vitamin b12 – medical science, mrs white and the church dr bevan hokin bsc mappsc phd director of...

Vitamin B12 – Medical science, Mrs White and

the Church

Vitamin B12 – Medical science, Mrs White and

the Church

Dr Bevan Hokin BSc MAppSc PhDDr Bevan Hokin BSc MAppSc PhD

Director of PathologyDirector of Pathology

SYDNEY ADVENTIST HOSPITALSYDNEY ADVENTIST HOSPITAL

Programme….Programme….

Vegetarianism and vitamin B12 – the Vegetarianism and vitamin B12 – the scientific basisscientific basis

QuestionsQuestions BreakBreak The Bible, Mrs White, The Church and The Bible, Mrs White, The Church and

vitamin B12vitamin B12 QuestionsQuestions Treatment of vitamin B12 deficiencyTreatment of vitamin B12 deficiency

Vegetarianism, with particular reference to vitamin B12

Vegetarianism, with particular reference to vitamin B12

VegetarianismVegetarianism

It is the position of the American Dietetic It is the position of the American Dietetic Association and Dietitians of Canada that Association and Dietitians of Canada that appropriately planned vegetarian diets are appropriately planned vegetarian diets are healthful, nutritionally adequate and healthful, nutritionally adequate and provide health benefits in the prevention provide health benefits in the prevention and treatment of certain diseases.and treatment of certain diseases.

JADA June 2003 Volume 103 Number 6JADA June 2003 Volume 103 Number 6

Proven benefits: Proven benefits:

Reduction in incidence of:Reduction in incidence of:ObesityObesityCardiovascular diseaseCardiovascular diseaseHypertensionHypertensionDiabetes (Type II)Diabetes (Type II)CancerCancerOsteoporosisOsteoporosisRenal diseaseRenal diseaseDementiaDementia

ADA Statement ‘qualifier’ADA Statement ‘qualifier’

Vegetarian diets must be Vegetarian diets must be “appropriately planned”“appropriately planned”

Nutrients for which planning is required in vegetarian diets:Nutrients for which planning is required in vegetarian diets:

ProteinProtein RDARDA 40-50 gm40-50 gm

IronIron 12-15 mg12-15 mg

CalciumCalcium 1200 mg1200 mg

Vitamin DVitamin D 400 IU400 IU

Vitamin B12Vitamin B12 2.4 ug2.4 ug

IodineIodine 150 ug150 ug

Omega three fatty acidsOmega three fatty acids 2-4 gm2-4 gm

Types of vegetarian dietsTypes of vegetarian diets

VeganVegan

VegetarianVegetarian

Lacto-vegetarianLacto-vegetarian

Lacto-ovo-vegetarianLacto-ovo-vegetarian

Semi vegetarianSemi vegetarian

Occasional or moderate use of fish or Occasional or moderate use of fish or chickenchicken

VeganVegan

Must pay strict attention to:Must pay strict attention to:CalciumCalcium

Can obtain sufficient from plant Can obtain sufficient from plant sourcessources

Vitamin B12Vitamin B12

MUST supplementMUST supplement

Vegetarians (Lacto- and lacto-ovo-)Vegetarians (Lacto- and lacto-ovo-)

Less of an issue (compared with veganism) Less of an issue (compared with veganism) but still important to consider:but still important to consider:

Calcium (as dairy products are included)Calcium (as dairy products are included)

Vitamin B12 (as eggs and dairy products (low Vitamin B12 (as eggs and dairy products (low fat) are includedfat) are included

Vitamin B12 – the scientific and medical position

Vitamin B12 – the scientific and medical position

Vitamin B12 – what is it?Vitamin B12 – what is it?

Water solubleWater soluble

Burgundy coloured crystalsBurgundy coloured crystals

Molecular weight 1355.4Molecular weight 1355.4

Formula CFormula C6565HH3838OO1414NN1414PCoPCo

AnaloguesAnalogues

hydroxyl-, hydroxo-, aquo-, nitrito-, methyl-, 5’-desoxy-, adenosyl-, hydroxyl-, hydroxo-, aquo-, nitrito-, methyl-, 5’-desoxy-, adenosyl-, cyano-, sulphuryl-.cyano-, sulphuryl-.

Vitamin B12 Reference RangesVitamin B12 Reference Ranges

Published 171-850 pmol/LPublished 171-850 pmol/L

Victor Herbert >221 pmol/LVictor Herbert >221 pmol/L

Clinical symptoms reported with Clinical symptoms reported with vitamin B12 of 258 pmol/Lvitamin B12 of 258 pmol/L

What does vitamin B12 do?What does vitamin B12 do?

Essential for all cell division – hence Essential for all cell division – hence implications with growth, repair and implications with growth, repair and reproductionreproduction

Maintenance of the integrity of myelin (the Maintenance of the integrity of myelin (the insulation that surrounds most nerves)insulation that surrounds most nerves)

Consequences of B12 deficiencyConsequences of B12 deficiency

Tired, “heavy” feelingTired, “heavy” feeling Numb lips or noseNumb lips or nose Macrocytic anaemiaMacrocytic anaemia Nerve (myelin sheath) damageNerve (myelin sheath) damage Spinal cord degenerationSpinal cord degeneration DementiaDementia DeathDeath

Symptoms of vitamin B12 deficiencySymptoms of vitamin B12 deficiency

Neurological Haematological OtherNeurological Haematological OtherParaesthesiaParaesthesia Shortness of breath Sore Shortness of breath Sore

tongue/mouthtongue/mouth

UnsteadinessUnsteadiness Anaemia Anaemia Weight loss Weight loss

Leg weakness Macrocytosis Loss of appetiteLeg weakness Macrocytosis Loss of appetite

Muscle tenderness Hypersegmentation TirednessMuscle tenderness Hypersegmentation Tiredness

Memory loss -Memory loss - General weakness General weakness

Psychiatric changesPsychiatric changes Hair loss Hair loss

DementiaDementia

DeathDeath

How is vitamin B12 absorbed?How is vitamin B12 absorbed?

