Vitamin B12 deficiency in vegetarians in Pakistan


Take home message:
Vitamin B12 deficiency in near-vegan vegetarians in Pakistan – high
Need to educate vegetarians in Pakistan about vitamin B12 – high 

Summary:
Study conducted in Mithi (District Tharparkar, Sindh), Pakistan, in 2012 and 2013, by the Department of Biochemistry, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan

Participants:
apparently healthy volunteers: 100 vegetarians + 100 non-vegetarians (ominvores), aged 20–40 years
“The present study has been carried out in Mithi, District Tharparker (Sindh), because a large number of the population in Mithi District belong to the Hindu community and most of the people of this community adhere to a vegetarian diet because of family conventions or religious reasons.”
The vegetarian group had adhered to a vegetarian diet since their childhood. Except for the small consumption of dairy products, they ate no animal sourced food such as meat, poultry, fish, or eggs. The omnivore group ate all types of food, including vegetables and animal foods such as meat, poultry, fish, and eggs.”
“We excluded the subjects from this study if they were taking multivitamins, […].”

Results:
44% of vegetarians were B12 deficient (based on serum MMA). 0% of non-vegetarians were B12 deficient. Vegetarians had higher rates of depression, paresthesia (feeling of “pins and needles” in hands or feet), and psychosis.

“Conclusion: Vegetarians [who do not add sufficient amounts of vitamin B12 to their diets by consuming supplements or fortified foods] have Vitamin B12 deficiency and are more prone to developing neuropsychiatric and neurological problems.”

Results summarized:

Variables
Vegetarians
(n=100)
Non-vegetarians
(n=100)
Age (years) (Ø) 
28
29
Men
77%
72%
Women
23%
28%
Vitamin B12(pg/ml) (Ø)
238
401
Frequency of B12 deficiency (serum B12 <200 pg/mL)
51%
(48% in men, 61% in women)
3%
Folate (nmol/L) (Ø)
16
25
Frequency of folate deficieny
0%
0%
MMA (nmol/L)  (Ø)
285
191
Frequency of high MMA (serum MMA >271 nmol/L – This indicates B12 deficiency.)
44%
0%
Frequency of depression
31%
12%
Frequency of paresthia
11%
3%
Frequency of peripheral neuropathy (not statistically significant)
9%
2%
Frequency of psychosis
11%
3%
Frequency of personality changes
5%
1%

“Therefore, it is recommended that people should eat a diet fortified with Vitamin B12 and folic acid to prevent these nutrient deficiencies, particularly in vegetarians. Early detection of Vitamin B12 deficiency is necessary for preventing potentially irreversible neuropsychiatric changes. So it is recommended that, in vegetarians with neuropsychiatric problems, their Vitamin B12 levels should be checked and treated if it is deficient to prevent irreversible neurological loss.”

“[…] early replacement of Vitamin B12 is suggested for preventing such catastrophic damages [irreversible nerve damage and/or psychological problems] in this high-risk group [vegetarians].”

Vitamin B12 deficiency in non-vegetarians in Pakistan:
“Recently, a study in Pakistan showed 57% prevalence of Vitamin B12 deficiency, after excluding strict vegetarians from their study.“ [Nizamani GS, Memon IA, Memon A, Khoharo HK. Vitamin B12 Deficiency with Megaloblastic Anemia: An Experience at Tertiary Care Hospital of Sindh. JLUMHS 2014; 13: 13-17.]

Reference:
Kapoor A, Baig M, Tunio SA, Memon AS, Karmani H: Neuropsychiatric and neurological problems among vitamin B12 deficient young vegetarians. Neurosciences 2017; Vol. 22 (3): 228–232. doi: 10.17712/nsj.2017.3.20160445

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