Vitamin B12 and Vegetarian Eating in Brampton: Who Needs to Pay Attention

Brampton is home to many families who follow vegetarian diets, whether for religious, cultural, ethical or health reasons. Many households cook delicious, varied meals built on lentils, beans, vegetables, grains and dairy, often following traditions passed down through generations. These diets can be very healthy. There is one nutrient, however, that deserves particular attention when animal foods are limited: vitamin B12.

Vitamin B12 is found naturally almost only in animal foods. People who eat little or no meat, fish, eggs or dairy can become low over time, often without realising it, because the body stores B12 and symptoms can take years to develop. Older adults and people taking certain common medicines are also at higher risk, regardless of diet.

This article explains what vitamin B12 does, who is most likely to be low, signs to watch for, and how to discuss food sources and supplements with the pharmacists at Pharmasave WestBram, 100 Pertosa Drive in Brampton.

What vitamin B12 does

Vitamin B12 has several important jobs in the body:

• Helping make healthy red blood cells
• Supporting the health of nerves and the brain
• Helping the body make DNA, the genetic material in cells

When B12 levels are low for a long time, the body may produce fewer, larger red blood cells that do not carry oxygen as well, a type of anemia. Low B12 can also affect the nerves, sometimes causing symptoms that can become long-lasting if deficiency is not treated.

How the body absorbs B12

Absorbing B12 from food is a multi-step process. Stomach acid helps release B12 from the proteins in food. A substance made in the stomach, called intrinsic factor, then binds to B12 so it can be absorbed further along in the small intestine.

Anything that interferes with these steps, such as reduced stomach acid, a lack of intrinsic factor, or conditions affecting the small intestine, can reduce absorption even when diet contains enough B12. This explains why diet is only one part of the picture.

The B12 in supplements and fortified foods is not bound to food proteins, so it does not need stomach acid to be released. This is one reason supplements and fortified foods can be helpful for older adults and people taking acid-reducing medicines.

Who is at higher risk of low B12

Groups more likely to have low vitamin B12 include:

• Vegans, who eat no animal products, and are at the highest dietary risk
• Vegetarians, especially those who eat little dairy or eggs
• Older adults, who often have less stomach acid
• People taking metformin for diabetes, particularly long term
• People taking acid-reducing medicines, such as proton pump inhibitors and H2 blockers, for long periods
• People with digestive conditions, such as celiac disease or Crohn’s disease, or after stomach or bowel surgery including some weight-loss surgeries
• People with pernicious anemia, an autoimmune condition that prevents absorption
• Babies breastfed by mothers with low B12

Many Brampton households include an older parent on metformin, a family member taking an acid reducer for heartburn, and others following a vegetarian diet. It is worth knowing that B12 could be a concern for more than one person in the same home.

Signs and symptoms to watch for

Low vitamin B12 often develops slowly, and early symptoms can be vague or attributed to other causes. They may include:

• Tiredness, weakness or low energy
• Pale or yellowish skin
• Shortness of breath or a fast heartbeat with activity
• A sore, red or smooth tongue, or mouth ulcers
• Pins and needles, numbness or tingling in the hands and feet
• Problems with balance or walking
• Memory problems, confusion or changes in mood

These symptoms have many possible causes, so they are not a reason to self-diagnose. If you have them, especially numbness, tingling or balance problems, see your doctor. B12 levels can be checked with a blood test, and earlier treatment gives the best chance of reversing nerve-related symptoms.

Food sources for different eating patterns

Natural sources of vitamin B12 include meat, poultry, fish, seafood, eggs, milk and dairy products. For people following vegetarian diets, useful sources include:

• Milk, yogurt, dahi, paneer and cheese
• Eggs, for those who eat them

For vegans, and for vegetarians who eat little dairy, fortified foods are key:

• Fortified plant-based beverages, such as soy, almond or oat drinks (check the label for B12)
• Fortified nutritional yeast
• Some fortified breakfast cereals and meat alternatives

Plant foods such as spirulina, seaweed, mushrooms and fermented foods are sometimes promoted as B12 sources, but they are not reliable sources of active B12 for humans. Do not rely on them to meet your needs.

Canada’s food guide supports eating more plant-based protein foods, and it is entirely possible to do so while getting enough B12 with a little planning.

