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Veganism isn’t new for Africans—it’s a return to our roots, say these chefs and entrepreneurs

South Africans love meat. Ask anyone what our national dish is: they’ll probably say a braai or shisa nyama, which in Zulu literally translates to ‘burn meat’.

However, the staple foods of South Africa are not meat-based. It’s said that Nelson Mandela’s favorite meal was umngqusho, or samp and beans, a traditional Xhosa dish made from white maize and sugar beans.

South Africa’s modern-day vegan movement has been concentrated in Cape Town with a small elite following, but now more South Africans, beyond that privileged group, are embracing the trend and finding innovative solutions to make their diet affordable and sustainable.

“More Africans are going back to being vegan, not becoming vegan,” says chef Nicola Kagoro from the culinary movement African Vegan on a Budget. The company hosts cooking classes and pop-up restaurants to showcase and educate customers about budget-friendly vegan African cuisine. Kagoro hosts ‘Dinners with Chef Cola’ in Harare and Cape Town.

When she first started hosting vegan dinners in Harare, finding willing patrons was a challenge. Kagoro had to charge just one dollar per person to encourage attendance, and show people that veganism isn’t difficult.

Vegan by default at Addis in Cape, Cape Town

Kagoro explains that our ancestors ate meat rarely: “Veganism originated in Africa. We keep sheep and cattle, but back in the day, when we slaughtered these animals, it was only for special reasons like a ceremony or a celebration like a wedding, the birth of a child, or a funeral.”

She believes that through colonization, and the monetization of cattle, Africans started eating more meat, and abandoned traditional plant-based diets. “We’ve forgotten our roots and our culture. Our grandmothers and great grandmothers had beautiful healthy diets, and even if they incorporated meat in those diets, it wasn’t as much as now.”

Kenn Ayere, owner of Hombaze Restaurant in Johannesburg, shares a similar perspective: “Our ancestors ate a lot of organic food. Food that was not tampered with. Food that was not produced in laboratories; and that gave them a lot of good health.” Ayere says Hombaze serves food from West, East and Central Africa, “a place where you eat home food, as your grandmother would have made it.”

Even though the restaurant serves meat, it also boasts an entire vegan menu. Ayere explains that many traditional African meals are already vegan: yam and vegetables, Ghanaian beans and plantains, South African pap and chakalaka, and Kenyan chapati and vegetable stew. These everyday African meals contain no meat, dairy, or eggs.

Similarly, many traditional Ethiopian dishes are vegan. Ethiopian Orthodox Christians observe 180 fasting days a year, and on those days they eat mostly vegan meals. “Growing up in Ethiopia, people are not attached to meat. The daily food is vegan food. They don’t really eat meat because it is expensive. Vegan is daily life,” explains Senait Mekonnen, owner of Addis in Cape Restaurant in Cape Town’s central business district.

Beans and fried plantains at Hombaze, Johannesburg

When it comes to vegan cuisine, Mekonnen specializes in comfort food. Hearty dishes like misir wat, a spiced red lentil stew; or shiro wat, a chickpea flour stew, are popular choices on her menu. She explains that vegan cafés usually use expensive nut-based products; but Ethiopian meals are made with affordable ingredients like lentils, chickpeas and spinach and is therefore more accessible to lower income customers.

Veganism has been on the rise in the richer countries like the United States and the UK as consumers become more conscious and concerned about the environmental impact of eating meat and growing dietary and health worries. The public perception of veganism is believed to have shifted. “The old-fashioned idea was that veganism is anhedonic lifestyle based on grim restrictions, requiring immense discipline and sacrifice,” says Cambridge University philosopher Sandy Grant.

Once a month, Addis in Cape hosts a forum discussion for environmental organization Talking Tree. Mekonnen has noticed that meeting attendance is no longer overwhelmingly white, with members coming from around the Western Cape, including Khayelitsha township. She believes that veganism is now a choice for everyone, not just the wealthy.

Young entrepreneurs in South Africa have also tapped into the trend and transformed veganism to create food that is meat-free and comforting. Sinenhlanhla Ndlela founded dairy-free ice cream business Yococo, which features traditional South African flavors like rooibos tea and granadilla. Chef Elisha Madzivadondo built a vegan following through hearty and satisfying plant-based burgers using homegrown ingredients.

