Evidence-Based Nutrient Recommendations

Vitamin B12

by Jack Norris, RD


Essential Information

Vitamin B12 is arguably the most important nutrient in vegan nutrition. B12 is found in meat, dairy, and eggs. In contrast, there are no reliable plant sources of B12. Luckily, B12 doesn’t need to be obtained from animal foods because it’s made by bacteria. B12-fortified foods are widely available in many countries and B12 supplements tend to be common and inexpensive. The discovery of vitamin B12 in the 1940s allowed veganism to become a realistic lifestyle.

The overwhelming consensus in the mainstream nutrition community and among vegan health professionals is that B12 supplementation is necessary for the optimal health of vegans. The good news is that vegans who supplement with B12 often have a superior B12 status to meat-eaters.

But what if a vegan feels fine and so doesn’t bother supplementing with B12?

B12 is normally needed for red blood cells to divide and become active and if B12 intake is low an overt deficiency can manifest through fatigue, known as macrocytic anemia or megaloblastic anemia. B12 also protects the nervous system and without it someone can develop tingling in the hands or feet. If not treated, the deficiency can progress to more serious symptoms such as blindness, deafness, and dementia.

To further complicate matters, someone can develop subclinical deficiency which manifests as elevated homocysteine levels. Homocysteine is a potentially toxic byproduct of protein metabolism that the body clears with the help of B12. Elevated homocysteine levels have been consistently associated with an increased risk of cognitive decline, cardiovascular disease (especially stroke), and early mortality; there’s also a link with low bone mineral density. Many studies have found a high prevalence of elevated homocysteine among vegans who don’t supplement with B12. In contrast, vegans who supplement with B12 have healthy homocysteine levels (details in Homocysteine and Mild B12 Deficiency in Vegans).

A 1955 study from the U.K., one of the earliest studies of vegans, found a high prevalence of B12 deficiency with some vegans suffering from nerve damage and dementia. There have been many documented cases of individual vegans developing overt B12 deficiency symptoms after a period of not supplementing (see Individual Cases of B12 Deficiency in Vegans). And I’ve personally known numerous vegans who neglected B12 and subsequently experienced fatigue and temporary neuropathy that resolved upon supplementation.

If you look further into the details of vitamin B12, you’ll quickly find that they’re expansive and complicated. But one thing is simple: Vegans should ensure a reliable source of B12.

There are many options for meeting B12 recommendations, depending on how often you take B12 or eat fortified foods. The table below shows options for meeting the U.S. Institute of Medicine (IOM) recommended dietary intake or the European Food Safety Authority (EFSA) adequate intake. We explain how these amounts were calculated in our Rationale for Recommendations.

2020-11-11 B12 regimens-rationale-daily-needs-h

The recommendations above are for the cyanocobalamin form of B12 which is the form used for most fortified foods and many supplements. Cyanocobalamin is the form that we recommend because it’s more stable and has been researched more thoroughly than other forms. The hype around the other forms of B12 is mostly propaganda from the supplement industry. For more information on the forms, see Coenzyme Forms: Methylcobalamin and Adenosylcobalamin.

Additional Tips

  • B12 is normally measured in micrograms, which can be abbreviated as either µg or mcg. 1,000 micrograms equals 1 milligram (mg).
  • If you haven’t had a regular source of B12 for more than a few months, take 2,000 µg once a day for 2 weeks to replenish your stores.
  • While there’s no definite cutoff for when larger amounts of B12 become unsafe, we somewhat arbitrarily recommend not taking more than 1,000 µg per day over the long-term without guidance from a physician.
  • Large doses of B12 can trigger acne-like symptoms in a small number of people.
  • To increase absorption, we recommend chewing B12-only supplements and swallowing multivitamins whole.
  • People with kidney disease or a suspected B12 deficiency or malabsorption should talk to their doctors about an appropriate B12 regimen.
  • In March of 2020, the Daily Value for B12 on food nutrition labels in the United States was lowered from the 1968 RDA of 6 µg to the current RDA of 2.4 µg.
  • Store B12 supplements and fortified foods in a dark, cool place, preferably a refrigerator. Exposure to light can damage B12.
  • B12-fortified toothpaste is available in some locations and has been shown to be a reliable source of B12 for vegans.

Further Information

Research on Vitamin B12

The links below provide a thorough review of the scientific literature on vitamin B12 and the vegan diet.

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  • If you have a question about whether it's okay to cut supplements in half or combine supplements to achieve the dose we recommend, the answer is “Yes.” Be aware that nutrient recommendations are only estimates—it's not necessary to consume the exact amount we recommend every single day.
  • We aren't able to respond to questions about which brands of supplements to take.
  • We cannot provide personal nutrition advice for specific health conditions. If you need private counseling, here's a list of plant-based dietitians and we especially recommend VeganHealth contributor Taylor Wolfram, MS, RDN, LDN.
  • We urge you to consult with a qualified health professional for answers to your personal questions.

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