It should not be any great surprise that a sizable number of your patients either already follow a vegetarian or vegan diet, or are interested in doing so.
Given chiropractic’s focus on wellness as a lifestyle, it will almost inevitably be an attractive alternative to standard Western medicine to those looking to eat healthier. Naturally, you should be doing everything possible to encourage your patients to follow a healthy diet.
With that in mind, it is particularly important to make certain that your vegetarian (and particularly vegan) patients are not inadvertently missing out on vital nutrients that are usually supplied in a diet that includes meat and dairy products. In fact, your vegetarian or vegan patients may actually be at an increased risk for pernicious anemia as a result of what is known as intrinsic factor deficiency.1
A classic example of one such nutrient is vitamin B12, which is usually found in meat and some dairy products.1 Although vitamin B12 can also be found in certain other foods, such as fortified cereals and soy products, it can still be difficult for vegetarians and vegans to get enough into their diet. Those who do not get enough vitamin B12 are at risk of developing pernicious anemia as a result of what is known as intrinsic factor deficiency.1
What is intrinsic factor deficiency?
Intrinsic factor is a protein that the body creates in order to properly absorb vitamin B12, which helps red blood cells form and develop.2 If the body is not producing enough red blood cells, pernicious anemia can develop. While lack of vitamin B12 in the diet is the most common culprit in causing intrinsic factor deficiency, it may also arise as a result of having most or all of the stomach surgically removed.2
In fact, studies have shown that vegans are at the greatest risk of intrinsic factor deficiency, while omnivores are in the lowest risk category. A 2003 study placed vegans at the highest risk (83 percent), followed by vegetarians (68 percent), and then omnivores at the lowest risk (5 percent).3 A later study, published in 2010, found 52 percent of vegans and 7 percent of vegetarians to be at risk of developing intrinsic factor deficiency.4
Testing for intrinsic factor deficiency
The easiest way to test for intrinsic factor deficiency and pernicious anemia is by running a count of the red blood cells.5 Not only will patients with intrinsic factor deficiency have fewer red blood cells than will a healthy individual, but the cells themselves will also be larger and less differentiated. Another test will search for methylmalonic acid concentrations. Patients with intrinsic factor deficiency will have higher levels of this particular acid.3,5
Symptoms and treatment
The most common symptoms for pernicious anemia as a result of intrinsic factor deficiency include fatigue, panting, and heart palpitations.6 Less common symptoms may include a sore mouth and tongue, weight loss, sporadic diarrhea, and a pale or yellowish look to the skin. Women may develop menstrual problems.6
The easiest way to prevent intrinsic factor deficiency is through a combination of diet and supplements that addres intrinsic factor deficiency.
The National Institutes of Health recommend that both male and female patients take 2.4 micrograms of vitamin B12 daily.7 Pregnant women should take 2.6 micrograms, and lactating women should take 2.8 micrograms.
While you should strive to make certain that your patients are meeting their daily nutritional needs, you will need to take extra care with your vegan and vegetarian patients. Suggesting vitamin B12 supplementation, along with increased intake of fortified foods, will help keep them healthy and strong.
- What causes pernicious anemia? National Heart, Lung, and Blood Institute. Accessed 4/9/2016.
- Intrinsic factor. Medline Plus. Accessed 4/9/2016.
- Herrmann W, Schorr H, Obeid R, Geisel J. Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am J Clin Nutr. 2003 Jul;78(1):131-136.
- Gilsing AM, Crowe FL, Lloyd-Wright Z, et al. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians, and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010;64(9):933-939.
- Vitamin deficiency anemia. Mayo Clinic. Accessed 4/9/2016.
- Vitamin B12 deficiency: Causes, symptoms and treatments. Medical News Today. Accessed 4/9/2016.
- Vitamin B12. National Institutes of Health. Accessed 4/9/2016.