Madzivadondo’s innovative approach to veganism is organic urban gardening. He grows microgreens and sprouts in a small city garden in Cape Town. Microgreens have a quick harvest time, and therefore do not require pesticides and herbicides.

“Farmers have let us down, the only way to trust is to grow your own,” says Madzivadondo. He believes that mass production farming uses too many chemicals, and he encourages others to start their own backyard gardens.

After selling burgers and juices at food markets, Madzivadondo now owns a popular café in Sea Point called The Sunshine Food Co. The burgers are 80% microgreens and sprouts, and 20% butternut and sweet potato.

Nicola Kagoro says, “South Africa is one of the leading vegan trendsetters in Africa”: Whether it’s burgers, shiro wat, or pap and chakalaka, South Africans are returning to their vegan roots and leading the trend with plant-based comfort food.

Vegetarians are smarter

BBC as we know have  since many years involved in controversies, bias, lies, and even false news !

One can remember how International media for example used fake videos and pictures from Pallywood (Palestinian  propaganda industry) to blame Israel of having killed children.

On January 20, 2020, BBC published an article by Zaria Gorvett: How a vegan diet could affect your intelligence

This cannot be true, else, how can one explain,  that there are  barely no famous scientists and major discoveries from African and Muslim countries ? How can one explain apart from Israel in the Middle East, the IQ quotient in other regions are not high. yet, there are many vegetarians like: Albert Einstein, Pythagoras, and famours writers like Rousseau and politician amongs others like Mahatma Gandhi (

The same BBC reported that:

The BBC just reported on a study by Southampton University scientists which showed that individuals who were vegetarian by the age of 30 recorded an average of five IQ points higher than meat-eaters. The initial IQ tests were performed in the ’70s, and the results of the study (after adjusting for social and economic factors) demonstrated that the intelligent children were significantly more likely to become vegetarian later in life. Researchers have hailed this study as a compelling explanation for why “higher IQ in childhood or adolescence is linked with a reduced risk of coronary heart disease in adult life.”

Incidentally, the study also showed that vegetarians were more likely to be female, which may be evidence that girls are smarter than boys. But I don’t really need to think about that.

BBC busted !
I think, either there are blinded by stupidity or by bad faith !


BBC Article Saying Veganism Affects Intelligence Uses Outdated Data

Articles like this do nutrition journalism no favours as misleading the public is irresponsible and dangerous

The BBC recently posted an article titled How a vegan diet could affect your intelligence, asking whether the diet’s ‘shortcomings’ could be ‘affecting vegans’ abilities to think’.

Was the author having a brain freeze when she wrote this article? It features a mismatch of outdated and obscure articles, which were cobbled together to argue that vegans are missing out on brain food.

But don’t be fooled.


A look at the arguments

As a vegan with a Ph.D., who works alongside many sharp and bright vegans at Viva!, I have strong anecdotal evidence to the contrary, but let’s have a look at the argument anyway.

Author Zaria Gorvett begins with our ancestors. She makes the common mistake of thinking that eating meat made us human or ‘clever’. The expensive-tissue hypothesis, proposed by scientists Leslie C. Aiello and Peter Wheeler 25 years ago, suggested that a ‘high-quality’ meaty diet enabled us to reduce the size of our gut, freeing up energy to increase brain size. In other words ‘meat made us smart’.

This is now considered outdated thinking as recent research, published in the journal Nature, refutes this, arguing that a higher-quality diet, including some meat but also improved by cooking, coupled with the energy saved by walking upright, growing more slowly and reproducing later, fuelled the growth in brain size. Prehistoric humans ate some meat but that alone didn’t make them smart.

Turnips v tuna

Gorvett says it’s hard to imagine our ancestors choosing turnips over tuna; yet that’s exactly what they did! Recent evidence shows that people in Palaeolithic times ate a far more plant-based diet than previously thought.

More than 9,000 remains of edible plants found in a Stone Age site in Israel provides compelling evidence that they enjoyed a varied, plant-based diet, including root vegetables, leafy veg, celery, figs, nuts, seeds and chenopodium seeds, similar to quinoa.

This is echoed by other research that Neolithic farmers, like their predecessors, also relied heavily on plant protein.


