B12 PPT

B12 Fuente Vegana http://fuentevegana.blogspot.com/ www.facebook.com/fuentevegana fuentevegana@gmail.com

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La información para esta charla fue tomada de http://veganhealth.org y http://nutritionfacts.org/ y el libro Vegan for Life. Los profesionales de la salud citados son los nutricionistas Jack Norris y Virginia Messina, y el médico Michael Greger.

ÂżQuĂŠ es el veganismo?

Deficiencia de B12 Los signos de deficiencia cl铆nica son una fatiga poco com煤n, mala digesti贸n, falta de apetito, nausea, amenorrea (falta de menstruaci贸n).

Pero hay muchos más síntomas tales como:                 

adormecimiento y cosquilleo en las manos y pies nerviosismo diarrea depresión leve cambios conductuales severos paranoia reflejos hiperactivos fiebre infecciones respiratorias superiores frecuentes impotencia deterioro de la memoria infertilidad dolor en la lengua engrandecimiento de las membranas mucosas en la lengua, vagina y estómago anemia macrocítica baja en la cuenta de plaquetas, mayor sangramiento neuropenia

Casos Individuales en adultos  

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57 Year Old Vegan Develops Irreversible Subacute Sclerotic Combined Degeneration of the Spinal Cord Brocadello et al. (2007, Italy) reported a 57-year-old man hospitalized due to weakness, inability to walk, difficulty in handling utensils, constipation, and urinary retention, among other things. His measurements were: serum B12 - 30 pg/ml MCV - 115 fl Hcy - 15.4 µmol/L uMMA - 1.3 µmol/L It's somewhat surprising that his homocysteine and urinary MMA levels weren't higher than that. The authors also mention that his diet was low in protein and calories. Upon treatment, his blood values returned to normal, but after one year he still had not regained the ability to walk.

Brocadello F, Levedianos G, Piccione F, Manara R, Pesenti FF. Irreversible subacute sclerotic combined degeneration of the spinal cord in a vegan subject. Nutrition. 2

Casos Individuales en adultos ď Ž ď Ž

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15 Year Old Vegan Not Supplementing with B12 Develops Lameness Chiron et al. (2001, France) reported a 15-year-old boy hospitalized because of lameness and jaundice. He had B12-deficiency anemia as well as rickets. A diet supplemented with calcium, vitamin D, and B12, and orthopedic treatment stabilized the bone lesions. The anemia was cured by a B12 injection(s). The authors state, "The adolescent and his brother were victims of a diet imposed by a cult and a lack of care due to their parents refusing that a vegan diet was the cause of the deficient pathology." The article is in French and no further information was given in the abstract.

Reference: Chiron R, Dabadie A, Gandemer-Delignieres V, Balencon M, Legall E, Roussey M. [Anemia and limping in a vegetarian adolescent] Arch Pediatr. 2001 Jan;8(1):62-5. French.

(Abstract)

Casos Individuales en adultos  

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10 Year Old Develops Serious Neurological Problems Cornejo et al. (2001, Spain) reported a 10 year old boy with serious neurological problems. They said the boy was as "a member of a religious community who were strict vegetarians." The article is in Spanish and no further information was given in the abstract.

Reference: Cornejo W, Gonzalez F, Toro ME, Cabrera D. [Subacute combined degeneration. A description of the case of a strictly vegetarian child] Rev Neurol. 2001 Dec 16;33(12):1154-7. Spanish. (Abstract)

Casos Individuales en adultos  

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14 Year Old Vegan Develops Fatigue, Aching, Stumbling, and Heart Murmur Licht et al. (2001, USA) reported a 14 year old boy with a serum B12 of 281 pg/ml. This is not particularly low. However, he had developed fatigue, daytime sleeping, an aching calf, stumbling, and a heart murmur. He was small for his age and withdrawn. His mean corpuscular volume was 108 fl, serum MMA was 2.5 µmol/l, and homocysteine was 64.4 µmol/l. He did not have anemia. His mother considered him a "picky eater." He was treated with a number of 1,000 µg intramuscular injections of B12.Treatment resulted in normal gait, but after 18 months he still had nerve problems.

Reference: Licht DJ, Berry GT, Brooks DG, Younkin DP. Reversible subacute combined degeneration of the spinal cord in a 14-year-old due to a strict vegan diet. Clin Pediatr (Phila). 2001 Jul;40(7):413-5.

