Vitamin B12 Deficiency Is Prevalent Among Czech Vegans Who Do Not Use Vitamin B12 Supplements

As not much is known about the prevalence and predictors of nutritional deficiencies among vegans in the Czech Republic, we evaluated whether supplement use and duration of adherence to the vegan diet are associated with the risk of cobalamin and iron deficiencies. Associations between self-reported supplementation and duration of vegan diet with biomarkers of cobalamin (serum cobalamin, holotranscobalamin, homocysteine, folate) and iron status (serum ferritin, iron binding capacity, transferrin and saturation of transferrin) were assessed by cross-sectional analyses of medical data from a clinical nutrition center. Data from 151 (72 females) adult vegans (age 18–67 years), who were free of major chronic diseases and 85 (40 females) healthy non-vegans (age 21–47 years) were analyzed. Overall, vegans had significantly lower cobalamin, hemoglobin and ferritin levels, but higher folate and MCV values compared to non-vegans. Vegans not using cobalamin supplements were at higher risk of low plasma cobalamin than regularly supplementing vegans (OR: 4.41, 95% CI 1.2–16.16 for cobalamin, OR: 19.18, 95% CI 1.02–359.42 for holotranscobalamin), whereas no significant differences in cobalamin status related to duration of the vegan diet were observed. Regularly supplementing vegans had similar levels of cobalamin/holotranscobalamin as non-vegans. Despite lower ferritin and hemoglobin levels, there was no indication of a higher risk of iron-deficiency among vegans. To conclude cobalamin deficiency risk depends on supplementation status and not on the duration of an exclusive vegan diet, which underlines the need to integrate cobalamin status monitoring and counselling on supplement use in routine clinical care in the Czech Republic.

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Evaluation of Anemia in Adults: Going after the Common Causes.

Blood ◽

10.1182/blood.v106.11.3769.3769 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3769-3769

Author(s):

Peter McPhedran ◽

Robert B. Hall

Keyword(s):

Vitamin B12 ◽

Blood Smear ◽

Binding Capacity ◽

Post Partum ◽

Serum Vitamin ◽

Chronic Inflammatory Disease ◽

Nutritional Deficiencies ◽

Deficiency Anemia ◽

Study Population ◽

Work Up

Abstract Unexplained anemia is a common problem in adult medicine. Traditional approaches to etiologic diagnosis have included testing for “nutritional” deficiencies such as serum vitamin B12, folic acid, iron and iron binding capacity (IBC)(often a house staff approach); performing upper and lower endoscopy (often the Gastroenterologist or the Surgeon); or review of peripheral blood and bone marrow smears and biopsy (the Hematologist). Decision trees starting from MCVs and reticulocyte counts are commonly suggested in Hematology teaching manuals. However none of these approaches are based on knowledge of the most likely causes of anemia in the population to be tested. We hoped to improve on these largely unfounded and unevaluated empiric strategies by determining the actual frequencies of different causes of anemia among non-pregnant adults (20 and older) with initially unexplained anemias (Hb <12 in men, <11 in women) in our hospital, and have done such studies on three occasions in the last 15 years at Yale New Haven Hospital. Patients selected were 1) 202 consecutive adults with anemia new to the hospital laboratory database; 2) 800 consecutive adults treated, or retreated, with iron in the hospital, focussing the analysis on the 200 who were anemic and not just given iron because they were post-operative or post-partum; and 3) 100 consecutive adults having what we would consider “anemia tests” drawn for work up (such as reticulocyte counts, or vitamin B12 assays, etc). Using standard criteria for diagnosis of different causes of anemia, and, mostly, available data, we were able to classify 80–90% of the anemic patients in each study population. From each of these patient groups we were able to draw pie charts showing relative frequencies of different causes of anemia. We recognized a total of 14 causes and groups of causes of anemia (we grouped hemoglobinopathies as one category, for example) in our hospital population. But the four commonest causes were the same in all three studies: anemia of chronic (inflammatory) disease (ACD) (24, 30, and 37%), acute, missed G I bleed (17, 16, and 13%), iron deficiency anemia (IDA)(13, 23, and 16%) and anemia of chronic renal insufficiency (13, 28, and 14%). Popular targets of work up such as B12 and folate deficiency, and hemolytic anemias, together constituted less than 4% of each study population. We therefore propose as initial work up/evaluation of unexplained anemia in adults the following tests: review of the patient’s history for ACD causes; erythocyte sedimentation rate; iron and IBC (and hepcidin when available); stool exam for blood, especially non-occult blood and melena, before considering colonoscopy; ferritin; attention to the probably already available MCV, RDW, and creatinine; and serum erythropoietin (relating its result to Hb and Hct). According to our hospital epidemiologic studies this approach should reveal the causes of anemia in 67–97% of adults. Clues to other specific anemias learned from the patient, such as a history of sickle cell disease, or the technologist’s discovery of many spherocytes on the blood smear should of course be attended to, as priorities. And, although helpful in only two of the four commonest anemias (ACD, IDA), review of a good blood smear is an important cross-check that occasionally yields surprises (Please see BJ Bain, NEJM, 8/4/05).

