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The Exclusive Vitamin
RECOMMENDED DIETARY INTAKE FOR μg vitamin B per day Vitamin B is found naturally in all foods of animal origin and a few foods that have been fortified.
Symptoms of vitamin B deficiency can take several years to develop as liver stores may be large and vitamin B is recycled internally. In older people, however, the ability to absorb vitamin B from the gut may be reduced by lack of intrinsic factor making onset more sudden. Dietary adequacy is achievable for most healthy New Zealanders who adopt a balanced eating pattern including lean red meat and dairy products.
WHAT DOES VITAMIN B DO? Vitamin B is involved in the maintenance of the nervous system, through the production of fatty acids in myelin. It is necessary for the rapid synthesis of DNA during cell division. This is particularly important where cells are dividing rapidly, such as bone marrow tissues responsible for red blood cell formation. In vitamin B deficiency, DNA production is disrupted and abnormal cells called ‘megaloblasts' occur, resulting in anaemia. In addition, low levels of vitamin B play a role in manifesting metabolic risk factors, such Breastfeeding women as fat accumulation, reduced skeletal muscle and increasing insulin resistance.
Source: NHMRC, 2006 POPULATION GROUPS AT RISK OF BIOCHEMICAL INDICATORS OF VITAMIN B DEFICIENCY Many New Zealanders have an adequate vitamin B intake, although the last adult nutrition survey showed • Serum vitamin B levels reflect both intake and
over 22% young women had inadequate intake. stores. <150pmol/L is the traditional clinical Certain groups may also be at greater risk of vitamin deficiency cut-off point, although this may vary B deficiency. This may be due to an inadequate between laboratories. Low concentrations will, however, represent a long-term deficiency or intake or a reduced ability to absorb vitamin B .
chronic low dietary intake. 150pmol/L – 250pmol/L VEGETARIANS, PARTICULARLY VEGANS
is defined as subclinical deficiency2. Serum vitamin
B levels may not be a reliable indicator of true Vitamin B is only found in fermented foods and vitamin B status in those taking seaweed or foods of animal origin, so those following a strict spirulina supplements. These products contain vegetarian or vegan diet are at greater risk of vitamin inactive vitamin B analogues, which may give a B deficiency and are recommended to take a false, inflated status and even interfere with vitamin PREGNANT AND BREASTFEEDING WOMEN
• Raised homocysteine levels, above 15μmol/L,
Recommended intakes for vitamin B are higher indicate clinical vitamin B deficiency. However, during pregnancy and while breastfeeding to allow raised levels may also be seen in folate and for the needs of both mother and foetus/infant vitamin B deficiencies, alcohol abuse3 and renal
(NHMRC, 2006). Women following a low animal food insufficiency4, so these should also be considered.
diet are recommended to eat foods fortified with • Serum methylmalonic acid (sMMA) levels
vitamin B or take a vitamin B supplement8.
>0.26μmol/l is a sensitive and more specific indicator of vitamin B deficiency, although raised levels can also occur in renal insufficiency5 and
Studies have shown infants born with vitamin during antibiotic use6.
B deficiency to vegan mothers. This is due to inadequate body stores. Normal infant body stores ABSORPTION ABNORMALITIES have been estimated to last around eight months9.
Infants of vegan mothers continue at risk if breastfed Intrinsic factor (IF) is produced in the stomach, and by mothers not taking vitamin B supplements. is required to release vitamin B from protein foods, One study showed a 14 month old boy breastfed allowing it to be absorbed in the terminal ileum. The exclusively until 9 months of age had severe vitamin following conditions interfere with this mechanism: B deficiency caused by his mother's strict vegan diet. Supplemental B led to a rapid improvement • Pernicious anaemia – in which antibodies to IF are in haematological and neurological symptoms, produced, preventing absorption.
although cognitive and language development • Gastric surgery - can lead to reduced or ineffective remained seriously delayed at the age of two IF production.
years9. Vegan infants who are not breastfed, should
be given a suitable soy-based infant formula until • Disorders or surgery of the small intestine, e.g. two years of age. Complementary foods should Crohn's disease – which can interfere with the include vitamin B -fortified foods each day. If not, a absorption of the vitamin B /IF complex.
supplement will be required10.