Gorvett dredges up a contemptible 2003 study, funded by the National Cattleman’s Beef Association and designed to use starving children in Kenya to promote the sales of meat in the developed world.

It looked at the effects of giving meat, milk, vegetable oil or nothing to children living on a subsistence diet. Of course, compared to plain vegetable oil that provides no nutrition other than empty calories – meat improved the growth and development of these starving children.

All this showed is that a diet lacking in energy, carbohydrates, fat, and protein is inadequate – nothing new there! That’s like finding that coca-cola benefits thirsty children suffering in a drought.

A fair comparison would have measured meat against a protein-rich plant-based food such as nuts, seeds, tofu or a soy-based meat substitute.


The list of nutrients vegans ‘miss out on’ was then rolled out, including omega-3 fats – which actually can be found in flaxseed oil and walnuts thanks.

B12 is mentioned again. Sure vegans need to ensure a good B12 intake but so should everyone, as low levels of B12 are common in the entire population, regardless of diet. Everyone over 50 in the US is advised to take B12 supplements and meat and dairy only contain it because animals are fed or injected with supplements.

Gorvett talks about B12 deficiency making one vegan child slip into coma. This highly unusual case occurred in the US in 1979. This fear-mongering is irresponsible given the damage the average UK diet is doing to children – the first generation who may die before their parents.

Appropriately planned diets

Apparently forcing a vegan diet on your offspring could be harmful. But all major health bodies agree that well-planned vegan diets are appropriate for all people at all ages.

For example: “It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes.”


Gorvett says vegans are particularly prone to iron deficiency, citing a 2004 German study looking at 75 vegan women.

I guess she missed the 2016 EPIC Oxford Study, one of the largest studies of vegetarians and vegans ever undertaken, comparing the diets of over 18,000 meat-eaters, 4,500 fish-eaters, 6,600 vegetarians and 800 vegans. They found vegans had the highest iron intake, followed by vegetarians then fish-eaters and with meat-eaters coming in last.

Vitamin D

Vegans are also missing out on vitamin D, apparently. Well, we are not alone – the 2016 National Diet and Nutrition Survey found that one in every two girls aged 11 to 18 is failing to meet even low targets along with over a quarter of women.

Boys and men have higher intakes but still, nine per cent of boys aged 11 to 18 are falling short. Public Health England recommends 10 micrograms a day and suggest everyone should consider taking a supplement in the winter months.

‘Irresponsible and dangerous’

Then there are the not so commonly known nutrients: taurine, choline and creatine – this last one is a compound found in the muscle of meat and fish that forms carcinogenic (cancer-causing) heterocyclic amines when it combines with amino acids and sugars found in muscle meats at high cooking temperatures. I’m happy to give that one a miss.

I recently wrote a piece for Viva!’s magazine Viva!life about the trend in vegan-bashing articles and this FOMO (fear of missing out) approach is popular click-bait claptrap.

However, articles like this do nutrition journalism no favours as misleading the public is irresponsible and dangerous. 


Mythbusting: “How A Vegan Diet Could Affect Your Intelligence”

March 26, 2020  |  By:


A recent article published by the BBC claims that vegan diets can be detrimental to brain health – so naturally, there has been a lot of speculation on this topic. What’s the truth when it comes to vegan brain health? Today I’m answering this question and explaining the science behind it.




Recently, the BBC posted an article on their website titled, “How a Vegan Diet Could Affect Your Intelligence”. I’m here to set the facts straight and debunk the sensationalized, biased and blatantly false claims laid out in this article.

This is one of several opinion pieces written by the BBC in the past year not-so-subtly attacking a plant-based diet. Typically, I would prefer not to call attention to articles that are pure nonsense, like this one, but in this case, I felt it was important to address the claims and falsities as I know many people have questions about them.

I also want to demonstrate the importance of using a critical eye when reading news articles. This is an example of how a seemingly reputable outlet can publish an astonishingly inaccurate opinion piece under the guise of journalism by cherry-picking studies and lying by omission.

The piece is biased, poorly researched, and in some cases, flat out factually inaccurate. Let’s start with what the author got completely wrong.



The article claims that to get the daily minimum required amount of vitamin B6 – a micronutrient important for cognitive development and immune function – vegans would have to eat about 5 cups of potatoes a day.

