For a good B12 source would recommend the 3 natural form supplement here : sunday.de/en/vitamin-b12/. 500mcg per day is a good safe dosage. You cannot overdose on B12 and although 500mcg seems like a lot, only an estimated 6-7mcg are absorbed of this dose so its actually spot on for covering the daily requirement with a nice cushion of safety.
Along with a whole foods plant-based diet I also take (and recommend) 100-150mcg Iodine, 50mcg Selenium (the amount in Brazil nuts can vary a lot). 250-300mg Calcium, 10-15mg Zinc, 5mg Iron, 120-150mg Magnesium, Vitamin D 400IU to 2000IU depending on season and sun exposure (average 1200IU), 300mg Omega-3 DHA, Choline sources - two teaspoons non-GMO Soya Lecithin or 250mg CDP-Choline/300mg Alpha-GPC weekdays. Vitamin K2 Mk.7 50mcg, Taurine 500mg, Creatine 2g, Phosphatidylserine 100mg.
Wishing you all continued good health!
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Please beware that a B12 deficiency is very slow to present, the really serious symptoms only begin when your B12 "tank"(in your liver) has run super low. If you are slightly underdosing B12 this could take years, maybe 10 years... you may slowly become accustomed to feeling a bit sluggish and under the weather. But by the time it gets really serious, neurological problems will likely happen first, with pins and needles and numbness. Do NOT ignore these symptoms, they may seem mild but they are symptoms of nerve damage beginning, and could become permanent if untreated.
You might be thinking - I will just go to a doctor and get my B12 levels checked - they will be able to guide me. In many cases this could be a SERIOUS mistake. Most GP's know next to nothing about B12 , or how much B12 vegans need to take to stay healthy. They dont know what the symptoms of B12 deficiency are, how supplementation effects test results, what the test results mean or don't mean, or in many cases, the best way to treat it. You could end up having to inject yourself just to get adequate treatment. Would you like to have injections twice a week for years? This might sound like a nightmare scenario but its a grim reality for many pernicious anemia patients (see the pernicious anemia society forum here for more info)
Please dont let yourself or any vegan friends get close to this situation. Take 500mcg a day, never skip a dose and never worry about entering this nightmare world of permanent neurological damage (and yes that includes potential brain damage). B12 is (IMO) the most important vitamin in the human diet. Your body needs it and uses it every single day of your life. It is the "axle" upon which very important metabolic cycles like the Folate and Methionine cycle sit. Without B12, your ability to repair DNA, maintain the myelin sheath that protects your nerves , and ability to produce neurotransmitters will slow and begin to malfunction. You have 6-12 months after the first neurological symptoms start to begin treatment in order to have the best chance of a complete recovery.
Dont take a chance on taking less or just about enough. You cannot overdose on B12 and there is no toxic upper limit. When someone is treated for cyanide poisoning, the treatment involves injections of Hydroxocobalamin B12 at a dosage tens of thousands of times higher than the highest oral dose B12 tablet. What happens? They may get a bit of a reddish/pink color in the face. They may have some acne breakouts. Their pee may be tinged pink. Thats it. That's the horrible outcome (LOL) of a dosage tens of thousands of times higher than what you will ever need to take. So do NOT listen to any doctor or medical "professional" who tells you to reduce your B12 dosage! Reduce it under NO CIRCUMSTANCES. Reducing your B12 dosage below the minimum requirement will eventually result in serious, permanent damage. Untreated B12 deficiency has a known outcome - slow and painful death! Overdose is impossible.
Taking your B12 tablet daily needs to become your life, your religion. It should be like breathing to you, its that important. Use the three natural cobalamin (B12) forms as linked above (methyl, hydroxo, adenosyl) - this is closest to what your body "expects".
So what happens if you skip a dose, or have been dosing too low for some years? This is where it gets a but tricky. The US RDA can be very deceiving! 2.5mcg (micrograms) is super low... you might think you can take 250mcg a week to cover it. Thats 100 times the daily requirement so should be more than adequate for a week, right? But NO! Its not at all. B12 is absorbed by 2 mechanisms, "intrinsic factor" and "passive absorption". Intrinsic factor is only able to absorb 1.5 to 2 micrograms of a 250mcg supplement, and passive absorption can take up only 1% of the total dose. So actually when you take 250mcg B12, you only absorb about 4mcg to 4.5mcg. That debatably enough for one day, but not for 2 days. In fact, more recent science suggests 6-7 mcg a day is a better target for better health. If you need to cover a whole week your safest bet is a 5k mcg tablet. I wouldn't advise this though, a daily dose is more natural and easier on the body.
So taking a 250mcg tablet once a week puts you at a B12 shortfall, for at least 5 days of that week. This means a slow, steady depletion of your B12 reserve tank in your liver and cellular stores. It could take more than 5 years to see problems. And if you're wondering, yes, I speak from my own experience of developing a deficiency.
If you have been dosing low for some time but do not yet have neurological symptoms, I recommend a temporary boost of 1000mcg B12 daily for a month or two and see if it improves how you feel. You can then reduce down to 500mcg daily.
For best absorption of B12 I advise to take it with a Calcium supplement (200-300mcg), 2 hours after a meal or one hour before, which helps absorption.
If you already have neurological symptoms, you should not take more supplements (as they will skew the results) but get your active B12, MMA and Homocysteine checked at your GP. You will need injections to quickly replenish body stores of B12 , to quickly halt and begin to reverse the damage.
Dont be like me!! Dont take chances with underdosing B12. You cant buy back the health you will lose if you do!