Role of stomachRole of stomach Parietal cells Parietal cells AcidAcid

Role of terminal ileum for absorptionRole of terminal ileum for absorption Problems – malabsorption Problems – malabsorption

Aging, some drugs and acid productionAging, some drugs and acid production Autoimmune – Autoimmune –

anti parietal cell antibodiesanti parietal cell antibodies Anti intrinsic factor antibodiesAnti intrinsic factor antibodies

Causes of vitamin B12 deficiencyCauses of vitamin B12 deficiency

Inadequate intake (dietary deficiency)Inadequate intake (dietary deficiency) Impaired absorption (IF or ileum related)Impaired absorption (IF or ileum related) Inadequate utilisation (transport proteins)Inadequate utilisation (transport proteins)

Increased requirement (pregnancy)Increased requirement (pregnancy) Increased excretion (enterohepatic circulation)Increased excretion (enterohepatic circulation) Increased destruction (NO anaesthesia, excessive Increased destruction (NO anaesthesia, excessive

vitamin C)vitamin C)

Vitamin B12 - Dietary SourcesVitamin B12 - Dietary Sources

Egg (one Medium)Egg (one Medium) 0.5 ug0.5 ug Fortified Soy Milk (So Good)Fortified Soy Milk (So Good) 4.0 ug/L4.0 ug/L MilkMilk 3.0 ug/L3.0 ug/L Cheese (50 gm)Cheese (50 gm) 1.0 ug1.0 ug Meat analogues (one serving)Meat analogues (one serving) 0.6-0.8 ug0.6-0.8 ug Yoghurt (150 gm)Yoghurt (150 gm) 0.3 ug0.3 ug MarmiteMarmite (5 gm serving)(5 gm serving) 0.5 ug0.5 ug

Exercise caution with USA food tables (Yeast and cereals)Exercise caution with USA food tables (Yeast and cereals)

Vitamin B12 – Other sourcesVitamin B12 – Other sources

FOOD SOURCEFOOD SOURCE Vitamin B12 content Vitamin B12 content ug/100gmug/100gm

Fish: Cod filletsFish: Cod fillets

Salmon cannedSalmon canned

SardinesSardines

22

44

2828

Beef – rump steakBeef – rump steak 22

Kidney – lambKidney – lamb 7979

Liver – lambLiver – lamb 8181

Myths surrounding vitamin B12Myths surrounding vitamin B12

Is there useable vitamin B12 in:Is there useable vitamin B12 in: SpinachSpinach Aloe Vera juiceAloe Vera juice Mushrooms Mushrooms SpirulinaSpirulina TempehTempeh YeastYeast

Vitamin B12 - factsVitamin B12 - facts

There is There is NONO useable vitamin B12 in: useable vitamin B12 in: SpinachSpinach Aloe Vera juiceAloe Vera juice Mushrooms (10 kg fresh to achieve the RDA)Mushrooms (10 kg fresh to achieve the RDA) SpirulinaSpirulina TempehTempeh Yeast – unless a fortified productYeast – unless a fortified product

There may be some useable vitamin B12 in the There may be some useable vitamin B12 in the seaweeds Nori and/or Chlorellaseaweeds Nori and/or Chlorella


Vitamin B12 comes from animals;Vitamin B12 comes from animals; The vitamin B12 used to fortify foods is extracted The vitamin B12 used to fortify foods is extracted

from animal sourcesfrom animal sources

ALL vitamin B12 from ALL sources comes from ALL vitamin B12 from ALL sources comes from bacteria. Animals concentrate it in their tissue.bacteria. Animals concentrate it in their tissue.

Vitamin B12 used to fortify food is manufactured in Vitamin B12 used to fortify food is manufactured in vats by vats by ProprionobacteriumProprionobacterium species of bacteria species of bacteria (and others) and purified.(and others) and purified.


What about Dr Mervyn Hardinge’s 1977 What about Dr Mervyn Hardinge’s 1977 report of vitamin B12 produced in the report of vitamin B12 produced in the mouth by oral bacteria?mouth by oral bacteria?

Repeated his studyRepeated his study Some people produce up to 10% of RDISome people produce up to 10% of RDI Some people produce zeroSome people produce zero Why the difference needs further researchWhy the difference needs further research

Why is vitamin B12 so important?Why is vitamin B12 so important?

