Vitamin B12 Deficiency: What are the consequences?

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Scientific publications Vitamin B12 Deficiency and Vegetarian or Vegan Diets

  1. Moore E, Mander A, Ames D, Carne R, Sanders K, Watters D Cognitive impairment and vitamin B12: a review. Int Psychogeriatr. 2012 Jan 6:1-16. [Epub ahead of print]

  2.  Ingenbleek Y, McCully KS Vegetarianism produces subclinical malnutrition, hyperhomocysteinemia and atherogenesis. Nutrition. 2012 Feb;28(2):148-53. Epub 2011 Aug 27.

  3. Woo J, Kwok T, Ho SC, Sham A, Lau E. Nutritional status of elderly Chinese vegetarians. Age Ageing. 1998 Jul;27(4):455-61

  4. Majchrzak D, Singer I, Männer M, Rust P, Genser D, Wagner KH, Elmadfa I. B-vitamin status and concentrations of homocysteine in Austrian omnivores, vegetarians and vegans. Ann Nutr Metab. 2006;50(6):485-91. Epub 2006 Sep 19

  5. Mądry E, Lisowska A, Grebowiec P, Walkowiak J. The impact of vegan diet on B-12 status in healthy omnivores: five-year prospective study. Acta Sci Pol Technol Aliment. 2012 Apr 2;11(2):209-12.

  6. Shobha V, Tarey SD, Singh RG, Shetty P, Unni US, Srinivasan K, Kurpad AV. Vitamin B₁₂ deficiency & levels of metabolites in an apparently normal urban south Indian elderly population. Indian J Med Res. 2011 Oct;134:432-9.

  7. Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Orning L, et al. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr. 2001;74:233–41. [PubMed]

  8. Gopalan C, Rama Sastri BV, Balasubramanian SC, Narasinga Rao BS, Deosthale YG, Pant KC. Nutritive value of Indian foods. Hyderabad: National Institute of Nutrition (ICMR); 1989. pp. 47–95.

  9. Ganguli M, Chandra V, Gilby JE, Ratcliff G, Sharma SD, Pandev R, et al. Cognitive test performance in a community-based nondemented elderly sample in rural India: the Indo-U.S Cross-National Dementia Epidemiology Study. Int Psychogeriatr. 1996;8:507–24. [PubMed]

  10. Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatr. 1995;10:367–77.

  11. Yajnik CS, Deshpande SS, Lubree HG, Naik SS, Bhat DS, Uradey BS, et al. Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians. J Assoc Physicians India. 2006;54:775–82. [PubMed]

  12. Specker BL, Brazerol W, Ho ML, Norman EJ. Urinary methylmalonic acid excretion in infants fed formula or human milk. Am J Clin Nutr. 1990 Feb;51(2):209-11. 

  13. Specker BL, Miller D, Norman EJ, Greene H, Hayes KC. Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B-12. Am J Clin Nutr. 1988 Jan;47(1):89-92

  14. Su TC, Jeng JS, Wang JD, Torng PL, Chang SJ, Chen CF, Liau CS. Homocysteine, circulating vascular cell adhesion molecule and carotid atherosclerosis in postmenopausal vegetarian women and omnivores. Atherosclerosis. 2006 Feb;184(2):356-62. Epub 2005 Jul 6.

  15. Gilsing AM, Crowe FL, Lloyd-Wright Z, Sanders TA, Appleby PN, Allen NE, Key TJ. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010 Sep;64(9):933-9. Epub 2010 Jul 21

  16. Mądry E, Lisowska A, Grebowiec P, Walkowiak J. The impact of vegan diet on B-12 status in healthy omnivores: five-year prospective study. Acta Sci Pol Technol Aliment. 2012 Apr 2;11(2):209-12.

  17. De Rosa A, Rossi F, Lieto M, Bruno R, De Renzo A, Palma V, Quarantelli M, De Michele G. Subacute combined degeneration of the spinal cord in a vegan. Clin Neurol Neurosurg. 2012 Feb 6

  18. Kuo SC, Yeh CB, Yeh YW, Tzeng NS. Schizophrenia-like psychotic episode precipitated by cobalamin deficiency. Gen Hosp Psychiatry. 2009 Nov-Dec;31(6):586-8. Epub 2009 Mar 27.

