The Secret Evils of a Healthy Diet.

(I'm probably going to get blasted for this one, but I am writing it anyway.)

 No-one wants to hear that a Healthy Diet has Evils. Actually, it was hard to find a clear definition of what constitutes a Healthy Diet, let alone what constitutes Good and Evil therein. But I found a definition and I have found two Evils, which can work together, and -with a bit of assistance from your well-intended and unsuspecting primary physician, can cause a pretty serious problem over time.

WTF are you talking about, OSM? I hear you ask.

I'm talking about B12 deficiency.

Don't be daft, OSM, (I hear you say) there is plenty of B12 in a healthy, balanced diet.

Is there? Show me. OK. scratch that. I'll show you that there might not be sufficient B12 in a healthy diet.

...what exactly constitutes a healthy, balanced diet, anyway?  I tried to find a definition or example online, and could find very little. I did find this:

 

Clinical nutrition definition: Any diet based on sound nutritional principles; the HD philosophy is often coupled with the  belief that organic and/or unprocessed foods–ie, produced without pesticides and chemical preservatives, are superior to adulterated foods

Healthy diets, features of

• High consumption of fruits & vegetables

• Low consumption of red meat & fatty foods

• Raw foods & whole grains are preferred to processed or refined foods

• Protein primarily from fish, dairy products, nuts

• Consumption of salt, pepper, sugar, coffee & other caffeinated beverages, and alcohol, is discouraged

 

OK that sound fair enough, it echoes what most of me doctors have told me: Lots of vegetables and whole grains, low on red meats, fats and chemicals.

Here is a list of some B12 sfood sources from the National Institute of Health (NIH). I figure they should know, right?

Table 1: Selected food sources of vitamin B₁₂

Food	Micrograms (μg) per serving	Percent DV*
Mollusks, clam, mixed species, cooked, 3 ounces	84.1	1400
Liver, beef, braised, 1 slice	47.9	780
Fortified breakfast cereals, (100%) fortified), ¾ cup	6.0	100
Trout, rainbow, wild, cooked, 3 ounces	5.4	90
Salmon, sockeye, cooked, 3 ounces	4.9	80
Trout, rainbow, farmed, cooked, 3 ounces	4.2	50
Beef, top sirloin, lean, choice, broiled, 3 ounces	2.4	40
Fast Food, Cheeseburger, regular, double patty & bun, 1 sandwich	1.9	30
Fast Food, Taco, 1 large	1.6	25
Fortified breakfast cereals (25% fortified), ¾ cup	1.5	25
Yogurt, plain, skim, with 13 grams protein per cup, 1 cup	1.4	25
Haddock, cooked, 3 ounces	1.2	20
Clams, breaded & fried, ¾ cup	1.1	20
Tuna, white, canned in water, drained solids, 3 ounces	1.0	15
Milk, 1 cup	0.9	15
Pork, cured, ham, lean only, canned, roasted, 3 ounces	0.6	10
Egg, whole, hard boiled, 1	0.6	10
American pasteurized cheese food, 1 ounces	0.3	6
Chicken, breast, meat only, roasted, ½ breast	0.3	6

Have a serious look at that list. Now take out the breakfast cereal, because I am pretty sure that's a red herring and then honestly add up how much B12 you consume in a day. Notice that a serving of chicken breast: that vaunted staple of The Healthy Diet, contains only 6% of the Daily Value of B12. A cup of milk (8oz) only 10% and a cup of yogurt, which is two of those little 4oz carton thingys BTW, contains 25% of the DV. 

So -breakfast cereal aside (because I am going to come to that in a minute), were I to try and to get adequate B12 from food, according to this chart from the NIH,  I would need to eat all this:

Food	Percentage DV
2 eggs	20%
A pint of milk (2 8oz cups)	30%
3oz (one little can) of tuna	15%
Two half chicken breasts, roasted	12%
1 cup plain skim yogurt (which I hate)	25%
Total	102%

This brings me to 102% of the daily value. OK fine. Better to be slightly over than under. And remember, I would have to eat all this  in ADDITION to my veggies and wholegrains, which contain virtually no B12.

That's a lot of food. I don't eat three servings of protein AND two eggs AND all that milk and yogurt in one day! I don't know who does. And in order to get adequate B12 from food, I would need to eat like that every single day. Actually more for me. Because I am recovering from a B12 deficiency, I need more B12 than the average Joe.

I can raise my B12 intake by eating Unhealthy food; steak, a taco or a burger all have much higher B12 than the healthy food. But then me Healthy Diet is blown.

...and now we understand the title of this piece.

Yes,  there are better sources of B12 on the list and you may say that I deliberately ignored them. But I can't tell you the last time I served my children wild rainbow trout for dinner, or indeed when I was a Mean Mom and had the audacity to serve farmed rainbow trout for dinner on a school night. Oh wait. I suddenly remembered when:

It was Never.  On both counts. 

We do eat tuna, which is a pretty low source of B12,  but not too much salmon, which is a much better source.  And both kids would probably run a mile if presented with a mollusk (although Grace will eat scallops) or a piece of liver.