Implications of vitamin B12 deficiencyImplications of vitamin B12 deficiency

Reversibility of vitamin B12 deficiency-Reversibility of vitamin B12 deficiency-induced dementia if treated within 1-2 years induced dementia if treated within 1-2 years of onset. of onset. (Ho 1999, Bopp-Kistler 1999)(Ho 1999, Bopp-Kistler 1999)

B12 deficiency and short-term memory loss- B12 deficiency and short-term memory loss- New brain cells are made daily for that New brain cells are made daily for that day’s short-term memory. Dependent on day’s short-term memory. Dependent on adequate vitamin B12 reserves. adequate vitamin B12 reserves. (Herbert 2002)(Herbert 2002)

More implications of vitamin B12 deficiencyMore implications of vitamin B12 deficiency

Increased risk of breast tumours in post Increased risk of breast tumours in post menopausal women who were deficient in menopausal women who were deficient in vitamin B12 during their teens.vitamin B12 during their teens.

Link between low maternal vitamin B12 Link between low maternal vitamin B12 during pregnancy and an increased during pregnancy and an increased incidence of brain tumours in their children incidence of brain tumours in their children when they reach puberty.when they reach puberty.

Incidence of vitamin B12 deficiency (B12 < 220 pmol/L)Incidence of vitamin B12 deficiency (B12 < 220 pmol/L)

Among:Among:

Lacto-ovo-vegetariansLacto-ovo-vegetarians 73%73%

Vegans (depends on duration)Vegans (depends on duration) 90+%90+%

The elderly in assisted careThe elderly in assisted care 65%65%

Why were the lacto-ovo-vegetarians vitamin B12 deficient?Why were the lacto-ovo-vegetarians vitamin B12 deficient?

Cholesterol and saturated fats lead to heat disease. Cholesterol and saturated fats lead to heat disease. (Health message of the mid 1970’s)(Health message of the mid 1970’s)

From 1976 to 2002, consumption of both eggs and From 1976 to 2002, consumption of both eggs and milk reduced, and vitamin B12 deficiency milk reduced, and vitamin B12 deficiency increased proportionally.increased proportionally.

Low vitamin B12 leads to an elevation in Low vitamin B12 leads to an elevation in homocysteine which is linked to increased risk of homocysteine which is linked to increased risk of heart diseaseheart disease

At-risk groups for vitamin B12 deficiencyAt-risk groups for vitamin B12 deficiency

Vegetarians (consuming less than 20 servings Vegetarians (consuming less than 20 servings of vitamin B12 –containing foods/week).of vitamin B12 –containing foods/week).

Vegans (MUST take supplements)Vegans (MUST take supplements)The elderly (reduced absorption after age The elderly (reduced absorption after age

about 55-60 years)about 55-60 years)In pregnancy (if commence with low body In pregnancy (if commence with low body

reserves or suffer severe or prolonged reserves or suffer severe or prolonged morning sickness)morning sickness)

Diagnosis of vitamin B12 deficiencyDiagnosis of vitamin B12 deficiency

SymptomsSymptoms History (vegetarianism or near History (vegetarianism or near

vegetarianism)vegetarianism) VeganismVeganism Age (assisted care facilities)Age (assisted care facilities) Blood testsBlood tests

Diagnosis of vitamin B12 deficiencyDiagnosis of vitamin B12 deficiency

BLOOD TESTSBLOOD TESTS Serum vitamin B12, Serum vitamin B12, homocysteine, MMAhomocysteine, MMA anti-IF antibodies, anti-IF antibodies, anti-parietal cell antibodiesanti-parietal cell antibodies

HOMOCYSTEINE and B12HOMOCYSTEINE and B12

Body stores vitamin B12 in liver: 3 - 5 Body stores vitamin B12 in liver: 3 - 5 years reservesyears reserves

As vitamin B12 reserves fall, homocysteine As vitamin B12 reserves fall, homocysteine increasesincreases

Homocysteine is an excellent marker of low Homocysteine is an excellent marker of low body vitamin B12 reservesbody vitamin B12 reserves

Reference range for good reserves of Reference range for good reserves of Homocysteine < 10 nmol/LHomocysteine < 10 nmol/L

Treatment of vitamin B12 deficiencyTreatment of vitamin B12 deficiency

SevereSevere: IM injection at once, then : IM injection at once, then assessassess

Less severeLess severe and after initial treatment: and after initial treatment:Dietary deficiency: Diet advice, Dietary deficiency: Diet advice,

supplements, follow-up in 3-6 monthssupplements, follow-up in 3-6 months IF Malabsorption: IM Injections 4-6 IF Malabsorption: IM Injections 4-6

weekly as neededweekly as needed

Treatment of vitamin B12 deficiencyTreatment of vitamin B12 deficiency

For those with a dietary deficiency – normalFor those with a dietary deficiency – normal

absorption:absorption: Food supplements (E.g. vitamin B12 fortified soy Food supplements (E.g. vitamin B12 fortified soy

milk) are effective in increasing serum B12 and milk) are effective in increasing serum B12 and decreasing homocysteine.decreasing homocysteine.

