Story:
(Published in the American Journal of
Medicine, 12 July 2019, see
here):
- 47-year-old woman in France (likely Paris or nearby)
- Vegan diet for 7 years (as
reported by the woman’s mother)
- History of psychosis for 5 years (on
medication “olanzapine”)
- Severe vitamin B12 deficiency (vitamin
B12 blood level < 83 pmo/L); serum homocysteine 80.8 µmol/L)
(- Thyroid stimulating hormone (TSH)
level was normal – good, no terrible iodine problems.)
- Examination of the patient
included a brain CT scan – which exposes the patient to some radiation (like taking
X-rays)
- Diagnosis: B12 deficiency anaemia and
psychosis
- Treatment: vitamin B12 supplement
(oral: 1,000 µg daily for 10 days; then 1,000 µg every ten days)
- Result: No more B12 deficiency
after 3 months, disappearance of psychosis after 6 months (“with control of
delirious and negativism behavior”)
Speculations:
- The megaloblastic anaemia makes it
seems like she was deficient in B12 but also in folate (folic acid), meaning
that her diet lacked vegetables and legumes – which should be a part of any healthy
vegan (or any) diet (unless you're allergic). Because of this megaloblastic anaemia
is uncommon in B12 deficient vegans. Consuming very little folate would also
make the homocysteine levels worse (higher; see above).
- It seems unusual (as in: a bit
unlikely) that after only 2 years on a vegan diet, the lack of vitamin B12
would have been the only cause of this woman’s psychosis. Maybe the mother did
not remember it correctly. Maybe the woman had been a dietary vegan or near-vegan
for longer than 7 years (i.e. 2 years
before the psychosis started. Or maybe there was another reason (or several – such
a genetic disposition, drugs, trauma, etc.) involved.
Take home message from the authors:
“Sublingual [which is oral too] or
oral supplementation is mandatory and effective for vegans.”
Take home message from me:
Vegan diets can be healthy for
everyone – but vegans should pay attention to some
nutrients, especially vitamin B12.
Everyone who wants to eat healthily
(vegan or not) should pay attention to some nutrients.
P.S.: In 2018 there was a report in
the Asian Journal of Psychiatry about a 26-year-old, male dairy-free vegetarian (quite possibly
near-vegan or vegan) in India (Karnataka) who also suffered from psychosis due
to (or at least associated with) vitamin B12 deficiency. After intramuscular vitamin B12 injections his psychosis improved in 2 weeks. His cognitive deficits improved in one month (see here).
P.P.S: What is psychosis anyway?
According to the Merriam-Webster dictionary, psychosis is “a serious mental
illness (such as schizophrenia) characterized by defective or lost contact
with reality often with hallucinations or delusions”.