The RDA for B6 is 1.3 mg a day for adults. According to the USDA national nutrient database, one large russet potato contains over 1 mg of vitamin B6. Since a large potato equates to about 2 cups chopped, you’d have to eat about 2 cups of potatoes to meet the RDA – not 5 cups. 

However, you don’t have to eat any potatoes if you don’t like them. B6 is widespread in a plant-based diet – good sources include pistachios, fortified cereal, and chickpeas. If your family is eating a balanced plant-based diet, you’re easily meeting your B6 needs.  


oatmeal and strawberries

Next, the article claims the typical vegan diet is “scarce” in iron. They reference a study that found that participating vegans were consuming 40% less iron than the recommended daily amount. This cherry-picked study is easily refutable, as the bulk of research shows there is no significant difference in iron intake between plant-based eaters and omnivores. In fact, some studies have shown that plant-based dieters often consume more iron than omnivores.

While it is true that plant-based, non-heme iron is less bioavailable than the heme iron found in animals, the reduced absorption can be overcome by pairing high iron foods with vitamin C rich foods. Vitamin C has shown to increase the absorption of plant-based iron as much as 3 to 6 times for every 50 mg of vitamin C added to a meal.

Finally, though vegans and vegetarians generally have lower iron stores, research has not shown that plant-based adults have a higher incidence of iron deficiency. Iron is the number one nutrient deficiency for adults and children of all dietary patterns. 

Therefore, it’s important that everyone focuses on incorporating iron-rich foods in their diet, and plant-based dieters should employ strategies to maximize iron absorption. This isn’t hard though. Most plant-based dieters naturally pair iron and vitamin C-rich foods together like oatmeal and strawberries, beans and bell peppers, or leafy greens and grains. 


vegan brain health greens

Another false claim in the article is that folate is a nutrient of concern for vegans. This is incorrect and shows the author’s blatant lack of nutritional knowledge. Plants are the top sources of folate in the diet. 

In fact, one study showed folate concentrations were highest among vegans, intermediate among vegetarians, and lowest among omnivores.


Edamame Soybeans

The last glaring inaccuracy I want to point out here is about choline. The article states that soy does not contain choline.

It’s actually one of the best dietary sources of choline with ½ cup of soybeans providing 117 mg of choline. Eggs, one of the best animal sources of choline, only have about 30 mg more per egg.

Vegan diets and brain health

Now let’s talk about the arguments the author uses to make the case that a vegan diet is bad for brain health. First, they cite a study of Kenyan school children that aimed to compare the cognitive effect of adding a serving of meat, milk, vegetable oil, or nothing (the control group) to the children’s daily diet. 

Results showed the children in the meat group performed the best, followed by the control group, then the oil group, and then the milk group. The BBC author attempted to equate this study to a comparison of omnivorous, vegetarian, or vegan diets. There are just so many issues with this study and the author’s attempt to extrapolate the results to vegan diets.

The biggest issue is that meat, milk, and oil are incredibly nutritionally different. It’s like comparing apples to orangutans. Meat is an excellent source of iron, an important nutrient for brain health (though remember as we just talked about – plants contain plenty of iron too).

Milk, on the other hand, is a very poor source of iron. Not only is it extremely low in iron, the calcium in milk actually inhibits iron absorption and kids who drink too much milk are more likely to be iron deficient. Oil contains zero iron. However, it does not inhibit iron absorption.


See the common denominator here? It’s iron. The children eating meat likely did the best because they received additional iron in their diet, not because they received meat. The milk group, despite receiving more protein than the oil and both more calories and more protein than the control group, likely did worse because milk inhibits iron absorption.

A smart study would have used an isocaloric amount of soy instead of oil for comparison as it contains protein, fat, and iron and is more nutritionally equivalent to meat.

Finally, many of the Kenyan children in this study had stunted growth and ranged from moderately to severely underweight. It’s simply not appropriate to compare a population of malnourished children to those consuming a well-planned plant-based diet.

The BBC author should have found a study that looked at adding meat to a nutritionally adequate diet, alas no such study exists.

Next, the author points out a few nutrients that are absent or low in vegan diets.

B12 and brain health

vit b12

First up, B12.

The article emphasizes the health-risks of B12 deficiency and the commonality of B12 deficiency among the plant-based population.