Small frequent doses (2ug) 6-8 hourly, are more Small frequent doses (2ug) 6-8 hourly, are more efficacious than infrequent large dosesefficacious than infrequent large doses

Law of mass action in malabsorbersLaw of mass action in malabsorbers

How not to treat B12 deficiencyHow not to treat B12 deficiency

SpirulinaSpirulina Case study:Case study:

Schillings test was normal, therefore probably Schillings test was normal, therefore probably inadequate intakeinadequate intake

Suggested 3 month trial of vitamin B12 Suggested 3 month trial of vitamin B12 supplement: 2 ug B12 three times/daysupplement: 2 ug B12 three times/day

Retested after 2-4 week equilibration periodRetested after 2-4 week equilibration period [B12] fell from 117 to 87 pmol/L[B12] fell from 117 to 87 pmol/L

Conclusions IConclusions I

Vitamin B12 deficiency is commonVitamin B12 deficiency is common At-risk groups include vegetarians and At-risk groups include vegetarians and

elderly non-vegetarians elderly non-vegetarians Reference ranges quoted by many Reference ranges quoted by many

laboratories are too low and fail to alert laboratories are too low and fail to alert clinicians of deficiency riskclinicians of deficiency risk

Mis-diagnosis of deficiency may be seriousMis-diagnosis of deficiency may be serious

Conclusions IIConclusions II

A ‘metabolic marker’ of vitamin B12 (e.g. A ‘metabolic marker’ of vitamin B12 (e.g. homocysteine) should be used along with serum homocysteine) should be used along with serum levelslevels

Supplementary tests are available to diagnose the Supplementary tests are available to diagnose the cause of deficiencycause of deficiency

Food supplements are efficacious in treating Food supplements are efficacious in treating dietary deficiency dietary deficiency

Treatment with IM injections or tablets is effective Treatment with IM injections or tablets is effective in long-term management.in long-term management.

Conclusions IIIConclusions III

The vegetarian diet is a healthy one.The vegetarian diet is a healthy one. All essential nutrients (except vitamin B12 in the All essential nutrients (except vitamin B12 in the

Vegan diet) are able to be obtained from a well Vegan diet) are able to be obtained from a well planned vegetarian diet. (Vegans MUST planned vegetarian diet. (Vegans MUST supplement with vitamin B12)supplement with vitamin B12)

The lacto-ovo-vegetarian diet is the least The lacto-ovo-vegetarian diet is the least complicated form of vegetarianism as there is complicated form of vegetarianism as there is sound provision of calcium and vitamin B12, and sound provision of calcium and vitamin B12, and it retains the health benefits of vegetarianism.it retains the health benefits of vegetarianism.

QUESTION TIMEQUESTION TIME

Vitamin B12 – the Bible, Mrs White and the Church

Vitamin B12 – the Bible, Mrs White and the Church

The BibleThe Bible

Man’s diet history:Man’s diet history: OriginalOriginal

“…“…I have given you every herb bearing seed I have given you every herb bearing seed which is upon the face of all the earth, and which is upon the face of all the earth, and every tree, in which is the fruit of a tree every tree, in which is the fruit of a tree yielding seed; to you it shall be for meat”.yielding seed; to you it shall be for meat”.

Gen 1:29Gen 1:29

The BibleThe Bible

Man’s diet history:Man’s diet history: OriginalOriginal

Source of vitamin B12 ???Source of vitamin B12 ???

Possible sources of vitamin B12 – ORIGINAL DIETPossible sources of vitamin B12 – ORIGINAL DIET

Produced by bacteria Produced by bacteria Intestinal tract colonisation / symbiosisIntestinal tract colonisation / symbiosis Modern man disruptedModern man disrupted

AntibioticsAntibiotics Diet changeDiet change PreservativesPreservatives

Speculative – more research neededSpeculative – more research needed Being undertaken in collaboration with University of Being undertaken in collaboration with University of

Newcastle and the ARINewcastle and the ARI

The BibleThe Bible

Man’s diet history:Man’s diet history: After the fallAfter the fall

Fruits, grains, nuts and vegetablesFruits, grains, nuts and vegetables ..

Gen 3:18-19Gen 3:18-19

Source of vitamin B12 ???Source of vitamin B12 ???

Possible sources of vitamin B12 – ORIGINAL DIETPossible sources of vitamin B12 – ORIGINAL DIET

Produced by bacteria Produced by bacteria Intestinal tract colonisation / symbiosisIntestinal tract colonisation / symbiosis Modern man disruptedModern man disrupted

AntibioticsAntibiotics Diet changeDiet change PreservativesPreservatives

Speculative – more research neededSpeculative – more research needed Being undertaken in collaboration with University of Being undertaken in collaboration with University of

Newcastle and the ARINewcastle and the ARI

The BibleThe Bible

Man’s diet history:Man’s diet history: After the floodAfter the flood

““Every moving thing that liveth shall be meat for Every moving thing that liveth shall be meat for you; even as the green herb have I given you all you; even as the green herb have I given you all things… But flesh with the life thereof, which things… But flesh with the life thereof, which is the blood thereof, shall ye not eat.”is the blood thereof, shall ye not eat.”

Gen 9: 3,4Gen 9: 3,4

Vitamin B12 source: Flesh foodsVitamin B12 source: Flesh foods

The BibleThe Bible

Man’s diet history:Man’s diet history: Patriarchs and ChristPatriarchs and ChristAbraham Gen 18: 7,8Abraham Gen 18: 7,8 CalfCalfIsaacIsaac Gen 27: 4 Gen 27: 4 KidKidChristChrist Luke 24: 42,43 Luke 24: 42,43 FishFish

Luke 22: 15Luke 22: 15 LambLamb

Vitamin B12 source: Flesh foodsVitamin B12 source: Flesh foods

Mrs WhiteMrs White

Strong advocate for vegetarianism:Strong advocate for vegetarianism: ““Flesh was never the best food” MH 313Flesh was never the best food” MH 313 ““Many die of disease caused wholly byMany die of disease caused wholly by

meat-eating” SG 147meat-eating” SG 147 ““Those who eat flesh are but eating grainsThose who eat flesh are but eating grains

and vegetables at second hand;….Howand vegetables at second hand;….How

much better to get it direct, by eating food thatmuch better to get it direct, by eating food that