Other nutrients to keep in mind on a plant-based diet

Vitamin B12 is the nutrient most often discussed for vegetarians and vegans, but it is not the only one worth a little planning. Iron from plant foods such as lentils, chickpeas, spinach and fortified cereals is absorbed less efficiently than iron from meat. Eating these foods alongside a source of vitamin C, such as tomatoes, peppers, citrus or a squeeze of lemon over dal, can help absorption, while drinking tea or coffee with meals may reduce it.

Calcium and vitamin D matter for bone health, particularly for people who avoid dairy. Fortified plant beverages, calcium-set tofu, almonds and some leafy greens can help. Zinc is found in legumes, nuts, seeds and whole grains. Omega-3 fats from fish are absent in vegetarian diets, though walnuts, flaxseed, chia and hemp seeds provide a plant form, and algae-based supplements exist for those who want them.

None of this means a vegetarian diet is lacking. It simply means variety and occasional label-checking go a long way. A registered dietitian can help families who want a detailed plan, and the pharmacist can help you avoid doubling up when combining supplements.

Supplements: forms and considerations

Vitamin B12 supplements come as tablets, sublingual tablets that dissolve under the tongue, chewables, sprays and liquids. B12 is also included in most multivitamins and B-complex products. Common forms on the label include cyanocobalamin and methylcobalamin. Both are used in supplements.

For people with absorption problems, such as pernicious anemia, a doctor may recommend B12 injections or specific oral treatment, and monitoring.

Some things to consider when choosing a supplement:

• NPN: Look for a Natural Product Number, which indicates Health Canada licensing.
• Amount and frequency: Products vary widely. The right choice depends on your diet, age and health. Ask the pharmacist rather than guessing.
• Dietary requirements: Check that capsules and coatings are suitable if you follow a vegetarian, vegan, halal or kosher diet.
• Combination products: If you already take a multivitamin or B-complex, check how much B12 it contains.

Vitamin B12 is generally considered to have low toxicity, but it is still best to follow the label and ask for advice, particularly if you have kidney disease or other medical conditions.

Metformin, acid reducers and B12

Two very commonly used medicines are linked with lower B12 levels over time.

Metformin is widely prescribed for type 2 diabetes. Long-term use can reduce B12 absorption in some people. Diabetes Canada guidelines suggest periodic B12 monitoring for people on long-term metformin. Some symptoms of low B12, such as numbness and tingling in the feet, can be mistaken for diabetic nerve damage, which makes monitoring especially important. Our diabetes support service can help you understand your medicines and monitoring.

Proton pump inhibitors and H2 blockers, used for heartburn and reflux, reduce stomach acid, which can reduce B12 absorption from food over time. If you have taken these medicines for a long time, ask your doctor whether your B12 should be checked.

Do not stop either type of medicine on your own. Instead, talk with your pharmacist or prescriber about monitoring and whether a supplement makes sense. A medication review is a good opportunity to raise this; ask the pharmacy whether you are eligible.

Pregnancy, breastfeeding and children

People who are pregnant or breastfeeding have increased B12 needs, and babies of vegan or vegetarian mothers with low B12 can develop deficiency. Prenatal vitamins typically contain B12, but people following a vegan diet should discuss their intake with their healthcare provider. Children raised on vegetarian or vegan diets also need reliable B12 sources; a pharmacist, doctor or dietitian can help plan this.

Questions to ask the pharmacist

When you speak with a pharmacist about B12, consider asking:

1. Based on my diet and medicines, am I at risk of low B12?
2. Does my multivitamin already contain enough?
3. Which supplement form and amount is appropriate for me?
4. Should I ask my doctor for a blood test?
5. Is the product suitable for my dietary or religious requirements?

Talk about B12 at Pharmasave WestBram

A vegetarian diet can be healthy and satisfying, and getting enough vitamin B12 is usually straightforward once you know where to look. If you or a family member may be at risk, our pharmacists can help you review food sources, supplements and medicines.

You will find us at 100 Pertosa Drive, Brampton, ON L6X 0H9. Phone (905) 454-5111, visit our contact page, or book a supplement conversation through the booking page.

This post provides general information about vitamin B12. It is not a substitute for medical advice or testing. Speak with a pharmacist or physician about your diet, medicines and any symptoms.