They are absolutely correct that B12 deficiency can cause serious, irreversible damage to the brain but what they gloss over is the fact that B12 deficiency is easily prevented with supplementation.

Let me make this clear – all plant-based dieters, vegan, vegetarian or otherwise – should supplement with b12. Supplementing with B12 is a simple, affordable way to avoid deficiency, and anyone following a properly-planned vegan diet already does this, which negates the author’s argument. 

Choline and brain health 

egg on soybeans

Next up, choline.

I’ve already pointed out the author’s error in stating that soy doesn’t contain choline – but let’s explore this claim further. The author argues that a vegan diet is low in choline and therefore harmful to brain health.

She cites a study showing that high choline supplementation during pregnancy improved infants’ reaction times. First, this study was not conducted on plant-based dieters and second, it’s unclear if a well-planned vegan diet actually has less choline than an omnivorous diet.

While it is true that choline during pregnancy is important, the truth is that the majority of people do not eat enough choline – both vegans and omnivores. The results of the study on choline during pregnancy highlight the importance of maternal choline intake, which is why many prenatal multivitamins now include it.

We recommend that all adults and children ensure proper choline intake one of two ways: by regularly eating eggs and or soy foods or by supplementing, especially during pregnancy and lactation. 

For more information on choline, check out my post Choline on a Plant-Based Diet!


Creatine is another nutrient of concern the author lists.

Creatine is a chemical naturally found in our muscles and brain, and it is one of the body’s sources of energy for muscle contraction. The thing is – our bodies have the ability to make creatine. While it is generally accepted that vegans and vegetarians have lower amounts of creatine in their skeletal muscle, the same is not true for the brain.

One study, linked directly by the author, shows that dietary creatine intake does not change how much creatine is in the brain because the brain relies on its own synthesis of creatine. This makes me think the author didn’t even read the study before drawing her erroneous conclusion.


Lastly, the author makes the claim that taurine is another nutrient of concern in a vegan diet.

Taurine is a non-essential amino acid that is involved in a variety of biological and physiological functions such as bile salt formation, retinal development, and electrolyte balance. The author states that because taurine is low in plant-based diets, this could have a negative effect on brain health and cognitive ability. 

However, our bodies make taurine, and while studies show that vegans do have a lower plasma content, there is substantial evidence that renal taurine excretion adapts to dietary taurine intake. Meaning if you eat less, you store more.

Taurine is only considered an essential amino acid for preterm infants, who typically receive dietary taurine through breast milk or infant formula. While studies show vegan mothers have a lower amount of taurine in their breast milk, there is no research showing signs of taurine deficiency in babies breastfed by vegan mothers.

There is also currently no conclusive evidence that a lack of taurine in the diet has any clinical manifestations for vegans. I will note that there is some evidence that taurine supplementation may be beneficial for people with cardiovascular disease, but more research is needed to make any recommendations.


And that’s that – as you see, the author is quick to make false, unfounded, or exaggerated claims about vegan diets and brain health. Additionally, the author fails to mention the plethora of proven health benefits that come with a plant-based eating pattern.


Properly planned plant-based diets have been shown to reduce all-cause mortality and the risk of cardiovascular disease, diabetes, and obesity. Studies show that vegan and vegetarian diets may also decrease cancer risk.

In fact, plant-based diets may actually have positive effects on brain health. Studies show plant-based diets are associated with lower blood pressure. Recent studies have linked persistent hypertension to mild cognitive impairment, which is a major risk factor for the development of dementia. 

Plant-based diets have also been shown to decrease incidence of atherosclerosis, the fatty plaque that can build up in your arteries, which is also a risk factor for the development of vascular dementia. Finally, several studies suggest diabetes is a contributing risk factor for the development of Alzheimer’s disease, and plant-based diets lower the risk of diabetes.

It’s scary that an organization like BBC would allow an article riddled with factual inaccuracies to even be published, but I hope this round-up has eased any fears you may have about a plant-based diet and brain health and provided you with some tools to use the next time you encounter a sensationalized article like this one.

Always aim to get your information from credible, qualified nutrition professions – and remember, if an article sounds biased, it probably is.

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vegan brain health

Weigh-in: Have you heard other outlandish claims about plant-based diets? Do you feel better prepared to determine the credibility and biases of a source?

