The loss of his 21-year-old daughter Georgina – who took her own life in 2019 after developing severe mental health problems – was a profound personal tragedy for consultant orthopaedic surgeon Julian Owen.
But it has also prompted him to campaign tirelessly to alert the public and his fellow doctors to what he believes is a hidden epidemic of serious mental and physical illnesses linked to a deficiency of vitamin B12.
Having inadequate levels of vitamin B12, he says, can raise 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 him.
Vitamin B12, which helps to keep the body’s nerve cells and blood healthy, is found naturally in foods of animal origin such as meat, eggs and milk, or fortified products such as breakfast cereal.
But the increased 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 severe mental health problems
Current figures show that in the UK at least 3 per cent of 20-39 year-olds – some 4.5million people – are B12 deficient, according to NICE (the National Institute for Health and Care Excellence). This figure rises to 6 per cent among over-60s and more than 20 per cent of over-85s, 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’s linked to diet.
Mr Owen, a consultant orthopaedic surgeon at Cambridge University Hospitals Trust, believes that in Georgina’s case it stemmed from following a strict vegan diet for more than three years before her death in 2019.
‘Georgina only sporadically took B12 supplements,’ says Mr Owen. ‘Sadly she became psychotic and took her own life suffering an “acute delusional episode”.’
A coroner’s court has already heard expert opinion that vitamin B12 deficiency ‘is reported to cause psychiatric symptoms including depression, apathy, irritability, dementia, delirium and hallucinations.’
And while the coroner has not yet given a final verdict on the cause of Georgina’s death, her father says: ‘I strongly believe that B12 deficiency may well have had a role to play.’
‘If you take B12 as a supplement, it should be a supplement alone, rather than incorporated in a multivitamin,’ warns dietitian Helen Bond
Mr Owen says that tissue and blood samples taken from Georgina’s organs are still being analysed in a bid to determine whether she was deficient in the vitamin by experts at the Quadram Institute, Norwich, a centre for food and health research that has links with the University of East Anglia and the Norfolk and Norwich University Hospitals NHS Trust.
Georgina had no prior history of psychotic episodes.
A 2022 report by clinicians at the Berkshire Healthcare NHS Foundation Trust and Leicestershire Partnership NHS Trust, in the journal Vitamins & Hormones warns: ‘Vitamin B12 deficiency can have distressing neuropsychiatric symptoms. It can have a causal role in clinical presentations like depression, anxiety, psychosis, dementia and delirium.’
Vegans are strongly advised by The Vegan Society to take B12 vitamin supplements or to ensure their daily diet includes foods fortified with the vitamin, such as breakfast cereals.
It warns: ‘If for any reason you choose not to use fortified foods or supplements you should recognise that you are carrying out 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 B12 deficiency has so alarmed him that he’s co-founded a group of experts including hospital clinicians 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 papers in medical journals about B12.
One published in the BMJ last November explains the vitamin’s role in regulating the nervous system and developing red blood cells – which is why anaemia is a common symptom of its deficiency.
The BMJ article also says explains that B12 enables our cells to produce energy (fatigue is another common deficiency symptom), helps to protect brain cells and dampens inflammation in the body.
In another article, 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 tiredness – and dyspnea [breathlessness], whilst the neurological complications may cause loss of sensation, muscle weakness, or loss of mental and physical drive.’
Separately, writing in the journal Anaesthesia last year, Mr Owen and his co-authors warned that nitrous oxide – used in anaesthetics in A&E units and dental surgeries but also as the recreational drug dubbed ‘hippy crack’ – can destroy the B12 in people’s bodies and attack the enzymes used to process nutrients into B12. For this reason, they argued, the NHS should phase out the use of nitrous oxide, wherever possible, only using it in anaesthetics ‘on a case-by-case basis when there are no alternatives’.
The risk posed by midwives and nurses working with the gas last year prompted The Princess Alexandra Hospital in Harlow, Essex, to suspend the use of Entonox (50 per cent nitrous oxide, 50 per cent oxygen), in its maternity unit. At least three other NHS hospitals have also suspended its use.
A major problem with B12 deficiency is that it can be invisible to current tests, Mr Owen told Good Health.
‘In some patients who have deficiency issues the level of B12 in their blood appears normal in tests. In most of these cases, the B12 that they have in their bloodstream no longer functions properly [called functional deficiency]. But the tests can’t pick that up. The current NHS blood test for B12 only picks up about one in three cases of functional deficiency,’ he says.
Similarly commercially available home blood tests that use homocysteine levels as a gauge of B12 levels can be perilously inaccurate, he suggests.
Homocysteine is an amino acid (a building block for proteins). Vitamin B12 breaks down homocysteine in the body. So when a home homocysteine tests shows high levels in the body, it may indicate a deficiency of B12, he argues.
‘However there are worries about interpreting homocysteine tests,’ says Mr Owen. ‘When they show a problem, as in high homocysteine, it may be due to a low level of some B-vitamin other than B12. Alternatively, a bad homocysteine score could indicate another problem altogether – so it does not mean that by improving your homocysteine level through B12 supplementation that you are solving the problem.’
In the BMJ paper, published last November, he and his co-author, Bruce Wolffenbuttel, a professor of endocrinology and metabolism at Groningen University in the Netherlands, wrote: ‘There is no “gold standard” test to define B12 deficiency.’
Instead of using tests, they recommended doctors examine the whole clinical picture and look for ‘anaemia, cognitive problems, insomnia, headaches (especially migraine), mood swings, depression, anxiety and psychosis’.
Other potential signs of B12 deficiency include pins and needles, tinnitus, muscle weakness and incontinence, they said.
In severe cases, B12 injections may be more effective than tablets, Mr Owen and Professor Wolffenbuttel wrote. Even with B12 injections, however, ‘neurological symptoms may take several months or even years to resolve completely’.
The NHS recommends that adults need about 1.5 micrograms a day of vitamin B12 and while warning that ‘vegans may not get enough of it’ through diet alone, the rest of us should get enough through sensible healthy eating, says Helen Bond, a dietitian and spokeswoman for the British Dietetic Association.
Sources of vitamin B12 including meat, dairy and fish, which you should be able to get from a balanced diet
‘This is definitely a case of an ounce of prevention is worth a pound of cure with B12,’ she told the Mail. ‘If your diet is pretty balanced, with a wide intake of natural foods including meat, dairy and fish, you should be able to get your recommended intake of B12.’
‘This is definitely a case of an ounce of prevention is worth a pound of cure with B12,’ she says. ‘If your diet is pretty balanced, with a wide intake of natural foods including meat, dairy and fish, you should be able to get your recommended intake of B12.’
However, she adds: ‘B12 has come to the forefront because it is derived from animal produce, so the rise of plant-based diets has put more people at risk of deficiency, if they aren’t incorporating bits of meat, dairy and eggs in their regular food intake.
‘The risk is particularly high for strict vegans – up to 2 per cent of the population – and vegetarians who avoid eggs and dairy. These people should definitely top up with a B12 supplement. On top of this, eating Marmite is a good idea, if you enjoy it, as is eating any breakfast cereals fortified with this vitamin.’
Helen Bond adds a very important caution about relying on multivitamin pills: ‘If you take B12 as a supplement, it should be a supplement alone, rather than incorporated in a multivitamin,’ she says. The high doses of chemical vitamin C in multivitamin pills can actually upset your absorption of vitamin B12. It’s not a problem with eating vitamin C in natural foods such as fruit.’
Visit www.club-12.org/contributors for information.