Casos Individuales en adultos ď Ž ď Ž

33 Year Old Vegan Not Supplementing with B12 Develops Nerve Problems and Vision Damage Milea et al. (2000, France) reported a male vegan of 13 years who appeared to have a poor diet given deficiencies of vitamins A, B1, B12 (154 pg/ml), C, D, E, and folate, and zinc and selenium. He had been vegan for "improved health," and did not smoke or drink alcohol. He was found to have severe optic nerve disease, sensory nerve problems, reduced hemoglobin, and a 110 fl. MCV. He had no signs of malabsorption. After a multivitamin and B12 injections of 1000 Âľg/day for 1 week, his hemoglobin and sensory nerve problems disappeared, but his vision didn't recover. The authors concluded that "The optic neuropathy in our patient was apparently related to deficiencies of B12 and B1, but other associated deficiencies may have had a role."

Casos Individuales en adultos  

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80 Year Old Vegan Not Supplementing with B12 Develops Nerve Damage Bernstein (2000, USA) describes a man in his eighties who had been in excellent health, and was a runner. He had been vegan for 38 years and attributed his ability to outperform younger people to his diet. In the span of a few weeks, mental disturbances began to set in. He cried, was confused, got lost, was incontinent, lost control of his bowels, and lost motor skills to the point where he could barely stand with help. He was diagnosed with "senile dementia." A blood test showed slightly large red blood cells. Further blood tests revealed that his B12 level was undetectable. He was given an injection of 1000 µg of B12. The next morning he could sit without help. His bladder control returned within 48 hours. By the end of the week, he could play simple card games, read get-well cards, and talk on the phone.

He still cried easily and his attention span was too short to go back to work. Bernstein concludes, "[A] diet free of animal protein can be healthful and safe, but it should be supplemented periodically with vitamin B12."

Reference: Bernstein, L. Dementia without a cause. Discover. February 2000:31

Casos Individuales en adultos  

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14 Year Old Vegetarian Not Supplementing with B12 Develops Nerve Problems Ashkenazi et al. (1987, Israel) reported a 14-year-old girl who had been vegetarian (and apparently vegan) for 8 years after witnessing the slaughter of a cow. She had been healthy previously and seemed well nourished. She had neurological problems including an unstable walk, unsteady standing with eyes closed, some impaired sensations, mildly reduced muscle strength, and reduced ankle-jerk reflex. Her serum B12 was 50 pg/ml. Absorption was normal. She had not been taking B12 supplements as her parents were unaware of the need and her doctor was unaware of her diet. Injections and supplements were given, and the girl followed advice to begin eating fish and dairy products. (This was, of course, unnecessary). A rapid improvement was noted with a complete neurological recovery after 4 months.

Reference: Ashkenazi S, Weitz R, Varsano I, Mimouni M. Vitamin B12 deficiency due to a strictly vegetarian diet in adolescence. Clinical Pediatrics. 1987;26(Dec):662-663.

Casos Individuales en adultos  

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Rastafarian Community Campbell et al. (1982, Jamaica) reported 10 Rastafarian men (age 18-49) with B12 deficiency. They had been vegan 2-20 years. 8 had neurological symptoms. B12 malabsorption was ruled out in all cases. 8 had moderate to severe macrocytic anemia. 6 were jaundiced, 3 had a swollen tongue, 2 had anorexia, 1 had vomiting, 1 had abdominal pain, and there were other symptoms. Their serum B12 range was 10-130 pg/ml, with only 2 over 75 pg/ml. Their blood completely responded to cyanocobalamin injections. Of 3 who had subacute neurological degeneration, one recovered completely.

Another improved considerably but had residual motor defects after several months of treatment. The third patient died of a heart attack 11 days after admission. Campbell stated, "Our patients were not very cooperative in taking oral vitamin B12 or attending the clinic for vitamin B12 injections…."

Reference: Campbell M, Lofters WS, Gibbs WN. Rastafarianism and the vegans syndrome. BMJ (Clin Res Ed). 1982 Dec 4;285(6355):1617-8.

Casos Individuales en adultos  

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56 Year Old Vegan Not Supplementing with B12 Develops Extremely Low B12 Levels Murphy (1981, UK) reported a male vegetarian of 40 years. He had been vegan for the previous 4 years since developing angina. He had been treated for the previous 8 years with phenobarbital for epileptic seizures. He was admitted for an aortic valve replacement and found to have low hemoglobin, a 98 fl. MCV, and 50 pg/ml B12 level. Folate was normal. A deoxyuridine suppression test showed B12 deficiency. He was treated with 5 µg B12/day, orally, for one month. His serum B12 levels rose to 205 pg/ml and his hemoglobin returned to normal.

Reference: Murphy MF. Vitamin B12 deficiency due to a lowcholesterol diet in a vegetarian. Ann Intern Med. 1981 Jan;94(1):578.