God provided for our use.” MH 313God provided for our use.” MH 313

Mrs WhiteMrs White

Strong advocate for vegetarianism:Strong advocate for vegetarianism:

Cancers, tumours and inflammatory diseases are Cancers, tumours and inflammatory diseases are largely caused by meat eating. CDF 385 largely caused by meat eating. CDF 385

Animals are becoming more and more diseased, and Animals are becoming more and more diseased, and it will not be long until animal food will be it will not be long until animal food will be discarded by many beside Seventh-day discarded by many beside Seventh-day Adventists. Foods that are healthful and life Adventists. Foods that are healthful and life sustaining are to be prepared, so that men and sustaining are to be prepared, so that men and women will not need to eat meat. CDF 202 women will not need to eat meat. CDF 202

Mrs WhiteMrs White


Flesh foods are injurious to the physical well-being, Flesh foods are injurious to the physical well-being, and we should learn to do without them”. CDF and we should learn to do without them”. CDF 403403

Grains, fruits, nuts and vegetables…prepared in as Grains, fruits, nuts and vegetables…prepared in as simple and natural a manner as possible, are the simple and natural a manner as possible, are the most healthful and nourishing. CDF 313 most healthful and nourishing. CDF 313

Mrs WhiteMrs White


So where can vegetarian Adventists obtain vitamin So where can vegetarian Adventists obtain vitamin B12?B12?

From a lacto-ovo-vegetarian diet.From a lacto-ovo-vegetarian diet.

But doesn’t Mrs White condemn eggs and dairy?But doesn’t Mrs White condemn eggs and dairy?

Mrs WhiteMrs White

Strong advocate for vegetarianism:Strong advocate for vegetarianism: Position on Dairy products and eggs:Position on Dairy products and eggs:

WARNING: WARNING:

““Cheese is wholly unfit for food” MH 302Cheese is wholly unfit for food” MH 302

““I wish to say that when the time comes that it I wish to say that when the time comes that it is no longer safe to use milk, cream, butter is no longer safe to use milk, cream, butter and eggs, God will reveal this.” CDF 206and eggs, God will reveal this.” CDF 206

Mrs WhiteMrs White


Cheese: Cheese: Made with arsenicMade with arsenicNo pasteurisationNo pasteurisationNo refrigerationNo refrigerationOverall poor hygieneOverall poor hygieneModerated her position to include some cheese in Moderated her position to include some cheese in her diether diet. (Counsel and reproof Letter 1873). (Counsel and reproof Letter 1873)

Mrs WhiteMrs White

Strong advocate for vegetarianism:Strong advocate for vegetarianism: Position on Dairy products and eggs:Position on Dairy products and eggs:““We use no lard,but in its place, milk,cream” MH We use no lard,but in its place, milk,cream” MH

302302““We have always used a little milk…This we have We have always used a little milk…This we have

never denounced, either in our writings or in our never denounced, either in our writings or in our preachings”. 1873 letterpreachings”. 1873 letter

““Milk…should not be classed with flesh meat.. The Milk…should not be classed with flesh meat.. The time has not come to say that the use of milk…time has not come to say that the use of milk…should be wholly discarded”. T7 p134 should be wholly discarded”. T7 p134

Mrs WhiteMrs White


““Great care should be taken…to obtain eggs Great care should be taken…to obtain eggs from healthy fowls” MH 320from healthy fowls” MH 320

““..eggs should not be classed with flesh meat. ..eggs should not be classed with flesh meat. In some cases the use of eggs is beneficial”. In some cases the use of eggs is beneficial”. T7 134 T7 134

Mrs WhiteMrs White


““Fruits, grains and vegetables, prepared in a Fruits, grains and vegetables, prepared in a simple way, free from spice and grease simple way, free from spice and grease (animal fat) of all kinds, make with milk or (animal fat) of all kinds, make with milk or cream, the most healthful diet. CDF 202cream, the most healthful diet. CDF 202

Mrs WhiteMrs White


““The time will come when (The time will come when (for health reasonsfor health reasons) ) we may have to discard some of the articles of we may have to discard some of the articles of diet we now use, such as milk and cream and diet we now use, such as milk and cream and eggs; but my message is that eggs; but my message is that you must not you must not bring yourself to a time of trouble beforehand, bring yourself to a time of trouble beforehand, and thus afflict yourself with death”and thus afflict yourself with death” . CDF 358 . CDF 358

CASE STUDY: Dr KressCASE STUDY: Dr Kress

In an interesting case, a Unites States trained, In an interesting case, a Unites States trained, Adventist physician, Dr Kress, while Adventist physician, Dr Kress, while working in Australia in the early 1900’s, working in Australia in the early 1900’s, became obsessed with the health benefits of became obsessed with the health benefits of the soybean, virtually eating nothing else. the soybean, virtually eating nothing else. Over time he developed symptoms Over time he developed symptoms consistent with vitamin B12 deficiency, consistent with vitamin B12 deficiency, coming close to death. Ellen White wrote to coming close to death. Ellen White wrote to him, instructing him to consumehim, instructing him to consume