Thank you for your informative post. As with anything it's important to get checked over by the GP if you have any concerns or worries. I would also say that symptoms can overlap and mean differen't things - so testing should be done before supplementation.
I am a great believer is certain supplements and my health has been greatly helped by them, but they will only work if you have a deficiency. The reason I mention this was because I went to see a nutritionalist (privately) and she loaded me up with lots of really strong supplements which made me very poorly because like with anything you only need a certain amount. Also I have and always have had very high levels of B12, so supplementing would not be the correct thing to do.
So please get your levels checked by your GP's first before supplementing
Good advice. Especially if you 're on medication for a health condition. I have Rheumatoid Arthritis and have to be so careful as some supplements are a no no with my meds.
I was diagnosed as being B12 deficient due to RA and now have an injection every 3 months.
hat is a very valid point about medications, that also needs to be taken into consideration - I have to take Thyroid medication and you are not allowed to take St Johns wort for example, also just because some of us on here are Vegan, does not necessarily mean we are lacking in certain vitamins/Minerals.
May I respectfully ask if you are medically qualified? You are making recommendations here as to doses to take but I would disagree that there is no upper limit when in fact there are side effects to taking too much. You have not mentioned the intrinsic factor in this and , in the case of some people with Pernicious Anaemia, there may be a reduction in IF meaning lack of absorption. Evidence would suggest that oral supplementation will not be successful hence the need for injections regularly. B12 and Intrinsic factor go hand in hand and there are many health conditions that will affect production of this.
Certain prescribed medications may also affect absorption.
There are cultures where vegan diet from birth is the norm and B12 supplements aren’t taken routinely. I have a dear older friend who was vegan from birth and now in her 70s. She is one of the healthiest people I know. The secret to a healthy vegan diet, as with any diet, is to ensure you eat a varied diet of pulses and fruit and vegetables.
As with anything, if you’re unsure as to whether you are B12 deficient, consult a GP. It is a bit broad sweeping to suggest that the medical profession knows nothing about B12. Perhaps we as patients need to be more proactive in the questions we ask?
I am glad that you have found a way to manage your own levels. However, one size does not fit all.
If you are vegan you should be ensuring you are getting adequate B12 from fortified foods or supplements. Since fortified foods often contain smaller amounts, it is riskier to get your B12 this way. There is no good reason to take this kind of risk. As I already said, there is no health risk from taking additional B12 beyond what you might need, any excess will be easily cleared by the body and there is no known level of toxicity. There is no reason to get your B12 levels checked before taking a B12 supplement as a vegan - taking a B12 supplement at between 100mcg to 500mcg daily is the safest choice for all vegans to ensure you do not run low.
With regard to the advice you got from this nutritionist - taking regular heavy doses of certain supplements such as Iron, Iodine or Selenium, in amounts that exceed the RDA is not advisable unless you have a deficiency as these nutrients have a tight window of adequacy versus toxicity. Things like Iron, Vitamin D, Vitamin A and Vitamin E can build up in the body and cause problems if high supplemental dosages are regularly taken. I am not advising mega-dosing which you can see from the dosages I recommended above. However there are other vitamins, particularly the B vitamins (excluding B6 and Folate) that can be taken at dosages substantially higher than the RDA with no known toxic effects.
"just because some of us on here are Vegan, does not necessarily mean we are lacking in certain vitamins/Minerals. ". If you are vegan and not adequately supplementing B12 from fortified foods or supplements you are absolutely at very high risk of B12 deficiency. But there are other nutrients of concern to a vegan diet, primarily Calcium, Iron, Iodine, Vitamin A, Vitamin D, Omega 3 EPA/DHA, Zinc and Selenium. If you dont already know how you're covering your requirement for these, you could also be risking deficiency there too. These are covered at the veganhealth.org site or in this short video : m.youtube.com/watch?v=XcuEI...
With regards to supplements only working if you have a deficiency - the blood levels of some nutrients such as Zinc, Magnesium and Calcium are either tightly controlled in the blood or affected by other factors so that only a very severe deficiency may actually manifest in a blood test but sub-clinical deficiency due to low dietary intake may still occur and cause health problems over time. Good luck trying to get an Iodine test if you cannot afford private testing, I recently asked for one from my GP and was refused because supposedly the test is expensive and not widely available.
The normal B12 blood test measures both active and inactive B12 in your blood, so the totals may not be reliable in diagnosing deficiency. I had neurological symptoms with my total B12 measured at 636. Active B12, MMA or Homocysteine are more accurate but there is no 100% reliable test for deficiency and most B12 specialists agree that the patient symptomology must take precedence. Many GP's do not know this and misdiagnosis is very common. There is a Sally Pacholok book (and film) - "Could it be B12 - an epidemic of misdiagnoses".
Recommended dosages for most nutrients will differ depending on your age, your activity level and lifestyle, menstruation, whether you have a deficiency, are taking specific medications, or have other health conditions like autoimmune diseases. These and other factors certainly need to be accounted for in calculating the right dosage for you. But for B12, the situation is different and there is no known adverse effects or toxicity, so taking a dosage slightly above the requirement makes sense - this makes 500mcg a day the best choice because of what we understand about how B12 is absorbed and the limitations of intrinsic factor and passive absorption as I explained above.
Please do NOT wait to supplement B12 before you get your B12 levels tested - unless you already have symptoms of a deficiency or suspect you have one. If you are vegan the safe thing to do is to regularly supplement B12 adequately to ensure you are "topped up" and never at risk of deficiency.
If you have very high levels of B12 but you are neither supplementing nor regularly eating fortified foods, this could be a secondary marker for serious conditions as explained in this article : academic.oup.com/qjmed/arti...
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