The loss of his 21-year-old daughter Georgina, who took her own life in 2019 after developing serious mental health problems, was a profound personal tragedy for consultant orthopaedic surgeon Julian Owen.
But it has also driven him to campaign tirelessly to alert the public and his medical colleagues to what he believes is a hidden epidemic of serious mental and physical illnesses linked to vitamin B12 deficiency.
Having inadequate levels of vitamin B12, he says, can increase the risk of serious cognitive problems such as depression, psychosis and dementia, as well as diseases such as multiple sclerosis and Parkinson’s. And the scientific evidence supports this.
Vitamin B12, which helps keep the body’s nerve cells and blood healthy, is found naturally in animal foods such as meat, eggs and milk, or in fortified products such as breakfast cereals.
But the growing popularity of plant-based diets means that B12 deficiency may be on the rise.
Georgina Owen, who took her own life in 2019 after developing serious mental health issues
According to current figures, at least 3% of people aged 20 to 39 in the UK (around 4.5 million people) are deficient in vitamin B12, according to the National Institute for Health and Care Excellence (NICE). This figure rises to 6% among those aged over 60 and more than 20% among those aged over 85, according to NICE.
But while the problem occurs in older people because the digestive system is less able to absorb the vitamin from food as we age, in younger people it is related to diet.
Mr Owen, a consultant orthopaedic surgeon at Cambridge University Hospitals Trust, believes Georgina’s condition was due to following a strict vegan diet for more than three years before her death in 2019.
“Georgina only took vitamin B12 supplements sporadically,” Owen says. “Unfortunately, she became psychotic and took her own life, suffering from an ‘acute delusional episode.'”
A coroner’s court has already heard from experts who say vitamin B12 deficiency “causes psychiatric symptoms including depression, apathy, irritability, dementia, delirium and hallucinations”.
And while the coroner has yet to give a final verdict on the cause of Georgina’s death, her father says: “I strongly believe that vitamin B12 deficiency may have played a part.”
“If you take B12 as a supplement, it should be a supplement alone, rather than incorporated into a multivitamin,” warns dietitian Helen Bond.
Mr Owen says experts at Norwich’s Quadram Institute, a food and health research centre linked to the University of East Anglia and Norfolk and Norwich University Hospitals NHS Trust, are still analysing tissue and blood samples taken from Georgina’s organs to try to determine whether she was deficient in the vitamin.
Georgina had no history of psychotic episodes.
A 2022 report by doctors at Berkshire Healthcare NHS Foundation Trust and Leicestershire Partnership NHS Trust, published in the journal Vitamins & Hormones, warns: “Vitamin B12 deficiency can lead to distressing neuropsychiatric symptoms. It may have a causal role in clinical conditions such as depression, anxiety, psychosis, dementia and delirium.”
The Vegan Society strongly recommends that vegans take vitamin B12 supplements or ensure that their daily diet includes foods fortified with this vitamin, such as breakfast cereals.
He warns: “If for whatever reason you decide not to use fortified foods or supplements, you must recognize that you are conducting a dangerous experiment, one that many have tried before with consistently low levels of success.”
And the NHS says symptoms of such “B12 deficiency anaemia” can include extreme tiredness and psychological problems that can range from mild depression or anxiety to confusion and dementia.
Mr Owen’s research into the risks of vitamin B12 deficiency has so alarmed him that he has co-founded a think tank including hospital doctors and medical academics, called cluB-12, to raise awareness of the problem, particularly among doctors, as nutrition is “poorly covered” in most medical training.
He has also co-authored articles in medical journals on vitamin B12.
An article published in the BMJ last November explains the role of the vitamin in regulating the nervous system and the development of red blood cells, which is why anemia is a common symptom of its deficiency.
The BMJ article also explains that vitamin B12 allows our cells to produce energy (fatigue is another common symptom of deficiency), helps protect brain cells, and reduces inflammation in the body.
In another paper, published two years ago in the European Journal of Nutrition, he and his co-authors warned that the cognitive consequences of following vegetarian or vegan diets without taking B12 supplements include “depression, memory impairment, confusion, psychosis and fatigue, and dyspnea (shortness of breath), while neurological complications may cause loss of sensation, muscle weakness or loss of mental and physical drive.”