  19. Nightingale LM, Paviour DC. Nutritional optic and peripheral neuropathy: a case report. Cases J. 2009 Jun 5;2:7762

  20. Brocadello F, Levedianos G, Piccione F, Manara R, Pesenti FF. Irreversible subacute sclerotic combined degeneration of the spinal cord in a vegan subject. Nutrition. 2007 Jul-Aug;23(7-8):622-4

  21. Chiron R, Dabadie A, Gandemer-Delignieres V, Balencon M, Legall E, Roussey M. [Anemia and limping in a vegetarian adolescent] Arch Pediatr. 2001 Jan;8(1):62-5. French

  22. Cornejo W, Gonzalez F, Toro ME, Cabrera D. [Subacute combined degeneration. A description of the case of a strictly vegetarian child] Rev Neurol. 2001 Dec 16;33(12):1154-7. Spanish

  23. Licht DJ, Berry GT, Brooks DG, Younkin DP. Reversible subacute combined degeneration of the spinal cord in a 14-year-old due to a strict vegan diet. Clin Pediatr (Phila). 2001 Jul;40(7):413-5

  24. Milea D, Cassoux N, LeHoang P. Blindness in a strict vegan. N Engl J Med. 2000 Mar 23;342(12):897-8.

  25. Li K, McKay G. Images in clinical medicine. Ischemic retinopathy caused by severe megaloblastic anemia. N Engl J Med. 2000 Mar 23;342(12):860 

  26. Bernstein, L. Dementia without a cause. Discover. February 2000:31. 

  27. Ashkenazi S, Weitz R, Varsano I, Mimouni M. Vitamin B12 deficiency due to a strictly vegetarian diet in adolescence. Clinical Pediatrics. 1987;26(Dec):662-663.

  28. Campbell M, Lofters WS, Gibbs WN. Rastafarianism and the vegans syndrome. BMJ (Clin Res Ed). 1982 Dec 4;285(6355):1617-8

  29. Carmel R. Nutritional vitamin-B12 deficiency. Possible contributory role of subtle vitamin-B12 malabsorption. Ann Intern Med. 1978 May;88(5):647-9

Vitamin B12 deficiency in Children of Vegan mothers

  1. Roed C, Skovby F, Lund AM. [Severe vitamin B12 deficiency in infants breastfed by vegans]. Ugeskr Laeger. 2009 Oct 19;171(43):3099-101. Danish.

  2. Mariani A, Chalies S, Jeziorski E, Ludwig C, Lalande M, Rodière M. [Consequences of exclusive breast-feeding in vegan mother newborn--case report]. Arch Pediatr. 2009 Nov;16(11):1461-3. Epub 2009 Sep 11. French

  3. Citak FE, Citak EC. Severe vitamin B12 deficiency in a breast fed infant with pancytopenia. J Trop Pediatr. 2011 Feb;57(1):69-70. Epub 2009 Jul 17

  4. Chalouhi C, Faesch S, Anthoine-Milhomme MC, Fulla Y, Dulac O, Chéron G. Neurological consequences of vitamin B12 deficiency and its treatment. Pediatr Emerg Care. 2008 Aug;24(8):538-41.

  5. Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev. 2008 May;66(5):250-5. Review

  6. Schlapbach LJ, Schütz B, Nuoffer JM, Brekenfeld C, Müller G, Fluri S. [Floppy baby with macrocytic anemia and vegan mother]. Praxis (Bern 1994). 2007 Aug 29;96(35):1309-14. German.

  7. Lücke T, Korenke GC, Poggenburg I, Bentele KH, Das AM, Hartmann H. [Maternal vitamin B12 deficiency: cause for neurological symptoms in infancy]. Z Geburtshilfe Neonatol. 2007 Aug;211(4):157-61. German.

