How to Get Vitamin B12 on a Plant-Based Vegan Diet | Dr. Michael Greger of Nutritionfacts.org

If not for protein, vitamin B12 would probably be the nutrient vegans are asked about most often.

Where do you get vitamin B12 on a plant-based diet? Are vegans deficient? Doesn’t B12 come from meat? Do only vegans need to take a supplement?

For help answering some of the most common questions on how to get B12 on a plant-based vegan diet, I asked specialist Dr. Michael Greger of NutritionFacts.org. 

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Introducing Dr. Michael Greger & the Vegan Nutrition Concerns Series

Dr. Greger is a licensed general practitioner specializing in clinical nutrition, an author, and an internationally-recognized speaker on nutrition, food safety, and matters of public health.

This interview is the sixth in the Vegan Nutrition Concerns Series with Dr. Greger. This series addresses common nutrient-specific concerns related to a plant-based diet, and touches upon the health impacts of animal products.

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Dr. Greger on How to Get B12 on a Plant-Based Vegan Diet

The following transcript of my interview with Dr. Greger (from the video above) is edited for clarity, order, and readability.

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Do We Need to Supplement Vitamin B12?

Dr: Greger: [S]ome vegans aren’t taking their vitamin B12, which is critical.

There’s only two vitamins that one can’t get…in the produce aisle where we should get all our vitamins and minerals. One is vitamin D which we already talked about which…comes from the sun [and is] artificially added, for example, to the dairy supply.

Vitamin B12 is not made by plants [and] not made by animals either. [It’s] made by little microbes that blanket the earth. We used to get all the B12 we needed, presumably, from drinking out of well water or mountain streams. But now, chlorinated water supplies kill off bacteria, so we don’t get a lot of B12 in our water anymore. [We] don’t get a lot of cholera either—that’s a good thing!

But now…we live in a sanitized world…[and] we’re not like our primate cousins, eating bugs [or] feces all day. We’ve got to get B12 from somewhere.

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How to Get Vitamin B12 & Supplement Recommendations

Dr. Greger: [T]he hygienic source, the safest source, the healthiest source, the cheapest source is vitamin B12 supplements. You can also use vitamin B12-fortified foods [including] soy milks [and] meat analogues.

But probably the simplest thing is to take one 2,500 microgram tablet of B12…the chewable [or] sublingual [variety] once a week. [It will] cost you $5 per year. [S]hare a bottle with your friends; it’s super easy, and you’ll actually have better B12 status than everybody else around you.

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Everyone Must Make Sure They Get Enough Vitamin B12 (Even Meat-Eaters)

Dr. Greger: [I]t’s serious not getting enough [B12], particularly for…vegan infants…who may start out with low levels if the mom has already had low levels and [they] just go downhill from there. [M]any people who…go vegan later in life…start out with pretty high levels and so [it] may take them a while to show deficiency.

But even then, everybody needs to ensure [a] regular, reliable source of vitamin B12—and that’s including those people who eat meat. Yes, they get it from meat, but that’s not where you want to get your nutrients, right? It’s lacking in all these wonderful things we want like fiber, and has things we don’t want like the saturated [and] trans fats, cholesterol, etc.

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Sublingual vs. Injected Vitamin B12 Supplements

Dr. Greger: The reason people get shots in [the United States] and sublingual everywhere else in the world is because [of] a doctor’s salary. [E]verywhere else in the world, they don’t get paid by the visit. …[If] you get shots, you have to go back and see your doctor and you have to pay them more, and you have to get your insurance to pay them more.

So, that’s the only reason, and studies [have] shown sublingual is just as effective. [F]or example…if you [a]re deficient, you can take 2,000 micrograms once a day for two weeks and basically restore your levels as good as if you had a B12 shot.

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Which Type of Vitamin B12 is Best?

Dr. Greger: Cyanocobalamin is the best. It’s the cheapest, it’s the most widely available, and [it’s] convenient to get.

The vast majority of research is on cyanocobalamin. [Y]ou take vegans…who have B12 deficiencies, give them cyanocobalamin, and they get better. We don’t have similar studies with some of these other [types] and the dosages are all different; people get confused.

And if people wanted to take methyl, then you would have to take [around] 1,000 [micrograms] a day, not 2,500 once a week.

With the exception [of] people who are heavy smokers or people that subsist off of cassava or have kidney function problems, cyanocobalamin is the best, cheapest, [and] most convenient source. [I]t’s not that it’s dirt cheap, but you use literally millionths of a gram. It’s measured in micrograms. Buy the cheapest and you should be fine.

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In Closing…

I hope you enjoyed hearing Dr. Greger’s take on how to get B12 on a vegan diet.

Like humans, animals do not produce enough B12; they get B12 in their diets by eating from the ground and drinking untreated water. However, our horrific farming practices—which have virtually sterilized our soil—and our water purification practices have left even farmed animals unable to get adequate B12. Some farmers actually give farmed animals B12 shots or supplement their feed in order to market their products as sources of B12.

While we all generate our own B12 to a small degree, it is not in sufficient amounts. B12 deficiency is a humanity-induced problem, not a vegan problem.

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Dr. Greger’s Vitamin B12 Recommendations

• At least 2,500 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach
  • or at least 50 mcg daily of supplemental cyanocobalamin (you needn’t worry about taking too much)
  • or servings of B12-fortified foods three times daily (at each meal), each containing at least 190% of the Daily Value listed on the nutrition facts label (based on the new labeling mandated to start January 1, 2020—the target is 4.5 mcg three times a day). 
• Those over 65 years of age should take at least 1,000 mcg (µg) cyanocobalamin every day.
• Tip: If experiencing deficiency symptoms, the best test is a urine MMA (not serum B12 level)

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Now I’d love to hear from you: Where do you get your B12? Do you supplement? Have your levels been tested? Let me know in the comments!

— Emily Moran Barwick

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Please note that when it comes to your health and nutrition, there is no substitute for the guidance of a trained medical professional, especially if you have any medical conditions or complications.

Finding a plant-based provider can be challenging, depending on your location and health insurance (or lack thereof). In the accordion below are online directories for plant-based providers. I hope to expand the list to include ones that serve more countries. If you know of any additional directories, please let me know!

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