- Whitney

Vegetarianism and vitamin B-12 (cobalamin) deficiency

Aśok C Antony
The American Journal of Clinical Nutrition, Volume 78, Issue 1, July 2003, Pages 3–6,

Vegetarian diets can be classified as either lactovegetarian, ovovegetarian, lactoovovegetarian, or vegan if they include, respectively, dairy products, eggs, both dairy products and eggs, or no animal products at all. Vegan diets have a very low cobalamin content, but a study by Herrmann et al (1) in this issue of the Journal forces us to reevaluate the shortcomings of the other forms of vegetarianism. Herrmann et al show that vegans and, to a lesser degree, lactoovovegetarians and lactovegetarians have biochemical evidence of cobalamin deficiency based on increased blood total homocysteine and methylmalonic acid (2–4) and low holotranscobalamin II concentrations; the test for the latter is still under investigation for addition to the diagnostic algorithm for vitamin B-12 deficiency (5). The adverse health consequences in 2 closely related groups, voluntary vegetarians who base their dietary preferences on religious or philosophical grounds and persons whose near-vegetarianism is imposed by poverty, are worth reexploring. Worldwide, vegetarians number in the hundreds of millions, so public health initiatives that seek to improve the health of this population will have a global effect.

Whereas vegetarianism is present in all geographic areas, only in the past 50 y was it recognized that vegetarians have consistently lower vitamin B-12 concentrations than do nonvegetarians and that vegetarians are at greater risk of vitamin B-12 deficiency than are nonvegetarians. Because vitamin B-12 is produced in nature only by vitamin B-12–producing microorganisms, humans must receive vitamin B-12 solely from the diet (3). Although there are abundant vitamin B-12–producing bacteria that colonize the large bowel, that organ is too distal to allow normal vitamin B-12 absorption. Herbivores obtain vitamin B-12 primarily from plants contaminated with nitrogen-fixing, vitamin B-12–producing bacteria that grow in roots and nodes of legumes and from plants contaminated with feces. Carnivorous lower animals receive their vitamin B-12 by eating insects and other animals and via coprophagy. Nonvegetarians obtain most of their vitamin B-12 through eating meat, whereas lactoovovegetarians obtain most of their vitamin B-12 from milk, dairy products, and eggs. Plants contaminated with vitamin B-12–producing bacteria through fertilization with manure may also be a source of vitamin B-12, so, in theory, “organically grown” leafy vegetables may have higher vitamin B-12 concentrations than do leafy vegetables exposed to chemical fertilizers.

Nonvegetarians in the developing world also obtain only marginal amounts of vitamin B-12 (6), because meat is expensive and those in the middle- and lower-income brackets cannot afford this luxury with any regularity. Moreover, a steak that is considered an average size for consumption by one person in the United States commonly feeds 6–8 persons when made into a stew or curry in the developing world. So professed nonvegetarians in developing countries often have a vitamin B-12 status that is only marginally better than that of lactoovovegetarians, and only daily meat eaters have vitamin B-12 status similar to that of nonvegetarians in the West (7).

In 1955, Wokes et al (6) systematically compared a group of US, Dutch, and British vegans with nonvegetarians from those same countries and found that many of the vegans had significantly lower vitamin B-12 concentrations than did the nonvegetarians. A year later, Dhopeshwarkar et al (8) observed that asymptomatic Indian lactovegetarians, who make up more than half of the Indian population, had distinctly lower serum vitamin B-12 concentrations than did nonvegetarians. This was confirmed by studies from different geographic regions in India (7, 9–11). Those who only occasionally ate meat had vitamin B-12 concentrations intermediate to those of lactoovovegetarians and nonvegetarians who frequently ate meat (7). Thus, the use of nonvegetarian cohorts in which most persons are “occasional meat eaters” could potentially account for the equally poor vitamin B-12 status of nonvegetarians and vegetarians in studies reported from the developing world (12, 13). Because vegetarianism has been widely practiced for several millennia in India, much of the population of that country is at risk of having low vitamin B-12 status throughout life. The superimposition of other conditions that perturb either vitamin B-12 absorption, eg, partial gastrectomy or bypass, proton-pump inhibitors, and ileal disease or surgical resection, or vitamin-B12 metabolism, eg, nitrous oxide exposure, can easily tip such persons into frank vitamin B-12 deficiency much earlier than in nonvegetarians who have replete cobalamin stones (3).

