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Vitamin B12 and Vegetarian Diets

Because vitamin B12 isn't generally found in plant foods, vegetarians are among the groups most likely to be vitamin B12 deficient.

Vitamin B12 is naturally found in animal products - including meat, fish, poultry, eggs, and dairy products.  Because vitamin B12 isn't generally found in plant foods, vegetarians are among the groups most likely to be vitamin B12 deficient, along with elderly populations, individuals with pernicious anemia, gastrointestinal disorders and pregnant women.


Methylcobalamin is the most active form of vitamin B12. It is better absorbed and more bioavailable than cyanocobalamin. Vitamin B12 is an essential component for proper digestion and absorption of foods, and for normal metabolism of carbohydrates and fat. It aids in maintaining healthy nerve cells and red blood cells and is needed to make DNA.

The main causes of vitamin B12 deficiency include vitamin B12 malabsorption from food, postsurgical malabsorption, pernicious anemia, and dietary deficiency.  

How can vegetarians and vegans make sure they get enough vitamin B12?  Typically, vitamin B12 deficiency is treated with vitamin B12 injections, since this method bypasses potential barriers to absorption. 
Download the free TeleWellnessMD Nutrient Injection Guide to learn more about Methylcobalamin B12 injection therapy prescribed by TeleWellnessMD providers.
Get Free eBook Nutrient Injection Guide


What is a vegetarian diet?

Once a fringy, unpopular notion dismissed by some as downright unhealthy, eating your vegetables is now a mainstream idea. If you're skipping meat entirely, you're in good company: More than 7 million Americans say they never eat red meat, poultry, or fish. Instead, they fill their plates with plant-based foods, from vegetables, legumes, and fruits to nuts and grains.

In truth, there is no one vegetarian diet but many kinds, depending on the foods you pull out of the food pyramid -- and, more important, those you leave behind. Vegetarian types include these:

  • lacto-ovovegetarians, who include milk and eggs in their diet
  • lacto-vegetarians, who include milk but no eggs
  • vegans, sometimes called total vegetarians, who eat no animal products at all
  • semi-vegetarians, who refuse red meat but eat fish and chicken

People become vegetarians for lots of reasons -- political, ecological, economic, religious, and medical. Some believe it's cruel to kill and eat animals. Others point out that an animal has to eat nine pounds of grain to produce one pound of meat. Around the world, many cultures and religions embrace vegetarianism, from certain Hindu sects to Trappist monks in the Roman Catholic Church. But recently the promise of better health and a chance at a longer life have prompted all sorts of people to permanently shove steaks off their dinner plates in favor of more vegetables and grains.

What are the benefits?

A vegetarian diet is often lower in fat and cholesterol, which cuts your risk of heart disease. And studies also show that eating lots of fruits, vegetables, and whole grains seems to lower your risk of obesity, high blood pressure, diabetes, and cancers of the stomach, pancreas, bladder, and lung. Certain items such as broccoli, brussel sprouts, and other members of the cabbage family may offer special protection against breast and colon cancer. Other studies have found that eating dark leafy greens reduces the risk of macular degeneration, a common cause of blindness in people over 65.

How do I plan a healthful vegetarian diet?

If you're a reasonably healthy adult, a little planning will do it. For others with special nutritional needs -- infants, growing children, and pregnant or breastfeeding women -- you'll have to give it a little more thought. A lot depends on which type of vegetarian diet you're talking about. For children, a balanced vegetarian diet with milk and eggs can provide enough calories and nutrients, but more restrictive vegan diets often fail to meet their needs for energy and proper growth. If you're raising your child on a vegan diet, consider talking to a registered dietitian for meal planning tips, and ask your child's pediatrician to keep an eye on your child's growth and development.

Otherwise, concentrate on the following food groups and aim to eat the suggested serving sizes each day. If you add them up, the total may seem like a lot of food, but keep in mind that a serving size is actually quite small -- as little as one slice of bread, a quarter cup of dried fruit, a half cup of vegetables, or two tablespoons of nuts.

  • Bread, cereal, rice, and pasta: 3 to 8 ounces daily (1.5 to 4 cups, cooked)
  • Vegetables: 1 to 3 cups daily
  • Fruit and fruit juices: 1 to 2 cups daily
  • Dry beans, nuts, seeds, eggs, and meat substitutes (tofu, veggie burgers made from soy products): 2 to 6 ounces
  • Milk, yogurt, and cheese: 2 to 3 cups daily (unless you're a vegan); go for low-fat choices if you're a non-lactating adult

Which nutrients should I be especially sure to get?

