Her er teksten vi har sendt til Nordic Nutritional Recommendations 2022. Dette, NNR 2022, er et forarbeid, eller vitenskapelig grunnlag, til fellesnordiske kostholdsråd. Les også: Innspill til NNR 2022
Vitamin B12 deficiency is common among the general population.
More research and food fortification may be needed.
Severe vitamin B12 deficiency is rare, but internationally it has been reported that up to 26% of the general population may have subclinical vitamin B12 deficiency. Its occurrence has not been investigated widely and well enough in Norway (1,2,3). Read also: Lack of vitamin D, b12, iron and plant-based nutrition for doctors and medical students (in depth)
Only animal or fortified foods contain vitamin B12.
At the same time, animal food is the biggest source of environmental toxins in the Norwegian diet. The recent report from the Science Committee for Food and Environment, VKM, says:
- On average, the Norwegian population is exposed to more dioxins and dioxin-like PCBs from food than the tolerance limit. And “The food groups that contribute the most are oily fish, milk and dairy products and meat”. (4)
Unlike environmental toxins, there are no downsides to fortification.
Report Development in the Norwegian diet 2021 from the Directorate of Health, (5 – page 9, 40, 41) states that dairy products (cheese, whole milk) and red meat are the main sources of saturated fat. Saturated is the type of fat that 80% of Norwegians eat in unhealthy amounts, according to the Action Plan for a better diet (6 – pages 13 and 56). (5,6)
Assumptions that animal foods are a robust source of B12 for the general population may not be correct. This is:
- Not safe (26% of the population is estimated to have subclinical B12 deficiency, in addition to many pregnant and lactating women)
- Not healthy (main source of environmental toxins and high content of saturated fat)
- Not good for the environment or sustainable food production (The Directorate of Agriculture’s concentrate feed statistics (Kraftfôrstatistikk) show that enormous amounts of food are used to feed livestock). (7)
However, a recent study of Norwegian vegans shows that all have a good B12 status. (8)
This shows that 1) use of fortified food, 2) increased attention to possible B12 deficiency and 3) use of B12 as a dietary supplement is important not only for vegans, but for the population in general – on a broad basis.
Both vitamin D and iodine are difficult to get enough of without supplements (see the reports to the Danish Nutrition Authority), and B12 should be considered one of such “difficult” nutrients. (9,10).
Content of vitamin B12 in various plant milks and meat substitutes, see table 5 page 17. (11) It is also listed in the official Norwegian food table.no (12). The enrichment can therefore be extended to other foodstuffs.
1. Mouland G, Lie Berg C, Nouri Sharikabad M, Thode Sommerschild H. Fylkesforskjeller i utredning og behandling av vitamin B12-mangel. Tidsskr Nor Legeforen 2022 doi: 10.4045/tidsskr.21.0749
2. Green R, Allen LH, Bjørke-Monsen AL et al. Vitamin B12 deficiency. Nat Rev Dis Primers 2017; 3: 17040.
3. Carmel R. Prevalence of undiagnosed pernicious anemia in the elderly. Arch Intern Med 1996; 156: 1097–100.
4. VKM. Dioksiner i maten til den norske befolkningen. Risk assessment of dioxins, furans, and dioxin-like PCBs in food in Norway
5. Helsedirektoratet. Utviklingen i norsk kosthold. Oslo: Helsedirektoratet; 2021. P. 9,40,41
6. Helse- og omsorgsdepartementet. Nasjonal handlingsplan for bedre kosthold (2017–2021). Oslo: Helsedirektoratet; 2017. S. 13 og 56
7. Landbruksdirektoratet. Kraftfôrstatistikk
8. Henjum, S. et al. (2022). Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians. British Journal of Nutrition, 1-20. doi:10.1017/S0007114522002987
9. Nasjonalt råd for ernæring, 2016. Risiko for jodmangel i Norge. Identifisering av et akutt behov for tiltak.
10. Nasjonalt råd for ernæring. (2018). Vitamin D i Norge: Behov for tiltak for å sikre god vitamin D-status?.
11. Rapport: Analyser av næringsstoffer og uønskede stoffer i plantebaserte middagsprodukter og drikker 2021. Havforskningsinstituttet.
12. Mattilsynet, Helsedirektoratet, Universitetet i Oslo. Matvaretabellen 2019
Plant based diets, despite being lower in vitamin B12, are more healthy and sustainable than Western diets (that is, with our high consumption of meat and dairy which are good sources of B12).