Although earlier reports consistently identified a lower vitamin B-12 concentration in lactovegetarians than in nonvegetarians, in the absence of clinical findings, it was difficult to confidently characterize that characteristic as representing a vitamin B-12–deficient state. That difficulty changed with the availability of plasma metabolite tests, but the ultimate proof that a deficiency existed must be the complete normalization of subsequent test results after the replacement of specific vitamins (4). Nevertheless, on the basis of what we know of the vitamin B-12 content of vegetarian diets, it seems likely (and Herrmann et al posit) that asymptomatic subjects who were found to be “normal” in earlier studies using vitamin B-12 concentrations as an indicator of cobalamin status would have been found to be vitamin B-12 deficient had more sophisticated metabolite tests been used.

Pathologic associations between nutritional vitamin B-12 deficiency and disease were sporadically reported from the West (14). Yet in 1975 the general assumption was that lactoovovegetarians in the West generally had no special problems in obtaining adequate vitamin B-12 in their diet (15). Nevertheless, the 1985 report on 138 Hindu vegetarians living in the United Kingdom with clinical evidence of vitamin B-12 deficiency (16) continued to highlight the low cobalamin status of vegetarian diets.

What has been termed a subclinical state of vitamin B-12 deficiency should be revisited in the light of the availability of far more sophisticated questionnaires, instruments, and other methods used to test brain function. Investigators have consistently found abnormalities in electroencephalography, evoked potentials, and P300 event-related potentials (electric signals from the brain that are found during the performance of various cognitive tasks and measured as an electrophysiologic marker of cognitive ability) in one-half or more of those with metabolically defined mild preclinical cobalamin deficiency (17–19). In most cases these abnormalities were reversed with cobalamin therapy, which supported the hypothesis of a causal relation.

The existence of clear-cut biochemical evidence of perturbed vitamin B-12 metabolism in vegetarians and the fact that hyperhomocysteinemia is a risk factor for occlusive vascular diseases (20), some neural tube defects (21), congenital heart defects (22), and dementia and Alzheimer disease (23) should spur even the most skeptical vegetarian to efforts to reverse an easily preventable dietary deficiency of vitamin B-12. Yet, studies on unique groups in the West such as Seventh-Day Adventists that showed the extent of poor cobalamin status (24) also highlighted the difficulty of persuading even highly educated populations that are at risk to routinely take cobalamin supplements (25, 26).

Given the likelihood that low vitamin B-12 status is widespread, it is not surprising that infants born to vitamin B-12–deficient vegetarian mothers would also be at risk of cobalamin deficiency. This is particularly relevant in the developing world, where prolonged breastfeeding over the first 2 y is common practice. A syndrome of nutritional dystrophy and anemia, first described in 1957, was found exclusively among breastfed infants of Indian mothers of extremely low socioeconomic status (27). Although these infants had adequate general nutrition, they also had apathy, megaloblastic anemia, skin hyperpigmentation, involuntary movements, and developmental regression that were rapidly corrected by vitamin B-12. Many of these features would be characteristic of the findings among breastfed, vitamin B-12–deficient infants of mothers in the West who consumed a macrobiotic diet. A 1962 study in South India of 6 breastfed infants who had a similar syndrome and whose mothers were asymptomatic vegetarians found that vitamin B-12 concentrations were low in both the serum and the breast milk of the mothers (28). This vitamin B-12–responsive syndrome has been extensively reported throughout India (29), and similar cases have been described in the West (30). The latter report documented low vitamin B-12 concentrations and biochemical evidence of increased metabolites in both mother and infant, which highlighted “the importance of educating strict vegetarians about the deficiency of vitamin B12 in their diets and the importance of vitamin B12 supplementation” (30). Evidence has accumulated that the fetus is dependent on the mother for cobalamin (31, 32), and the longer the mother has been a vegetarian, the greater the likelihood that she will have low maternal serum and breast milk cobalamin concentrations that closely correlate with cobalamin insufficiency in the infant (33–35).

