 19 (the RDI for pregnant women is 2.6 mcg), but recent evidence suggests that 4-7 mcg might be better (SOURCE).

These numbers assume that you’re a healthy adult with a healthy gut, and if you’ve got IBD or a current deficiency, then you may be advised to take many times that amount. I always try to get my B12 checked along with my regular lab work, since IBD is a risk factor for deficiency (SOURCE).

Supplemental B12 often has much more B12 than food sources, including fortified foods. In the example below, you can see that this sublingual B12, which can be taken daily, has 1000 mcg!!

B12 supplements are generally recognized as safe AT ANY DOSE (SOURCE), but some supplements contain other nutrients like folic acid (which help B12 metabolize, but you don’t want too much in synthetic form), so you should only take the recommended dose unless your doctor or pharmacist says otherwise.

Things to Consider

• B12 deficiency can often take YEARS to manifest as symptoms in healthy adults, but that doesn’t mean you should wait for symptoms before taking action.
• Often the first sign of B12 deficiency is tiredness and weakness. Since those are common symptoms of IBD, the two may be related, and some people find fast relief once they’ve received B12 therapy.
• Some medication may cause deficiency or affect absorption. Speak with your doctor or pharmacist if you have any concerns.
• Many people will claim that B12 can be obtained naturally through plant-based foods like seaweed, Blue-Green Algae, tempeh, etc., but most of these sources contain B12 analogues, which actually interfere with true B12 absorption (SOURCE).  Don’t rely on these for your B12 intake!

Further Reading/Sources

• Vitamin B12: Are you Getting it: VeganHealth.org
• Food Sourced of Vitamin B12: Dietitians of Canada
• Vitamin B12 (Cobalamin): University of Maryland Medical Center
• Bor, M. V. “Daily Intake of 4 to 7  g Dietary Vitamin B-12 Is Associated with Steady Concentrations of Vitamin B-12-related Biomarkers in a Healthy Young Population.” American Journal of Clinical Nutrition 91.3 (2010): 571-77. Web.
• Vitamin B12. Fact sheet for consumers (NIH)
• Nascobal, nasal B12 drug information
• Should we monitor vitamin B12 and folate levels in Crohn’s disease patients?
• Vitamin B12 malabsorption in patients with limited ileal resection.
• B12 in Plant Food (summary on VeganHealth)
• Select Committee on GRAS Substances (SCOGS) Opinion: Vitamin B12 (cyanocobalamin) (FDA)
• Which type of vitamin B12 is best–cyanocobalamin, methylcobalamin, or hydroxycobalamin?