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Recurrent Aphthous Stomatitis and Nutritional Deficiencies: Report of Three Cases with Literature Review

Odovtos - International Journal of Dental Sciences ◽

10.15517/ijds.v0i0.37071 ◽

2019 ◽

pp. 93-103

Author(s):

Yadira V. Boza Oreamuno DDS, MSc ◽

María F. Rugama Flores BSND

Keyword(s):

Folic Acid ◽

Iron Deficiency ◽

Vitamin B12 ◽

Systemic Disease ◽

Recurrent Aphthous Stomatitis ◽

Blood Analysis ◽

Aphthous Stomatitis ◽

Vegan Diet ◽

Nutritional Deficiencies ◽

First Case

Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year-old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.

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Iron Status of Vegans, Vegetarians and Pescatarians in Norway

Biomolecules ◽

10.3390/biom11030454 ◽

2021 ◽

Vol 11 (3) ◽

pp. 454

Author(s):

Sigrun Henjum ◽

Synne Groufh-Jacobsen ◽

Tonje Holte Stea ◽

Live Edvardsen Tonheim ◽

Kari Almendingen

Keyword(s):

Binding Capacity ◽

Iron Status ◽

Transferrin Saturation ◽

Meat Products ◽

Female Gender ◽

Reproductive Age ◽

Iron Supplement ◽

Dietary Practices ◽

Supplement Use ◽

Iron Binding Capacity

Although plant-based diets provide well-established physical and environmental health benefits, omitting meat or meat products has also been associated with a risk of being deficient in specific nutrients, such as iron. As data on the iron status among Norwegian vegans, vegetarians and pescatarians are lacking, the present study aimed to assess iron status in these groups of healthy adults. Blood markers for iron status were measured in 191 participants (18–60 years old) comprising 106 vegans, 54 vegetarians and 31 pescatarians: serum-ferritin (S-Fe), serum-iron (S-Iron) and serum-total iron binding capacity (S-TIBC). Serum-transferrin-saturation (S-TSAT) was estimated (S-Iron/S-TIBC × 100). The median concentration of blood markers for iron status were within the normal range with no difference between the different dietary practices. In total, 9% reported iron supplement use the last 24 h. S-Fe concentrations below reference (<15 μg/L) were found in 8% of the participating women, of which one participant reported iron supplement use. In multiple regression analysis, duration of adherence to dietary practices and the female gender were found to be the strongest predictors for decreased S-Fe concentration. In conclusion, although the participants were eating a plant-based diet, the majority had sufficient iron status. Female vegans and vegetarians of reproductive age are at risk of low iron status and should have their iron status monitored.

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Appendix 1. Case Study: Methanol Mass Poisoning Outbreak in the Czech Republic: Diagnosis, Treatment and Outcome

Chemical Health Threats - Issues in Toxicology ◽

10.1039/9781782623687-00263 ◽

2018 ◽

pp. 263-270

Author(s):

Sergej Zacharov ◽

Daniela Pelclova

Keyword(s):

Czech Republic ◽

The Czech Republic

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Social variation in size at birth and preterm delivery in the Czech Republic and Sweden, 1989-91

Paediatric and Perinatal Epidemiology ◽

10.1046/j.1365-3016.1998.00075.x ◽

1998 ◽

Vol 12 (1) ◽

pp. 7-24 ◽

Cited By ~ 1

Author(s):

Koupilova ◽

Vagero ◽

Leon ◽

Pikhart ◽

Prikazsky ◽

...

Keyword(s):

Czech Republic ◽

Preterm Delivery ◽

The Czech Republic ◽

Social Variation ◽

Size At Birth

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On Geropsychology in the Czech Republic

GeroPsych ◽

10.1024/1662-9647/a000066 ◽

2012 ◽

Vol 25 (3) ◽

pp. 161-166

Author(s):

Hana Stepankova ◽

Eva Jarolimova ◽

Eva Dragomirecka ◽

Irena Sobotkova ◽

Lenka Sulova ◽

...

Keyword(s):

Czech Republic ◽

Clinical Practice ◽

Old Age ◽

Cognitive Rehabilitation ◽

The Czech Republic ◽

Rehabilitation Research

This work provides an overview of psychology of aging and old age in the Czech Republic. Historical roots as well as recent activities are listed including clinical practice, cognitive rehabilitation, research, and the teaching of geropsychology.

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