A longitudinal cohort study reported the development of vitamin B-12 deficiency in infants who consumed a macrobiotic diet (36). The same investigators showed that 15-mo-old infants in a cohort consuming a macrobiotic diet had markedly impaired cobalamin status and impaired psychomotor functioning (37). Whereas most of the families switched their children to a lactovegetarian, lactoovovegetarian, or even omnivorous diet and did so, on average, after the infant's sixth birthday, one-fifth of these children continued to have impaired cobalamin status (38). Later, this group showed that cognitive functioning continued to be affected in adolescents aged 10–16 y who had been switched to a lactovegetarian or omnivorous diet by their sixth birthday (39). The most important associations were between cobalamin status and performance on tests of fluid intelligence, which involves the use of faculties related to reasoning, abstract thinking, and learning ability (39). Thus, compromised vitamin B-12 status during childhood (< 6 y of age) has potential negative consequences well into adulthood.

Reports on nutritional macrocytic anemia identified vitamin B-12 deficiency as the basis for anemia in ≤ 50% of Indian children aged 6 mo to 12 y who were studied (40), and one-fifth of anemic children aged 3 mo to 3 y in an urban Indian slum had vitamin B-12 deficiency as shown by serum concentrations (41). It is likely that metabolite testing would have identified many more asymptomatic vitamin B-12–deficient children, because only anemic children were studied, and there is probably widespread low vitamin B-12 status among children in India. Parallel results came from a study of Guatemalan schoolchildren (42). In an earlier study in Guatemala, vitamin B-12 deficiency was highly prevalent in lactating women and was associated with deficiency of the vitamin in their infants (43). Guatemalan children continue to have low vitamin B-12 status through either dietary insufficiency alone or a combination of that status and as yet uncharacterized gastrointestinal malabsorption (42). The risk of poor cognitive and neuromotor performance is real among these children with low vitamin B-12 status (44), in whom reasoning, short-term memory, and perception were worse than they were in the group with adequate vitamin B-12 (45). This study is instructive because Guatemalan children can be seen as representatives of the status of poverty-imposed near-vegetarianism that is prevalent throughout the developing world. Collectively, the adverse consequences of vitamin B-12 deficiency in children fed vegetarian diets and in those with poverty-imposed near-vegetarianism have significant implications for millions of children worldwide.

Recent studies that have begun to revisit issues related to the bioavailability of vitamin B-12 in dairy products and fortified grain are encouraging (46). Whereas intake from vitamin B-12 supplements and fortified cereals appears to be protective against low vitamin B-12 status (47), we still lack prospective trials to define the optimum diet for various at-risk populations. Nagging questions persist. How can the conversion of vitamin B-12 to inactive analogues as a result of multivitamin-mineral chemical interactions (48, 49) or interaction with foods and other nutrients be avoided? Does the cooking of certain “ethnic-specific” foods containing vitamin B-12 lead to conversion to vitamin B-12 analogues? What is the influence of large-scale processing on the shelf life and subsequent bioavailability of foods fortified with vitamin B-12?

Clearly, recommendations for supplementation of vitamin B-12 are not that easily implemented, as witnessed by the continued documentation of probable vitamin B-12 deficiency among vegetarians described in this issue of the Journal. Nevertheless, the data are compelling, and they indicate that vegetarians should routinely take cobalamin or vitamin B-12 supplements, which in their generic form are relatively inexpensive. In developing countries, other formidable problems were incurred in attempts to implement a program of supplementation of other vitamins (50). Yet the lack of a comprehensive initiative to protect vegetarians from vitamin B-12 deficiency can lead to a whole generation of cobalamin-deficient children (and adults) who are incapable of making good decisions because of the additional burden of neurologic deficits induced by cobalamin deficiency. The international nutrition community must take up the challenge posed by this body of evidence and enact practical steps to ensure parity in the vitamin B-12 status of vegetarians and omnivores.


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See corresponding article on page131.
Dedicated to the memory of Victor Herbert (1927–2002), whose sustained investigations of clinically relevant issues related to vitamin B-12, folate, and one-carbon metabolism earned him respect, admiration, and status as one of the giants in this field. (Internet:, accessed 4 March 2003.)
Supported by NIH grants R01CA58919 and R01HD39295 and by a Veterans Affairs Merit Review Award.
© 2003 American Society for Clinical Nutrition