The B-12 Dilemma

In our house, 1998 has a pet name…the year from hell. Everyone has them…those years that you literally count the days until they end…even living a macrobiotic lifestyle does not guarantee immunity to such years. We may like to think that it does, that living natural, whole lives makes us somehow magically immune to disease and other natural disasters. Well, maybe not everyone thinks this, but I surely did. I thought that having had…and survived cancer through macrobiotics (trial by fire, in my case) ensured that the rest of my life would sail smoothly along. I was ‘all in’ in the tragedy department.

It was April. I was working a million hours a week, if it was possible to work that much. I was cooking privately, teaching both private and public classes and helping my husband, Robert run our business. It was also the first season of my cooking show on national public television and I was adjusting to that life change. We had both decided that work was overtaking our lives and that we needed to make some changes, to rest more, play more. But we loved our work and loved working together, so we never actually got around to making things change. We were ‘saving the world,’ one meal at a time.

I was teaching a class on healing foods (ahhh, irony…) and was feeling uncharacteristically irritable. My husband (nursing a broken foot) was trying to help me unload my supplies as we arrived back home after class. I remember telling him that he was more of a hindrance than help and he limped away, somewhat confused and hurt by my out-of-character shortness. I thought I was just tired.

As I stood up from placing my last pot in the lower cabinet, I was struck by the most pure and intense pain I had ever experienced. It felt as though an ice pick had been inserted at the base of my skull, just where that precious soft spot resides. I called to Robert who, hearing the clear panic in my voice was there in a second. I told him to call 9-1-1, as I was having a brain hemorrhage. As of this writing, I have no idea how I knew so clearly what was happening, but I did. At that moment, I lost motor control and collapsed.

At the hospital, everyone stood over me asking about my ‘headache.’ I responded by saying that I was having a brain hemorrhage, but they just smiled and said they would run some tests and see what was going on. As I lay in neuro-trauma intensive care, I began to cry. The pain was excruciating, but that was not the cause for the tears. I knew I was in serious trouble, despite the patronizing reassurances from the doctors.

Robert sat by my side all night, holding my hand and talking. We knew we were once again at a crossroads. Change would be forced on us…of that, we were sure, even though we did not know the severity of my condition.

The next day, the head of neurosurgery came to talk with us. As he sat on the bed, this kind doctor took my hand and said, ‘I have good news and bad news. The good news is very good and the bad is well, pretty bad, but not awful. Which would you like to hear first?’
With the worst headache of my life still pounding, I gave him carte blanche to choose. What he told me shocked me, leaving me to reflect on my diet and lifestyle choices yet again. He explained that I had experienced a brainstem aneurysm and that 85% of the people who suffer these hemorrhages do not survive (I guess that was the good news). He knew from the questions I had answered that I did not smoke, drink coffee or alcohol, eat meat or dairy; that I ate a very healthy diet and exercised regularly. He also saw from test results that at the age of 42, I had not one hint of plaque in my arteries, not one hint of blockage (both of which are characteristic of the condition). And then he surprised me.

Since I did not fit the ‘mold’ for this condition, they wanted to runs some more tests. He was of the mind that there had to be some underlying condition that had caused the aneurysm to rupture (it was apparently genetic and I have three more of them in the same area…the bad news). He also was puzzled by the fact that my burst aneurysm had closed; the vein wall literally sealed shut and the pain I was experiencing was from a blood pool pressing on nerves. He rarely, if ever had seen this kind of thing, he said.

After days of blood and other tests, Dr. Zagar came and sat on the bed again. He had answers, which made him very happy. He explained that I was seriously anemic and that my blood was severely deficient in Vitamin B-12, causing my homocysteine level to increase enough to cause the hemorrhage to occur. He told me that the walls of my veins and arteries were as thin as rice paper, again from this deficiency and that without proper supplementation I would be a high risk for a recurrence of my condition with less likelihood of a happy ending. He also explained that my tests indicated that my diet was too low in fat, resulting in numerous other deficiencies (but those are for another article). He said that my dietary choices had to be modified because they could not sustain my level of activity. At the same time, he said, the way I had chosen to live and eat had most likely saved my life.

I was shocked. I ate a macrobiotic diet, as I had for 15 years. Robert and I cooked most of our meals at home, using the best quality ingredients we could find. I had heard…and believed…that I was getting sufficient amounts of this essential nutrient in the fermented foods I ate daily. Boy, was I wrong.

I came to macrobiotics from a background in science and biology. In the beginning of my holistic study, my scientific thinking made me skeptical, unwilling to believe what I was learning simply based on ‘energy.’ That slowly changed and I learned to marry the two styles of thought to create my own understanding, one that would serve me well at this juncture.