As long as you include enough protein, calories, vitamin B-12 (which comes only from animal foods), and other nutrients, you don't need to worry that you're compromising your health. Be sure to get these :

  • Calcium, essential for strong bones and teeth. If you're a vegan and skipping milk or dairy products, you can get the calcium you need from dark green vegetables (broccoli, kale, collard and turnip greens), fortified soy milk and orange juice, and tofu processed with calcium sulfate. Blackstrap molasses is another excellent source of calcium.
  • Vitamin D, which helps the body absorb calcium. Get it in fortified milk and egg yolks. Exposing your hands and face to sunlight each day for ten to 15 minutes helps your body make vitamin D, too.
  • Vitamin B-12, crucial for a healthy nervous system and blood cells. Dairy products are a good source. If you're a vegan, you may want to take a calcium supplement as well as vitamin supplements or fortified soymilk, cereals, and nutritional yeast to get enough B-12. Foods such as spirulina, miso, and tempeh are promoted as good sources, but they often contain inactive forms of B-12 that can harm you by preventing your body from absorbing active B-12.
  • Protein, which your body needs for tissue growth and repair. Grains, legumes, nuts, and dairy products are good sources.
  • Iron, needed for healthy red blood cells. Some dried fruits and fruit juices, such as raisins and prune juice, have lots of iron; so do legumes and enriched breads and grains. Next to cooked soybeans, blackstrap molasses provides the highest amount of iron per serving. To boost your body's ability to absorb iron, eat a food rich in vitamin C (orange juice, citrus fruit, melons, strawberries, kiwi, or tomatoes) at every meal. A tip for increasing the iron in your food: use iron cookware. Finally, don't fall back on taking iron supplements without a call to your doctor first; too much iron can be harmful.
  • Zinc, essential for healthy tissue and for insulin, the hormone that regulates blood sugar. You'll find zinc in wheat germ as well as in hard cheeses, nuts, tofu, and legumes.

Finally, to give your body a shot at warding off certain cancers, work these vegetables into your diet: dark leafy greens, such as spinach and collard greens; deep yellow vegetables, such as carrots, yams, and squash; and cruciferous vegetables such as broccoli, brussels sprouts, and cauliflower. Other good choices are cabbage, broccoli sprouts, and tomatoes.

How do I escape the same old salad and pasta routine?

Today, vegetarian cookbooks and Web sites offer enough recipes and tips to make every meal an adventure. And don't just look for new dishes -- find new friends, too. It's tough to be the only vegetarian in the crowd. In many cities, vegetarians form their own local groups, who get together for potlucks and recipe swaps. For fun outings, some groups head for vegetarian restaurants or reserve a room at an eatery and request a special vegetarian menu just for them.

What else can I do to eat well in a nonvegetarian world?

If you're invited for a meal at a nonvegetarian home, gently inform your hosts that you're vegetarian and offer to bring a dish. Thanksgiving and Christmas feasts usually feature much more food than the centerpiece turkey or roast, so concentrate on the "side" dishes. When dining out with friends, suggest Indian, Chinese, or Italian food. Indian restaurants often have vegetarian entrees on the menu, Chinese places stock so many fresh vegetables that they're often able to prepare something upon request, and Italian eateries can usually serve up pasta and vegetables.

When you're traveling, you'll find that many hotel kitchens are willing to make small changes to menu items. Say you spot a pasta and sausage entree with side dishes of mushrooms or artichoke hearts. Ask the chef to toss the pasta with mushrooms and artichoke hearts and hold the sausage. Being on the road doesn't mean you have to make do with just a salad.

Download the free TeleWellnessMD Nutrient Injection Guide to learn more about Methylcobalamin B12 injection therapy prescribed by TeleWellnessMD providers.

Get Free eBook Nutrient Injection Guide


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Seddon JM, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye disease case-control study group. JAMA 1994 Nov 9;272(18):1413-20.

The American Dietetic Association. Vegetarian Diets,Volume 109, Issue 7, Pages 1266-1282 (July 2009).

"How Many Vegetarians Are There?" Vegetarian Journal. Issue 1, 2003.

Vegetarian Resource Group. Iron in the Vegan Diet. April 2006.

Vegetarian Resource Group. Calcium in the Vegan Diet. March 2006.

US Department of Agriculture. Food Pyramid: Inside the Pyramid.

US Department of Agriculture. Vegetarian Diets.

Vegetarian Times. Vegetarian Times Study Shows 7.3 Million Americans Are Vegetarians. April 2008.

Last Updated: Jan. 20, 2018

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