  8. Fadyl H, Inoue S. Combined B12 and iron deficiency in a child breast-fed by a vegetarian mother. J Pediatr Hematol Oncol. 2007 Jan;29(1):74. No abstract available.

  9. Cetinkaya F, Yildirmak Y, Kutluk G, Erdem E. Nutritional vitamin B12 deficiency in hospitalized young children. Pediatr Hematol Oncol. 2007 Jan-Feb;24(1):15-21.

  10. Baatenburg de Jong A, Bekhof J, Zwart P, Langenhorst VJ, Roorda RJ. [Developmental delay in breastfed children due to inadequate diet of the mother]. Ned Tijdschr Geneeskd. 2006 Mar 4;150(9):465-9. Dutch.

  11. Casella EB, Valente M, de Navarro JM, Kok F. Vitamin B12 deficiency in infancy as a cause of developmental regression. Brain Dev. 2005 Dec;27(8):592-4.

  12. Wagnon J, Cagnard B, Bridoux-Henno L, Tourtelier Y, Grall JY, Dabadie A. Breastfeeding and vegan diet]. J Gynecol Obstet Biol Reprod (Paris). 2005 Oct;34(6):610-2. French.

  13. Codazzi D, Sala F, Parini R, Langer M. Coma and respiratory failure in a child with severe vitamin B(12) deficiency. Pediatr Crit Care Med. 2005 Jul;6(4):483-5.

  14. Roschitz B, Plecko B, Huemer M, Biebl A, Foerster H, Sperl W. Nutritional infantile vitamin B12 deficiency: pathobiochemical considerations in seven patients. Arch Dis Child Fetal Neonatal Ed. 2005 May;90(3):F281-2. No abstract available.

  15. Jarosz M, Irga N, Wierzba J. [Vitamin B(12) deficiency anaemia in a 7.5 months old girl]. Med Wieku Rozwoj. 2004 Apr-Jun;8(2 Pt 1):283-8. Polish.

  16. Chalouhi C, Faesch S, Anthoine-Milhomme MC, Fulla Y, Dulac O, Cheron G. Neurological consequences of vitamin B12 deficiency and its treatment. Pediatr Emerg Care. 2008 Aug;24(8):538-41. PubMed PMID: 18708898

  17. Abu-Kishk I, Rachmiel M, Hoffmann C, Lahat E, Eshel G. Infantile encephalopathy due to vitamin deficiency in industrial countries. Childs Nerv Syst. 2009 Jul 8. [Epub ahead of print] PubMed PMID: 19585126.

  18. Guez S, Chiarelli G, Menni F, Salera S, Principi N, Esposito S. Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy. BMC Pediatr. 2012 Jun 24;12(1):85

  19. Davis JR, Goldenring J, Lubin B. Nutritional vitamin B12 deficiency in infants. Am J Dis Child. 1981(Jun);135:566-7

  20. Close, GC. Rastafarianism and the vegans syndrome. British Medical Journal. 1983;286(Feb 5):473.

  21. Hellebostad M, Markestad T, Seeger Halvorsen K. Vitamin D deficiency rickets and vitamin B12 deficiency in vegetarian children. Acta Paediatr Scand. 1985 Mar;74(2):191-5.

  22. Sklar R. Nutritional vitamin B12 deficiency in a breast-fed infant of a vegan-diet mother. Clin Pediatr (Phila). 1986 Apr;25(4):219-21.

  23. Gambon RC, Lentze MJ, Rossi E. Megaloblastic anaemia in one of monozygous twins breast-fed by their vegetarian mother. Eur J Pediatr. 1986 Dec;145(6):570-1.

  24. Stollhoff K, Schulte FJ. Vitamin B12 and brain development. Eur J Pediatr. 1987 Mar;146(2):201-5.

  25. Cheron G, Girot R, Zittoun J, Mouy R, Schmitz J, Rey J. Severe megaloblastic anemia in 6-month-old girl breast-fed by a vegetarian mother. Arch Fr Pediatr. 1989 Mar;46(3):205-7. [Article in French.] (Abstract)

  26. Bar-Sella P, Rakover Y, Ratner D. Vitamin B12 and folate levels in long-term vegans. Isr J Med Sci. 1990;26:309-312.

  27. Michaud JL, Lemieux B, Ogier H, Lambert MA. Nutritional vitamin B12 deficiency: two cases detected by routine newborn urinary screening. Eur J Pediatr. 1992 Mar;151(3):218-20.