So that leaves "unhealthy" food.

Now, I know most of you have probably looked at this list, zeroed in on the 'fortified breakfast cereal', then relaxed, with the thought  I eat me Special K every day. I'm fine.

Are you?

Let's explore that for a minute.

I was quite amazed, when researching this subject to find differing opinions on the recommended daily amount of B12 a healthy adult should intake. Here is an excerpt from the NIH page where I got that daily value grid.

The DV for vitamin B₁₂ is 6.0 micrograms (μg).

This is from the next paragraph, on the exact same page:

Table 2: Recommended Dietary Allowances (RDA) for vitamin B₁₂ for children and adults [7]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	0.9	N/A	N/A
4-8	1.2	N/A	N/A
9-13	1.8	N/A	N/A
14-18	2.4	2.6	2.8
19 and older	2.4	2.6	2.8

 

So which is it, NIH?  Is it 6 micrograms or 2.4 micrograms?   Because that is a big difference! The 6 mcg number comes from the FDA, BTW.  The 2.4 mcg number comes from the Institute of Medicine. Personally, I prefer the FDA number. I'm going with that one for me and my kids. But here's the problem I have now:  Which number was used in the food values table above?  The FDA number or  the IOM one?  As 0.6mcg=10% of DV on that table, it must be the FDA number.  OK fine.

Then I  looked at me box of special K:

	Cereal only	Cereal with ½ cup vit A&D fat-free milk
B12	100%	110%
Folic Acid	100%	100%

 

These are only percentages. There no values in micrograms. So I don't know if this figure is 100% of the FDA-recommended  6 mcg or of the IOM-recommended 2.4mcg. There is a big difference between the two, right?  Reading all the small print of the box I see "The Institute of Medicine suggests...." So I figure the numbers are IOM numbers. Therefore, the cereal does NOT provide 100% of my FDA recommended daily value.  And also, that first NIH table, with the food values:

Fortified breakfast cereals, (100%) fortified), ¾ cup

6.0

100

 

...is wrong! That's the FDA number, but Kellogg's are using the IOM one. Therefore, that line should read 2.4mcg and 40%.  For special K, at least.

I had a quick look online at the B12 value for Cheerios and again, no hard numbers, just percentages. This time the precentage was 25% without milk and 35% with milk. This time there was neither reference to the FDA or the IOM that I could see, so I have no idea which guideline they are using. For me  the point is moot because we don't really eat fortified breakfast cereal in this house. The Special K box that I used as an example here had been sitting there for ages! But if anyone out there is using fortified cereal as a means to keep their B12 levels propped up, just be sure you understand what those numbers actually represent.

Regardless of whether the recommended amount is 6.0 or 2.4, I figure that many of us who are trying to eat a healthy diet are not getting our full quota of B12 every day, (while the people scarfing down steak, burgers and tacos are doing much better on the B12 front!).   But that's OK, right?  If any of us are B12 deficient, the doctor will catch it in the annual physical  (because we all go for our annual physical right after our birthday, right)?  That's our safety net.  The annual physical.

Maybe. Maybe not.

The Mean Corpuscular Volume (MCV) test in the standard CBC is the method most doctors use to measure your B12 levels. It is an indirect measure:  The science behind it is relatively simple: If B12 levels are too low, the red blood cells (RBCs)  start coming out wonky. Instead of being a nice, neat doughnut shape,   like in this picture on the left, they are bigger and uneven with lumpy bits (that's a medical term!), like the picture on the right.  Personally I don't see too much of a difference, but that's probably why I don't work in a lab...

There are a few problems I see with this MCV approach for detecting dietary B12 deficiency:

1 Folic Acid (will explain in a tick).

2. The human liver can store up to four  years worth of B12, so by the time your red blood cells are coming out wrong, your diet will have been deficient for years.

3. Making red blood cell is not B12's only job. B12 also makes myelin, the stuff your nerve cells need in order to transmit signal properly:   Multiple Sclerosis is  disease in which myelin is effected;  so yeah. We need it. A lot. And by the time your blood cells start showing problems, the myelin could have been in trouble for a long time.

4. There is a perfectly good test  available that will directly measure blood serum levels of B12.

 

Sorry, wrong Superhero.

In 1998 the FDA required that certain manufacturers of grain staples like bread and cereal should  add Folic Acid to their product.  Folic Acid (B9)  is like a Vitamin Superhero.  It does lots of things in the body. It is most famous for preventing spina bifita  in babies if taken by women prior to conception and during pregnancy.  In fact, Folic Acid is such a superhero, that if your B12 levels are low, it will step in and help those little blood cells to stay healthy and doughnutty.

However, sending Folic Acid to do B12's job is problematic. Because if Folic Acid is a superhero,  it is like the Batman of Vitamins. Well meaning, with lots of tricks up it's sleeve,  but ultimately human. Batman can't fly. He can jump, glide and absail. He fakes it pretty well, but it isn't real flying.