Dr Kress 2Dr Kress 2

““raw eggs from healthy fowls, mixed with raw eggs from healthy fowls, mixed with good quality unfermented grape juice. This good quality unfermented grape juice. This will supply that which is necessary to your will supply that which is necessary to your system…. system…. We appreciate your experience as a We appreciate your experience as a physician, and yet I say that milk and eggs physician, and yet I say that milk and eggs should be included in your diet… The should be included in your diet… The doctrine of dispensing with them should not doctrine of dispensing with them should not be taught”. CDF 202 be taught”. CDF 202

Dr Kress 3Dr Kress 3

Current knowledge of nutrition, reveals that the remedy Current knowledge of nutrition, reveals that the remedy prescribed included both an excellent source of prescribed included both an excellent source of vitamin B12 and also of iron. This patient recovered vitamin B12 and also of iron. This patient recovered and lived normally for many years. While a scientific and lived normally for many years. While a scientific and medical understanding of the role and and medical understanding of the role and importance of vitamin B12 did not occur until 1948, importance of vitamin B12 did not occur until 1948, the Seventh-day Adventist church, while advocating the Seventh-day Adventist church, while advocating vegetarianism on health grounds, unwittingly vegetarianism on health grounds, unwittingly protected its adherents from vitamin B12 deficiency protected its adherents from vitamin B12 deficiency by insisting that the healthiest diet was the lacto-ovo- by insisting that the healthiest diet was the lacto-ovo- form of vegetarianism. form of vegetarianism.

The Church’s position SPDThe Church’s position SPD

DDairy foodsairy foods (preferably low fat (preferably low fat varieties for adults) such as milk, varieties for adults) such as milk, cheese and yoghurt and/or soy cheese and yoghurt and/or soy alternatives fortified with calcium and alternatives fortified with calcium and vitamin B12 such as Sanitarium So vitamin B12 such as Sanitarium So Good soymilk. Adults should aim for 2 Good soymilk. Adults should aim for 2 serves of these foods daily (1 serve = serves of these foods daily (1 serve = 250ml milk/soymilk, 40g cheese, 200g 250ml milk/soymilk, 40g cheese, 200g yoghurt). (SPD Web page)yoghurt). (SPD Web page)

The Church’s position SPDThe Church’s position SPD

In addition to 2 serves of dairy and calcium In addition to 2 serves of dairy and calcium enriched soy foods, vegetarian adults should aim enriched soy foods, vegetarian adults should aim to include 2 serves* of protein foods each day, to include 2 serves* of protein foods each day, selecting from the following foods:selecting from the following foods:

oo eggseggs; omega-3 enriched eggs or free range eggs are preferable ; omega-3 enriched eggs or free range eggs are preferable as vegetarian diets tend to be high in omega-6 fats. (1 serve = 2 as vegetarian diets tend to be high in omega-6 fats. (1 serve = 2 eggs)eggs)

oo pre-prepared vegetarian foodspre-prepared vegetarian foods such as tofu, tempeh, textured such as tofu, tempeh, textured vegetable protein, soy burgers/sausages/luncheon slices. Look for vegetable protein, soy burgers/sausages/luncheon slices. Look for products that are fortified with iron and vitamin B12, where possible. products that are fortified with iron and vitamin B12, where possible. (1 serve = 100g tofu)(1 serve = 100g tofu)

oo legumeslegumes oo nuts and seedsnuts and seeds, ,

The Church’s position SHFThe Church’s position SHF

Including vitamin B12 in the diet -Including vitamin B12 in the diet - Consume milk (and other dairy products) or a vitamin B12 Consume milk (and other dairy products) or a vitamin B12

fortified soymilk daily. Two cups of fortified soymilk daily. Two cups of Sanitarium So Good® Sanitarium So Good® soymilksoymilk provides the daily B12 requirement for an adult. provides the daily B12 requirement for an adult.

Include other plant foods fortified with vitamin B12 such as Include other plant foods fortified with vitamin B12 such as some soy burgers/sausages/luncheon slices and some soy burgers/sausages/luncheon slices and Sanitarium Sanitarium Marmite®Marmite®..

Eggs supply vitamin B12 for lacto-ovo vegetarians.Eggs supply vitamin B12 for lacto-ovo vegetarians. Take a daily vitamin B12 supplement if you are pregnant, Take a daily vitamin B12 supplement if you are pregnant,

breastfeeding, travelling or don’t include a regular supply of B12 breastfeeding, travelling or don’t include a regular supply of B12 containing foods in your diet.containing foods in your diet.

Despite the claims, mushrooms, tempeh, miso, seaweed, Despite the claims, mushrooms, tempeh, miso, seaweed, spirulina and sauerkraut are not reliable sources of vitamin B12.spirulina and sauerkraut are not reliable sources of vitamin B12.

The Church’s position GCThe Church’s position GC

Health reform and the teaching of health and Health reform and the teaching of health and temperance are inseparable parts of the Advent temperance are inseparable parts of the Advent message. Instruction came to us through the Lord's message. Instruction came to us through the Lord's chosen messenger "that those who are keeping His chosen messenger "that those who are keeping His commandments must be brought into sacred commandments must be brought into sacred relationship to Himself, and that by temperance in relationship to Himself, and that by temperance in eating and drinking they must keep mind and body in eating and drinking they must keep mind and body in the most favourable condition for service.'' - the most favourable condition for service.'' - Counsels Counsels on Healthon Health, pp. 132, 133. Also, "it is the Lord's design , pp. 132, 133. Also, "it is the Lord's design that the restoring influence of health reform shall be a that the restoring influence of health reform shall be a part of the last great effort to proclaim the gospel part of the last great effort to proclaim the gospel message." - message." - Medical MinistryMedical Ministry, p. 259., p. 259.