Casos Individuales en adultos  

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57 Year Old Vegan Not Supplementing with B12 Develops Nerve Problems Carmel (1978, USA) reported on a man admitted to the hospital in 1976 with trouble walking. He had been in good health until 1972 when he retired because of fatigue. He had been almost vegan, eating small amounts of dairy, for 25 years. He had siblings who ate a similar diet, but who took B12 and did not develop problems. In 1974, a chiropractic nutritionist told him his problems were not related to a B12 deficiency. He then replaced the dairy in his diet with a raw egg yolk every other day. He improved for a short time but then got worse. Two weeks before admission, he began taking 100 µg B12/day. Upon admission, he had decreased sensation in the hands and below the knees, with slight megaloblastic anemia. His B12 level was 146 pg/ml. He was injected with 1000 µg/day of B12 for 3 weeks which caused rapid improvement. He then received B12 injections once a month for 6 months (by which time his only neurological problem was in his feet) and then he started 100 µg/day orally. He also started eating fish, dairy products, and eggs. His B12 level stabilized at about 300 pg/ml. He had slightly depressed intrinsic factor secretion and reduced stomach acid, which was apparently not due to the B12 deficiency as it did not improve with treatment. His problems were probably due to a combination of low B12 intake and decreased absorption.

Reference: Carmel R. Nutritional vitamin-B12 deficiency. Possible contributory role of subtle vitamin-B12 malabsorption. Ann Intern Med. 1978 May;88(5):647-9.

Recomendaciones 

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Primer paso: Si tiene una fuente de B12 regular, ve al paso 2. Si no has tomado una fuente regular de B12 por un tiempo se recomienda: Consumir 2500µg diarios por 2 semanas. Luego de eso puede pasar a una dosis de 2500µg semanales. No es problema tomar más de lo recomendado. Luego de ese periodo siga las recomentaciones del paso 2.

Paso dos:

Recomendaciones de Vitamina B12 (Cianocobalamina*) Sigue uno de estas recomendaciones Edad

Dosis Diaria Recomendada en USA (µg)

2 dosis diarias (µg)

Dosis diaria (µg)

2 dosis semanales (µg)

0 a 5 meses

0,4

NA

NA

NA

6 a 11 meses

0,4

0,4 - 1

5 - 20

200

1 a 3 años

0,9

0,8 - 1,5

10 - 40

375

4 a 8 años

1,2

1-2

13 - 50

500

9 a 13 años

1,8

1,5 - 2,5

20 - 75

750

14 años y +

2,4

2 - 3,5

25 - 100

1000

Embarazo

2,6

2,5 - 4

25 -100

1000

Amamantamie nto

2,8

2,5 - 4

30 -100

1000

µg = mcg = microgramo = 1/1,000 de un miligramo (mg) NA: No aplica. Los bebés deben recibir leche materna o fórmula para bebés comercial la que contiene las cantidades necesarias de vitamina B12.

Se siguen considerando seguras cantidades mucho mayores, pero probablemente lo mejor es no exceder estas recomendaciones a más del doble. * Estas recomendaciones son sólo para cianocobalamina. No hay suficientes datos provenientes de investigaciones acerca de las otras formas de la vitamina B12 para poder recomendar dosis de suplementos específicos. Para más información, ver Alternativas a la cianocobalamina: Metilcobalamina y Dibencozide.

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NOTAS Los alimentos fortificados en USA: Las cantidades enlistadas en la etiqueta están basadas en 6 µg/día. Por ejemplo 25% del Valor Diario sería 0,25 x 6µg = 1,5µg. No he podido encontrar un consenso respecto a las dosis recomendadas en Chile o cuán rigurosas son las etiquetas con información nutricional.

No se confíen en las algas (nori, spirulina, etc), levadura de cerveza, tempeh, o suplementos de vitamina "Vivos" que usan vegetales como fuenes de B12.

No se confíen de un único alimento como fuente de B12.

La ruta sublingual no es más efectiva que el simplemente tragar un suplemento.

Los bebés veganos: El instituto de Medicina recomienda que los bebés de madres veganas suplementen con B12 desde el nacimiento, debido a sus reservas al momento de nacidos y a que el suministro por leche materna puede ser demasiado bajo.

Excepciones: Las personas con enfermedades de mal absorción o digestivas (como anemia perciciosa), falla renal crónica, defectos metabólicos de B12 o de cianuro deberían consultar un profesional de la salud de confianza.

Los fumadores deberían considerar una fuente de B12 que no sea cianocobalamina. http://veganhealth.org/b12/smoke

Fuentes ‘falsas’ 

Nori, spirulina, combucha, clorella, tempeh, frutas orgánicas, frutas y verduras sin lavar, reabsorción intestinal, 'buena salud y equilibrio'...

Pero… ¿Dónde se compra? 

Nutrabulk http://www.nutrabulk.c om/index.php? dispatch=products.vie w&product_id=30242

Farmacia ahumada  Farmacia Serey 

多Preguntas?

ยกMuchas gracias!

http://fuentevegana.blogspot.com/ www.facebook.com/fuentevegana fuentevegana@gmail.com