B12 is more Like the Superman of vitamins. He doesn't need tricks or gadgets. He can fly.

B12's primary Superman trick is that it makes myelin.  Folic Acid just can't do that.  So if your B12 is low or missing, and your Folic Acid is high -and it often is  for those of us who like to eat healthy, because we pile on those leafy green vegetables-  Folic Acid will do it's very best to take over B12's job where it can: In the blood cell department.  Unfortunately, your myelin is on its own. Because Folic Acid can't fly.

So remember that blood test, the MCV that the doc will use to indirectly check your B12 levels?  It is now  actually useless for that purpose, and could even be dangerous, because Folic Acid is taking up the slack with the blood cells, but not with myelin.

That is the second secret evil of a healthy diet: Too much folic acid may mask B12 deficiency.

You need a serum B12 test to really know your B12 levels. Don't bother  faffing  around with MCVs for that purpose.  I'm serious.

What does B12 deficiency feel like?

Now all this -especially the folic-acid-masks-B12-deficiency thing this isn't scientifically proven. Yet. They are starting to find some stuff; see this,  this and this. It is relatively early days yet.  Most people can store about 4 year's supply of B12, so it will take a long time for a dietary deficiency to become apparent.  And B12 deficiency is sneaky and unobvious. For me, it started as fatigue and these hideous mouth ulcers that I used to intermittently get all along one side of my mouth and throat. 

I didn't notice that I was losing feeling in my hands until I burned my hand  and didn't feel it. -I didn't flinch at all, but I SAW my hand was burning and pulled it off the grill (ended up with a lovely blister about an inch across).  If that accident hadn't happened, I don't know when I would have realized there was a problem. Other people who have had B12 deficiency will say the same thing: That  it snuck up so slowly and they didn't realize there was a big problem until it was well advanced.

Because most people do what I did when I first started to feel tired. I blamed myself. I figured. I am unhealthy. I should eat better: More fruits and vegetables, less fast food and less red meat...

See the vicious cycle?

This is why we should go to the doctor, people.

... and ask for the correct test.

Comments

[queen-slug]

Well you know I went & checked my test results to see which way I was being tested for my B-12 & it was serum. Now I get why my neuro was impressed with that test. I bet she thought it would be the other form.

Just a side note, I don't trust fortified cereals. Are the amounts the amount they add or is it the amount that is bio-available once the product is on the shelf. Plus who needs that much iron? 'Cause my word is there a lot in them.

[Carleen]

I'm not a health guru and certainly don't eat anything that resembles a "healthy" diet, probably because I was an obligate carnivore in a past life and traces of it have hung on into this one, so I take all kinds of vitamin supplements. Whether or not doing so helps is anyone's guess, but it does lessen the twinges of guilt in the old conscience every now and again. :)

[yanub]

Bah to a "healthy" diet. I used to eat "healthy." And I used to constantly break out in rashes, have asthma attacks, and extremely socially awkward intestinal disturbances. Then I found out I was allergic to all that "healthy" stuff. I hate to think of all the damage I was doing to myself by continuing to eat "healthy" instead of listening to my body.

And liver? Love it. Eat it at least once a week now, smothered in cream and onions.

[Ann]

A great article! And if you happen to be a vegetarian you risk a deadly form of anemia due to a deficiency of B12. So many peole are suffering from depression today and this vitamin deficiency is often overlooked as a root cause. Most psychiatrist's I know suggest supplementing the B vitamins but primary care physicians often do not. If you feel you cannot get enough B12 into your daily diet perhaps you could supplement. Also I personally feel that lean red meat can be a part of a "healthy" diet and perhaps should be especially for menstruating women. All things in moderation!

[Travacor]

There are always exceptions in every which method of life you follow,but healthy and unhealthy has to be balanced beautifully to move ahead in this life isn't it?

[helen]

Hi
Another example of the way funding affects health care. But it gets more complicated.
Low iron causes microcytosis (small red blood cells) , and as iron, B12 and folate are all absorbed in the same part of the small intestine, it's not uncommon to have all low, especially in conditions like coeliac disease. BTW you can be gluten intolerant without the biopsy signs of coeliac. The gliaden IgA and IgM antibodies should be checked.
Low B12 +/-folate can cause psychosis (megaloblastic mania - known for at least 50 years) and subacute spinal cord degeneration (although different from that in syringomyelia)in addition to peripheral paraesthesias and hypoaesthesias. I find dizzyness often responds to B12. B12 and RC folate are part of the screening process for dementia, and should be for any neurological disorders (especially MS which is exacerbated by low levels of B12).
Here (Australia) we would check serum B12 and red cell folate (more accurate)- I routinely screen all women. In my experience only vegans ( no meat,dairy or eggs), those with pernicious anaemia (low intrinsic factor and family history) and coeliac/gluten sensitivity/gut dysbiosis have B12 below accepted range, although about 10% are at bottom of range. Sublingual B12 is much better absorbed.
Very nicely researched. You are a writer.