The Church’s position GCThe Church’s position GC

We belong to God, body, soul, and spirit. It is therefore our We belong to God, body, soul, and spirit. It is therefore our religious duty to observe the laws of health, both for our own religious duty to observe the laws of health, both for our own well-being and happiness and for more efficient service to God well-being and happiness and for more efficient service to God and our fellow men. The appetite must be kept under control. and our fellow men. The appetite must be kept under control. Health is promoted by an intelligent observance of the hygienic Health is promoted by an intelligent observance of the hygienic principles having to do with pure air, ventilation, suitable principles having to do with pure air, ventilation, suitable clothing, cleanliness, proper exercise and recreation, adequate clothing, cleanliness, proper exercise and recreation, adequate sleep and rest, and an adequate, sleep and rest, and an adequate, wholesome dietwholesome diet. God has . God has furnished man with a liberal variety of foods sufficient to satisfy furnished man with a liberal variety of foods sufficient to satisfy every dietary need. every dietary need. Fruits, grains, nuts, and vegetables Fruits, grains, nuts, and vegetables prepared in simple ways "make, with milk or cream, the most prepared in simple ways "make, with milk or cream, the most healthful diet."healthful diet." - - Christian Temperance and Bible HygieneChristian Temperance and Bible Hygiene, p. , p.

4747..

Independent assessment of lacto-ovo vegetarianismIndependent assessment of lacto-ovo vegetarianism

While the SDA church has historically promoted a While the SDA church has historically promoted a vegetarian diet, independent studies have vegetarian diet, independent studies have highlighted its health benefit. The incidence of highlighted its health benefit. The incidence of certain cancers is less in those who use some milk. certain cancers is less in those who use some milk. The US Committee on Diet, Nutrition and Cancer, The US Committee on Diet, Nutrition and Cancer, reports that dairy milk consumption was reports that dairy milk consumption was protective of stomach cancer, oesophageal cancer, protective of stomach cancer, oesophageal cancer, colorectal cancer and bladder cancer (CDNC colorectal cancer and bladder cancer (CDNC 1982).1982).

Lacto-ovo-vegetarian dietLacto-ovo-vegetarian diet

The Church maintains it strong position on Diet and The Church maintains it strong position on Diet and Health, continuing to promote a lacto-ovo-Health, continuing to promote a lacto-ovo-vegetarian diet (Fraser 1995). The Sanitarium vegetarian diet (Fraser 1995). The Sanitarium Health food Company manufactures vegetarian Health food Company manufactures vegetarian products suitable for both vegetarians and vegans products suitable for both vegetarians and vegans that are fortified with vitamin B12 (Radd 1999). A that are fortified with vitamin B12 (Radd 1999). A dairy milk alternative, dairy milk alternative, So GoodSo Good contains similar contains similar amounts of vitamin B12 as does milk. One serving amounts of vitamin B12 as does milk. One serving of any of the meat analogues manufactured, contains of any of the meat analogues manufactured, contains 25% of the RDI for vitamin B12.25% of the RDI for vitamin B12.

Vitamin B12 sources for AdventistsVitamin B12 sources for Adventists

Lacto-ovo-vegetarians. Consume at least 20 Lacto-ovo-vegetarians. Consume at least 20 servings of vitamin B12 containing foods servings of vitamin B12 containing foods each weekeach week

Vegans. Consume at least 20 servings of Vegans. Consume at least 20 servings of So So Good, Soy healthy and MarmiteGood, Soy healthy and Marmite each week each week

AND/ORAND/ORTake a vitamin B12 supplement regularlyTake a vitamin B12 supplement regularly

Conclusions 1Conclusions 1

While there may come a time when eggs While there may come a time when eggs and milk become unsafe:and milk become unsafe: We will know whenWe will know when We should not prematurely discard themWe should not prematurely discard them

Vitamin B12 is a critical issue that must be Vitamin B12 is a critical issue that must be taken seriouslytaken seriously

The Church recommends a lacto-ovo-The Church recommends a lacto-ovo-vegetarian diet.vegetarian diet.

Conclusions 2Conclusions 2

At least 20 servings/week of vitamin B12 –At least 20 servings/week of vitamin B12 –containing foods are requiredcontaining foods are required

Low fat dairy and Low fat dairy and So GoodSo Good are good sources of are good sources of vitamin B12vitamin B12

If you choose to be vegan, or do not consume at If you choose to be vegan, or do not consume at least 20 servings/week, take a supplementleast 20 servings/week, take a supplement

Regardless of diet preference, those over age 60 Regardless of diet preference, those over age 60 should ask their doctor to monitor their vitamin should ask their doctor to monitor their vitamin B12 levels, and seek supplementation if low.B12 levels, and seek supplementation if low.

QUESTIONS QUESTIONS

And if there is time after, a research report And if there is time after, a research report on the most effective B12 treatment on the most effective B12 treatment methods.methods.

