Vitamin B-12 and homocysteine status among vegetarians: a global perspective

Am J Clin Nutr. 2009 May;89(5):1693S-1698S. doi: 10.3945/ajcn.2009.26736Y. Epub 2009 Apr 8.


Evidence exists that well-planned vegetarian diets provide numerous health benefits and are appropriate for all stages of the life cycle. It is also known that animal foods provide micronutrients that are nonexistent or available only in limited amounts in plant foods. Restriction or exclusion of all animal foods may therefore result in low intake of certain micronutrients such as vitamin B-12, thereby affecting vitamin B-12 status and elevating plasma homocysteine concentrations. Overall, the studies we reviewed showed reduced mean vitamin B-12 status and elevated mean homocysteine concentrations in vegetarians, particularly among vegans. Low vitamin B-12 intake may lead to decreased bioavailability and functional deficiency of cobalamin. Although early noticeable symptoms of vitamin B-12 deficiency are nonspecific (unusual fatigue, digestion problems, frequent upper respiratory infections), the best-known clinical manifestations of cobalamin malabsorption are hematologic (pernicious anemia) and neurologic symptoms. Hyperhomocysteinemia is associated with an increased risk of atherosclerosis and cardiovascular disease. Given these health concerns, vegetarians, particularly vegans, must be advised to carefully plan their diets, to monitor their plasma vitamin B-12 on a regular basis to facilitate early detection of low cobalamin status, and to use vitamin B-12-fortified foods or take vitamin B-12 supplements if necessary.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia, Pernicious / epidemiology
  • Anemia, Pernicious / etiology
  • Atherosclerosis / epidemiology
  • Cardiovascular Diseases / epidemiology
  • Diet, Vegetarian / statistics & numerical data*
  • Homocysteine / blood*
  • Humans
  • Hyperhomocysteinemia / epidemiology
  • Risk Factors
  • Vitamin B 12 / blood*
  • Vitamin B 12 Deficiency / epidemiology*


  • Homocysteine
  • Vitamin B 12