• Long term medication use – proton pump inhibitors OLDER PEOPLE
and H2-receptor antagonists, such as omeprazole and cimetidine, reduce gastric acid production A study using a nationally-representative sample of and hence vitamin B absorption. Metformin, used older New Zealanders, aged over 65 years, showed to treat diabetes, prevents the absorption of the 12% were vitamin B deficient with another 28% vitamin B /IF complex.
marginally deficient. Atrophic gastritis, common amongst older people, was found in 33% of those Where malabsorption exists, increasing the intake of with vitamin B deficiency11. This can impair vitamin
foods either rich or fortified in vitamin B is unlikely to B absorption due to reduced gastric acid and be effective; supplements or intramuscular injections pepsin secretion. But this didn't fully explain the may be required.
prevalence of vitamin B deficiency. Inadequate intakes have also been suggested12. The Ministry of
Health recommends all older people have at least one serving a day of lean meat, chicken, seafood or eggs at least three servings of milk or dairy products each day13.
VITAMIN B DEFICIENCY DIETARY SOURCES OF VITAMIN B Inadequate dietary intake of vitamin B may not be ½ lamb's kidney (14g) detected at first as liver stores can be substantial. Symptoms of deficiency may include: 2 sardines, canned (24g) 1 grilled sirloin steak (145g) 100g cooked lean beef* 100g cooked lean lamb* • shortness of breath 2 steamed mussels (24g) 2 slices roast leg of lamb (84g) ¾ cup stewed lean beef mince • longer term, tingling in the hands and feet, a sore 1 boiled egg (50g) tongue and possibly memory loss, confusion and Baked tarakihi fillet (140g) These are largely due to the two major syndromes ½ cup grated Cheddar cheese resulting from vitamin B deficiency – megaloblastic 1 teaspoon Marmite anaemia and neuropathy. In older adults, dementia may also occur in those with low plasma B 90g can tuna in brine concentrations. A dietary balance of vitamins 1 grilled chicken breast (100g) B , B and folate is required for the conversion of 1 grilled lean pork leg steak (82g) methionine to cysteine, via homocysteine at all 1 pottle low fat fruit yoghurt (150g) ages. Low levels of vitamin B , combined with high folate renders folate unavailable and homocysteine *average all cuts accumulation cannot be prevented. Elevated homocysteine is a strong, independent risk factor EVERYDAY MEALS PROVIDING for dementia, cognitive decline and cardiovascular BREAKFAST
μg VITAMIN B12
• Bowl of cereal(45g) with 1 cup trim milk Vitamin B is only found naturally in foods of animal origin, i.e. meat, fish, eggs, milk and dairy products. • 2 slices toast with 2 teaspoons Marmite Vitamin B is not found in any plant foods including and a boiled egg grains, fruit and vegetables. Most New Zealand adults and children obtain the majority of their vitamin B from these foods, with beef the most common • Filled roll with 100g lean beef and salad source for children and second only to dairy products • 2 canned sardines on toast in adults14,15. Some soy products and a few yeast
extracts have vitamin B added.
• Pita filled with 100g lean lamb, lettuce, tomato FOOD AND NUTRITION GUIDELINES • Medium jacket potato filled with ¾ cup beef chilli con carne, topped with ½ cup grated The Ministry of Health Food and Nutrition Guidelines cheese and served with salad recommend the inclusion of vitamin B for all New Zealanders. For example, the adult guidelines state: Tip: Add some chopped kidneys or grated lamb's
"Meat, seafood, milk and milk products, egg and fry* to chilli con carne for an extra vitamin B boost.
liver are rich sources of vitamin B . The consumption *Pregnant women should avoid eating more than
of foods rich in vitamin B should be encouraged"16.
100g of lamb's fry/liver a week.
DINNER
• Steak and kidney pie (136g piece) and
Dairy products, eggs and/or foods with added vitamin B should be eaten every day. Foods with added vitamin B include some fortified soy products • Lean lamb leg steak (120g) stir-fry with and a few yeast extracts. Strict vegetarians or vegetables and noodles vegans, should take a vitamin B supplement. This is • Pizza topped with 90g tinned tuna particularly important when breastfeeding, to ensure and 1 cup cheese adequate infant stores. Spirulina and other seaweed products are not considered suitable sources of • Grilled sirloin steak with wedges and salad Tip: Desserts, including dairy products, such as fresh
fruit and yoghurt or fruit crumble and custard, will add
extra vitamin B .