Efficacy of treatment methods in vitamin B12 deficiency

Efficacy of treatment methods in vitamin B12 deficiency

Research MethodResearch Method

Initial blood tests (MBA, FBC, B12, Folic Initial blood tests (MBA, FBC, B12, Folic acid, Homocysteine) acid, Homocysteine)

Initial life-style and well-being Initial life-style and well-being questionnairesquestionnaires

Monthly B12 and Homocysteine (3 months)Monthly B12 and Homocysteine (3 months) Final blood tests (MBA, FBC, B12, Folic Final blood tests (MBA, FBC, B12, Folic

acid, Homocysteine)acid, Homocysteine) Final well-being questionnaireFinal well-being questionnaire

Treatment GroupsTreatment Groups

ControlsControls

So GoodSo Good (2, 250mL/day, 2ug vitamin B12) (2, 250mL/day, 2ug vitamin B12)

Meat Analogues (1 serving/day, Meat Analogues (1 serving/day, Today'sToday's GourmetGourmet Range, 0.6-0.8 ug vitamin B12) Range, 0.6-0.8 ug vitamin B12)

Treatment GroupsTreatment Groups

High dose tablets (50 ug, one/week)High dose tablets (50 ug, one/week)

Low dose tablets (2 ug, one/day)Low dose tablets (2 ug, one/day)

IM injection (100ug, one/month)IM injection (100ug, one/month)

ControlControl

Serum B12 Decreased2.3%

p=0.18

Homocysteine decreased4.2%

p=0.07

Wellbeingscore

No change p=0.24

Meat AnaloguesMeat Analogues

Serum B12 Increased5.7%

p=0.24

Homocysteine Decreased5.6%

p=0.09

Wellbeingscore

No change p=0.19

High Dose TabletHigh Dose Tablet


p=0.003


p=0.003

Wellbeingscore

Significantimprovement

p=0.0002

Injection IMInjection IM

Vitamin B12 Increased21%

p=0.0009


p=0.11

Wellbeingscore

No change p=0.11

Low Dose TabletLow Dose Tablet


p=0.03


p=0.008

Wellbeingscore


p=0.009

So GoodSo Good


p<0.00001


p=0.0007

Wellbeingscore


p=0.01

Wellbeing ScoresWellbeing Scores

Statistical analysis of pre- and post Statistical analysis of pre- and post treatment Wellbeing scores revealed treatment Wellbeing scores revealed

that subjects “felt better” after that subjects “felt better” after treatment.treatment.

p=0.0006p=0.0006

ConclusionConclusion

Low serum levels of vitamin B12 are Low serum levels of vitamin B12 are common (vegetarians and the elderly)common (vegetarians and the elderly)

Dietary inadequacy is the most common Dietary inadequacy is the most common cause.cause.

Serious health risks are associated with low Serious health risks are associated with low levels of vitamin B12levels of vitamin B12

Food supplements are useful in prevention Food supplements are useful in prevention and treatment of vitamin B12 deficiencies.and treatment of vitamin B12 deficiencies.

ConclusionConclusion

Vitamin B12 Fortified Soy Milk is effective Vitamin B12 Fortified Soy Milk is effective in the treatment of vitamin B12 deficiencyin the treatment of vitamin B12 deficiency

Daily Low dose tablet supplements are Daily Low dose tablet supplements are more effective than weekly High doses.more effective than weekly High doses.

There is an inverse relationship between There is an inverse relationship between serum B12 and homocysteine (body serum B12 and homocysteine (body reserves)reserves)

People “feel better” after treatment People “feel better” after treatment

1 How have you been feeling in general ? (DURING THE PAST MONTH) 5 [ ] In excellent spirits 4 [ ] In very good spirits 3 [ ] In good spirits mostly 2 [ ] I have been up and down in spirits a lot 1 [ ] In low spirits mostly 0 [ ] In very low spirits 2 How often were you bothered by any illness, bodily disorder, aches or pains ? (DURING THE PAST MONTH) 0 [ ] Every day 1 [ ] Almost every day 2 [ ] About half of the time 3 [ ] Now and then, but less than half the time 4 [ ] Rarely 5 [ ] None of the time 3 Did you feel depressed ? (DURING THE PAST MONTH) 0 [ ] Yes - to the point that I felt like taking my life 1 [ ] Yes - to the point that I did not care about anything 2 [ ] Yes - very depressed almost every day 3 [ ] Yes - quite depressed several times 4 [ ] Yes - a little depressed now and then 5 [ ] No - never felt depressed at all

4 Have you been in firm control of your behaviour, thoughts, emotions, or feelings ? (DURING THE PAST MONTH) 5 [ ] Yes, definitely so 4 [ ] Yes, for the most part 3 [ ] Generally so 2 [ ] Not too well 1 [ ] No, and I am somewhat disturbed 0 [ ] No, and I am very disturbed 5 Have you been bothered by nervousness or your “nerves” ? (DURING THE PAST MONTH) 0 [ ] Extremely so - to the point where I could not work or take care of things 1 [ ] Very much so 2 [ ] Quite a bit 3 [ ] Some - enough to bother me 4 [ ] A little 5 [ ] Not at all 6 How much energy, pep, or vitality did you have or feel ? (DURING THE PAST MONTH) 5 [ ] Very full of energy - lots of pep 4 [ ] Fairly energetic most of the time 3 [ ] My energy level varied quite a bit 2 [ ] Generally low in energy or pep 1 [ ] Very low in energy or pep most of the time 0 [ ] No energy or pep at all - I felt drained, sapped

vitamin b12 – medical science, mrs white and the church dr bevan hokin bsc mappsc phd director of...

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