I began to do research into Vitamin B-12, its sources and its importance in our health. I knew that, as a vegan, I faced more challenging ways to source it, since I was unwilling to eat animal flesh. In my macrobiotic practice, I had also eschewed supplementation, believing that I could get all the nutrients I needed from my food, something I learned the hard way was untrue. What I discovered in my research has served me well in regaining and in maintaining my neurological health, so I am no longer a walking ‘time bomb’ waiting for the next hemorrhage to occur. This is only my story, not a critique of other people’s beliefs and practices, but it is a subject worthy of serious discussion as we advise people in the art of using food as medicine.

Here is what I found out….it’s going to get a little ‘science-y’ from this point. Use it as you see fit in your own life and practice.

Vitamin B12 is a member of the vitamin B complex. It contains cobalt, and so is also known as cobalamin. It is exclusively transmuted by bacteria and is found primarily in meat, eggs and dairy products. Necessary for the synthesis of red blood cells, the maintenance of the nervous system, and growth and development in children, deficiency of Vitamin B-12 can cause anemia, neuropathy, stroke, the degeneration of nerve fibers and irreversible neurological damage.

Vitamin B12’s primary functions are in the formation of red blood cells and the maintenance of a healthy nervous system. It is necessary for the rapid synthesis of DNA during cell division, like in the bone marrow tissues responsible for red blood cell formation. If B12 deficiency occurs, DNA production is disrupted and abnormal cells called megaloblasts occur. This results in anemia, with tiredness, breathlessness, listlessness, pale complexion and poor resistance to infection among the symptoms.
B12 is also important in maintaining the nervous system (now I was listening…). Nerves are surrounded by an insulating fatty sheath comprised of a complex protein called myelin. B12 plays a vital role in the metabolism of fatty acids essential for the maintainence of myelin. Prolonged B12 deficiency can lead to nerve degeneration and irreversible neurological damage, which can result in strokes and brain hemorrhages.

The most common form of deficiency occurs when there is a failure to effectively absorb B12 from the intestine rather than a dietary deficiency. Absorption of B12 requires the secretion from the cells lining the stomach of a glycoprotein, known as intrinsic factor. The B12-intrinsic factor complex is then absorbed in the ileum (part of the small intestine) in the presence of calcium. Certain people are unable to produce intrinsic factor and are treated with injections of B12.

Vitamin B12 can be stored in small amounts by the body. Total body store is 2-5mg in adults, with about 80% of this is stored in the liver. Vitamin B12 is excreted in the bile and effectively reabsorbed. This is known as enterohepatic circulation. People eating diets low in B12, including vegans and some vegetarians, may be obtaining more B12 from reabsorption than from dietary sources, which is the reason that it can take more than 20 years for deficiency disease to develop in people changing to diets absent in B12. In comparison, if B12 deficiency is due to a failure in absorption it can take only 3 years for deficiency disease to occur.

The only reliable unfortified sources of Vitamin B12 are meat, dairy products and eggs. There has been considerable research into possible plant food sources of B12, with fermented soy foods, sea plants and algae have proposed as possible sources of B12. However, analysis of fermented soy products, including tempeh, miso, shoyu and tamari, found no significant B12.

Spirulina, on the other hand, an algae available as a dietary supplement in tablet form, and nori, a sea plant, have both appeared to contain significant amounts of B12. However, research is now showing that what exists here are compounds structurally similar to B12, known as B12 analogues, which are unusable by humans. Researchers have suggested that supposed B12 supplements such as spirulina may in fact increase the risk of B12 deficiency disease, as the B12 analogues can compete with B12 and inhibit metabolism. In the final analysis, at least for the moment, the current nutritional consensus is that no plant foods can be relied on as a safe source of vitamin B12.

Bacteria present in the large intestine are able to synthesize B12. In the past, it was thought that the B12 produced by these colonic bacteria could be absorbed and utilized by humans. But the truth is that the bacteria produce B12 too far down the intestine for absorption to occur.

Good sources of vitamin B12 for vegetarians are dairy products or free-range eggs. Fermentation in the manufacture of yogurt destroys much of the B12 present as does boiling milk, so even within dairy products, the choices must be carefully thought out. And yes, there’s raw versions, but there are risks with those options. So what about plant food lovers? Science recommends that their diet includes foods fortified with vitamin B12, including yeast extracts, soy milks, vegetable and sunflower margarines (without hydrogenated or trans fats) and some enriched breakfast cereals.

There are no reliable plant sources of useable Vitamin B12 for those of us who choose not to eat any animal protein. I choose to take sublingual supplements and injections of the vitamin, rather than enriched packaged foods. However we choose to obtain this essential vitamin in our diet, it is imperative that we do. From my own experience, I can tell you that my standard macrobiotic practice did not provide the amount of B12 I needed. With simple supplementation, an increase in good quality fat…and a new understanding of how to balance work and rest, I am once again, living the great life promised me by this lifestyle.