Sources about diets. health and sustainability:
- World Health Organization. Regional Office for Europe. (2021). Plant-based diets and their impact on health, sustainability and the environment: a review of the evidence: WHO European Office for the Prevention and Control of Noncommunicable Diseases. WHO. Regional Office for Europe. https://apps.who.int/iris/handle/10665/349086 License: CC BY-NC-SA
- Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT Lancet Commission on healthy diets from sustainable food systems [published correction appears in Lancet. 2019 Feb 9;393(10171):530] [published correction appears in Lancet. 2020 Feb 1;395(10221):338] [published correction appears in Lancet. 2020 Oct 3;396(10256):e56]. Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
- Altomkost.dk. Fødevarestyrelsen. De officielle Kostråd – godt for sundhed og klima. Spis mindre kød – vælg bælgfrugter og fisk. https://altomkost.dk/raad-og-anbefalinger/de-officielle-kostraad-godt-for-sundhedog-klima/spis-mindre-koed-vaelg-baelgfrugter-og-fisk/
- USDA. Scientific Report of the 2020 Dietary Guidelines Advisory Committee. Advisory Report to the Secretary of Agriculture and Secretary of Health and Human Services. First Print: July 2020
Canada’s food guide. Healthy food choices link
- Food and Agriculture Organization of the United Nations Food-based dietary guidelines – Belgium lenke
- Springmann M, Godfray HCJ, Rayner M, Scarborough P. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci U S A. Published online March 21, 2016.
- Rinaldi S, Campbell EE, Fournier J, O’Connor C, Madill J. A Comprehensive Review of the Literature Supporting Recommendations From the Canadian Diabetes Association for the Use of a Plant-Based Diet for Management of Type 2 Diabetes. Canadian Journal of Diabetes. 2016.
- Marteau, T. M., Chater, N., & Garnett, E. E. (2021). Changing behaviour for net zero 2050. BMJ (Clinical research ed.), 375, n2293. https://doi.org/10.1136/bmj.n2293
- Martin C. Parlasca and Matin Qaim. Meat Consumption and Sustainability. Annual Review of Resource Economics. Annu. Rev. Resour. Econ. 2022. 14:6.1–6.25 https://doi.org/10.1146/annurev-resource-111820-032340
- Helsedirektoratet. Bærekraftig kosthold – vurdering av de norske kostrådene i et bærekraftperspektiv
- Helsedirektoratet. Utviklingen i norsk kosthold. Oslo: Helsedirektoratet; 2021.
- Helse- og omsorgsdepartementet. Nasjonal handlingsplan for bedre kosthold (2017–2021). Oslo: Helsedirektoratet; 2017
- Kreftforeningen.no. Kosthold og kreft
Chapter 6, Vegans/Vegetarians
Les også: Kosttilskudd for veganere og Mangel på vitamin D, b12, jern
We (in The Norwegian Medical Association for Nutrition) propose that the entire text be changed to the following:
Vegan diets do not contain vitamin B12 except in fortified foods and supplements. Vegetarian diets containing dairy and eggs on regular bases can provide adequate amounts of vitamin B12. Vegan and vegetarian diets were (before 2000 – 2020) associated with an increased risk of vitamin B12 deficiency (22, 57-60). But a recent study on Norwegian vegetarians and vegans (Henjum 2022) shows, on the contrary, that all study participants have a good B12 status.
This shows the following:
- 1) appropriate information and communication (as the Norwegian Directorate of Health already did from 2015)
- 2) use of fortified foods,
- 3) awareness of possible B12 deficiency and
- 4) use of B12 as a dietary supplement
will give good results, when animal food is excluded and significantly reduced in quantity.
Plant food can contain trace amounts due to bacterial or soil contamination or as a result of fermentation. Green and purple lichens (Nori) may contain some vitamin B12 and can be used by humans, while blue-green algae or
cyanobacteria (Spirulina) contain biologically inactive B12 analogs (2, 61).
All of these are not good sources and should not be mentioned/discussed as reliable sources of vitamin B12.
Plant-based milk and other milk substitutes are usually fortified with vitamin B12
(with the exception of biologically/organically produced plant milk). These milk substitutes can be a source of vitamin B12 in vegans, but due to varying intestinal absorption, they may not be enough to meet the requirements, especially in children, pregnant and lactating women. Therefore, vegans should receive a recommendation to take supplements of/with vitamin B12 in sufficient doses.
A plant-based diet (which means a significantly reduced intake of animal food compared to a Western, including Nordic diet) is generally better for health and the environment. Public health strategies should therefore facilitate the transition to a balanced diet with more varied, nutrient-dense plant foods through consumer education, food fortification and possible subsidies.
Animal food is also the biggest source of environmental toxins in the Norwegian diet.
The recent (2022) report from the Science Committee for Food and Environment, VKM, says:
“On average, the Norwegian population is exposed to more dioxins and dioxin-like PCBs from food than the tolerance limit”. And “The food groups that contribute the most are oily fish, milk and dairy products and meat”.
Unlike poisons, there are no downsides to fortification. Therefore, dietary supplements should be considered the best choice/source of vitamin B12.
- Henjum, S. et al. (2022). Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians. British Journal of Nutrition, 1-20. doi:10.1017/S0007114522002987
- Helsenorge.no Vegetarian Diet lenke
- Vegetarian and vegan diet – expert opinion from the National Council for Nutrition. Chapter 2. What kind of supplements should adults on a vegetarian or vegan diet take?
- VKM. Dioksiner i maten til den norske befolkningen. Risk assessment of dioxins, furans, and dioxin-like PCBs in food in Norway https://vkm.no
- Miljøgifter i norsk mat. Henrik S. Huitfeldt, Bjørn J. Bolann Tidsskr Nor Legeforen 2021 doi: 10.4045/tidsskr.21.0499