SNACKS
• 1 slice of bread and 1 teaspoon of Marmite
• 1 tablespoon of liver paté on 2 crackers • Fruit smoothie with 250ml milk and • A pottle of yoghurt WHAT DOES THIS MEAN FOR HEALTH National Health and Medical Research Council (NHMRC). (2006). Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: Commonwealth Department of Health and Carmel, R., Green, R., Rosenblatt, D. S., & Williams, D. (2003). Update on • Check strict vegetarians or vegans are cobalamin, folate and homocysteine. Hematology Am Soc Hematol Educ eating fortified foods or taking a supplement Program: 62-81.
Carmel, R. & James, S.J. (2002). Alcohol abuse: an important cause of particularly when pregnant or breastfeeding. severe hyperhomocysteinaemia. Nutr Rev, 60 (7pt1): 215-221.
Herrmann, W., Schorr, H., Geisel, J., & Riegel, W. (2001). Homocysteine, cystathionine, methylmalonic acid and B-vitamins in patients with renal disease. Clin Chem Lab Med, 39 (8): 739-746.
• Monitor infants of vegan mothers carefully to Rasmussen, K., Vyberg, B., Pedersen, K.O., & Brochner-Mortensen, J. (1990). Methylmalonic acid in renal insufficiency: evidence of accumulation and ensure vitamin B sufficiency. implications for diagnosis of cobalamin deficiency. Clin Chem, 36 (8pt1): Lindenbaum, J., Savage, D.G., Stabler, S.P., & Allen, R.H. (1990). Diagnosis of cobalamin deficiency: II Relative sensitivities of serum cobalamin, • Consider the many causes of vitamin B methylmalonic acid, and total homocysteine concentrations. Am J Hematol, 34 (2): 99-107.
deficiency when a diagnosis is made. Is it an Mann, N.J., Li, D., Sinclair, A.J., et al. (1999). The effect of diet on plasma inadequate intake or reduced ability to absorb homocysteine concentrations in healthy male subjects. Eur J Clin Nutr, 53: Ministry of Health. (2006). Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper. Wellington: Ministry of Health.
von Schenck, U., Bender-Götze, C., Koletzko, B. (1997) Persistence of • Encourage those planning a pregnancy to neurological damage induced by dietary vitamin B deficiency in infancy. Arch Dis Child 77, 137-139.
ensure an adequate intake of vitamin B . Like 10. Ministry of Health. (2008). Food and Nutrition Guidelines for Healthy Infants folate, vitamin B is most needed throughout and Toddlers (Age 0-2): A background paper (4th ed.) – Partially revised December 2012. Wellington: Ministry of Health.
pregnancy and breastfeeding and ideally 11. Green, T.J., Venn, V.J., Skeaff, C.M., Williams, S.M. (2005). Serum vitamin B should be adequate before pregnancy. concentrations and atrophic gastritis in older New Zealanders. Eur J Clin Nutr, 59: 205-10.
12. Truswell, A.S. (2007). Vitamin B . Nutrition & Dietetics, 64 (suppl 4): S120-S125.
13. Ministry of Health. (2013). Food and Nutrition Guidelines for Healthy Older • Healthy adults can fulfil their vitamin B People: A Background Paper. Wellington: Ministry of Health.
14. Ministry of Health. (2003b). NZ Food: NZ Children: Key results of the 2002 requirement through just one serving of lean National Nutrition Survey. Wellington: Ministry of Health.
beef or lamb or a couple of sardines or mussels. 15. University of Otago and Ministry of Health. (2011). A Focus on Nutrition: Key findings of the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Pregnant and breastfeeding women who eat Ministry of Health.
16. Ministry of Health. (2003a). Food and Nutrition Guidelines for Healthy Adults: red meat only need an additional yoghurt or ½ A background paper. Wellington: Ministry of Health.
cup of milk to achieve their increased needs.
NEW ZEALAND
For copies of an accompanying Vitamin B patient fact sheet or additional nutrition resources, available free of charge, please contact Beef + Lamb New Zealand Inc 0800 733 466 I beeflambnz.co.nz Reviewed by Professor Elaine Rush, Auckland University of Technology, Auckland and Scientific Director, New Zealand Nutrition Foundation October 2014

Source: http://www.beeflambnz.co.nz/resources/Vitamin_B12_FINAL.pdf