Separately, in a paper published last year in the journal Anaesthesia, Owen and his co-authors warned that nitrous oxide – used in anaesthetics in emergency departments and dental surgeries, but also as a recreational drug dubbed “hippy crack” – can destroy vitamin B12 in people’s bodies and attack the enzymes used to process nutrients into vitamin B12. For this reason, they argued, the NHS should phase out the use of nitrous oxide wherever possible, and use it only in anaesthetics “on a case-by-case basis, where there are no alternatives”.
The risk posed to midwives and nurses working with the gas last year led Princess Alexandra Hospital in Harlow, Essex, to stop using Entonox (50 per cent nitrous oxide, 50 per cent oxygen) in its maternity unit. At least three other NHS hospitals have also stopped using it.
A major problem with B12 deficiency is that it can be invisible to current tests, Owen told Good Health.
“In some patients with deficiency problems, the level of vitamin B12 in their blood appears normal on tests. In most of these cases, the vitamin B12 they have in their bloodstream is no longer working properly (called functional deficiency), but tests cannot detect it. The current NHS blood test for vitamin B12 only detects about one in three cases of functional deficiency,” she says.
Similarly, commercially available home blood tests that use homocysteine levels as an indicator of B12 levels may be dangerously inaccurate, he suggests.
Homocysteine is an amino acid (a building block of proteins). Vitamin B12 breaks down homocysteine in the body. Therefore, when a home homocysteine test shows high levels in the body, it may indicate a B12 deficiency, he argues.
“However, there are questions about the interpretation of homocysteine tests,” Owen says. “When they show a problem, such as a high homocysteine level, it may be due to a low level of a B vitamin other than B12. On the other hand, a low homocysteine level could indicate another problem, so it doesn’t mean that improving homocysteine level by supplementing with vitamin B12 is solving the problem.”
In the BMJ article, published last November, he and his co-author, Bruce Wolffenbuttel, a professor of endocrinology and metabolism at the University of Groningen in the Netherlands, wrote: “There is no ‘gold standard’ test to define B12 deficiency.”
Instead of using tests, they recommended that doctors look at the entire clinical picture and look for “anemia, cognitive problems, insomnia, headaches (especially migraine), mood changes, depression, anxiety and psychosis.”
Other potential signs of B12 deficiency include tingling, tinnitus, muscle weakness and incontinence, they said.
In severe cases, vitamin B12 injections may be more effective than pills, Owen and Professor Wolffenbuttel wrote. However, even with vitamin B12 injections, “neurological symptoms may take several months or even years to resolve completely.”
The NHS recommends that adults need around 1.5 micrograms a day of vitamin B12 and while it warns that “vegans may not get enough” through diet alone, the rest of us should get enough through healthy, sensible eating, says Helen Bond, a dietitian and spokesperson for the British Dietetic Association.
Sources of vitamin B12 include meat, dairy products and fish, which you should be able to get from a balanced diet.
“This is definitely a case of better safe than sorry with vitamin B12,” she told the Mail. “If your diet is fairly balanced, with a broad intake of natural foods including meat, dairy and fish, you should be able to get the recommended intake of vitamin B12.”
“This is definitely a case where prevention is better than cure with vitamin B12,” she says. “If your diet is fairly balanced, with a broad intake of natural foods, such as meat, dairy products and fish, you should be able to get the recommended intake of vitamin B12.”
However, she adds: ‘Vitamin B12 has gained importance because it comes from animal products, so the rise of plant-based diets has put more people at risk of deficiency if they do not incorporate pieces of meat, dairy and eggs into their regular food intake.
‘The risk is especially high for strict vegans (up to 2 per cent of the population) and vegetarians who avoid eggs and dairy products. These people should supplement their diet with a vitamin B12 supplement. It’s also a good idea to eat Marmite, if you like it, as well as any breakfast cereal fortified with this vitamin.’
Helen Bond adds a very important warning about relying on multivitamin pills: “If you take vitamin B12 as a supplement, it should be just a supplement, rather than incorporated into a multivitamin,” she says. The high doses of chemical vitamin C contained in multivitamin pills can alter the absorption of vitamin B12. This is not a problem if you consume vitamin C in natural foods such as fruit.”
Visit www.club-12.org/contributors for information.