  28. Graham SM, Arvela OM, Wise GA. Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants. J Pediatr. 1992 Nov;121(5 Pt 1):710-4.

  29. Kuhne T, Bubl R, Baumgartner R. Maternal vegan diet causing a serious infantile neurological disorder due to vitamin B12 deficiency. Eur J Pediatr. 1991 Jan;150(3):205-8.

  30. Monfort-Gouraud M, Bongiorno A, Le Gall MA, Badoual J. Severe megaloblastic anemia in child breast fed by a vegetarian mother. Ann Pediatr (Paris). 1993 Jan;40(1):28-31. [Article in French.] (Abstract)

  31. Drogari E, Liakopoulou-Tsitsipi T, Xypolyta-Zachariadi A, Papadellis F, Kattamis C. Transient methylmalonic aciduria in four breast fed neonates of strict vegetarian mothers in Greece. Journal of inherited metabolic disease. 1996 19S:A84.

  32. Lovblad K, Ramelli G, Remonda L, Nirkko AC, Ozdoba C, Schroth G. Retardation of myelination due to dietary vitamin B12 deficiency: cranial MRI findings. Pediatr Radiol. 1997 Feb;27(2):155-8.

  33. von Schenck U, Bender-Gotze C, Koletzko B. Persistence of neurological damage induced by dietary vitamin B-12 deficiency in infancy. Arch Dis Child. 1997 Aug;77(2):137-9.

  34. Grattan-Smith PJ, Wilcken B, Procopis PG, Wise GA. The neurological syndrome of infantile cobalamin deficiency: developmental regression and involuntary movements. Mov Disord. 1997 Jan;12(1):39-46.

  35. Renault F, Verstichel P, Ploussard JP, Costil J. Neuropathy in two cobalamin-deficient breast-fed infants of vegetarian mothers. Muscle Nerve. 1999 Feb;22(2):252-4.

  36. Wiley V, Carpenter K, Wilcken B. Newborn screening with tandem mass spectrometry: 12 months' experience in NSW Australia. Acta Paediatr. Suppl 1999 Dec;88(432):48-51

  37. Ciani F, Poggi GM, Pasquini E, Donati MA, Zammarchi E. Prolonged exclusive breast-feeding from vegan mother causing an acute onset of isolated methylmalonic aciduria due to a mild mutase deficiency. Clin Nutr. 2000 Apr;19(2):137-9.

  38. Fogarasi A, Neuwirth M, Bekesi A, Bocskai E. [No title given.] Orv Hetil. 2001 Nov 18;142(46):2581-5. Hungarian.

  39. Smolka V, Bekarek V, Hlidkova E, Bucil J, Mayerova D, Skopkova Z, Adam T, Hruba E, Kozich V, Buriankova L, Saligova J, Buncova M, Zeman J. [Metabolic complications and neurologic manifestations of vitamin B12 deficiency in children of vegetarian mothers] Cas Lek Cesk. 2001 Nov 22;140(23):732-5.

  40. Codazzi D, Sala F, Parini R, Langer M. Coma and respiratory failure in a child with severe vitamin B12 deficiency. Pediatr Crit Care Med. 2005 Jul;6(4):483-5.

  41. Wagnon J, Cagnard B, Bridoux-Henno L, Tourtelier Y, Grall JY, Dabadie A. J Gynecol Obstet Biol Reprod (Paris). 2005 Oct;34(6):610-2.

  42. Mathey C, Di Marco JN, Poujol A, Cournelle MA, Brevaut V, Livet MO, Chabrol B, Michel G. Arch Pediatr. 2007 May;14(5):467-71. Epub 2007 Apr 6.

Further Information on Dietary Requirements for vitamin B12

Further Information on the recommended daily allowance for vitamin B12 can be found at the following web-sites: