Evidence-Based Nutrient Recommendations

B12 Status of Macrobiotic Vegetarians



Many macrobiotics who do not supplement their diets with B12 are found to be deficient. There is growth retardation in some macrobiotic children due to low B12 intake.

The Macrobiotic Diet

A macrobiotic diet typically consists of 50-60% whole cereal grains, 5% soups, 20-25% vegetables, and 5-10% beans and sea vegetables. Occasionally, small quantities of other foods, such as seafood, are included. Meat is avoided and little or no dairy or eggs are eaten. Vitamin supplements generally are not taken (Miller, 1991). Infants are normally breast-fed until whole foods are added (i.e., infants are not fed formula).

Macrobiotic Adults

Miller et al. (1991, New England USA) (Miller, 1991) studied 110 macrobiotic adults and 42 macrobiotic children:

  • The group’s average B12 level was 202 pg/ml.
  • 51% of adults had serum B12 < 200 pg/ml.
  • 30% of adults sampled had high uMMA.
  • Serum B12 negatively associated with time on the diet and urinary MMA.
    • Several had low serum B12 after a short time as a MAC (they may have had poor status before beginning the diet).

Macrobiotic Children

Dagnelie & van Staveren (1994, Netherlands) (Dagnelie, 1994) found that growth in macrobiotic infants and children was retarded between ages of 6 – 18 months, and did not catch up (by age 10) unless animal products were added to the diet.

Miller et al. (1991, New England USA) (Miller, 1991) studied 110 macrobiotic adults and 42 macrobiotic children:

  • The group’s average B12 level was 202 pg/ml.
  • 55% of the children had high urinary MMA.
  • Children were short in stature. Decreased stature was related to high uMMA.

Dwyer et al. (1982, Boston, MA) (Dwyer, 1982) studied 39 vegetarian and semi-vegetarian children. Average age was 4.0 years old (range: 0.8 ? 8.4 years). 27 were macrobiotic, and 9 of those were vegan. 2 of the vegans used supplements. The average B12 level was 489 pg/ml (range: 100 ? 700 pg/ml). All the children appeared to be normal.

Macrobiotic Infants

Schneede et al. (1994, Netherlands) (Schneede, 1994) compared macrobiotic infants to non-vegetarian infants. See Table 1.

Homocysteine and serum MMA levels were above normal in the macrobiotic infants, and were inversely related to B12 levels.

Table 1. B12 levels in Macrobiotic Infants (1994, Netherlands)
Diet Group Number Serum B12 (pg/ml)
Macrobiotic 41 191
(Range: 79-459)
Non-Veg 50 538
(Range: 261-1108)

Dagnelie et al. (1989, Netherlands) (Dagnelie, 1989) compared macrobiotic infants to non-vegetarian infants. See Table 2.

Table 2. B12 levels in Macrobiotic Infants (1989, Netherlands)
Diet group Number Serum B12 (pg/ml)
Macrobiotic 50 201
Non-Veg 57 545

50% of macrobiotics had B12 levels < 188 pg/ml, and 10% had levels < 107 pg/ml. The authors stated, “Our findings indicate that the plasma B12 concentration in macrobiotic infants is sufficiently low to have physiological consequences raising concerns about neurological development.”

Specker et al. (1988, USA) (Specker, 1988) studied 17 vegan, macrobiotic mothers. 56% had B12 levels less than 200 pg/ml. They were compared to 6 non-vegetarian mothers whose B12 levels were not reported. The infants of the vegan mothers had higher urinary MMA levels, which dropped after 7 to 10 days of B12 therapy.

Macrobiotic Breast Milk

Specker et al. (1990, USA) (Specker, 1990) compared the B12 levels of breast milk in 13, mostly vegan macrobiotics who did not take supplements (312 ± 127 pg/ml) to 6 non-vegetarians, 5 of whom took supplements (510 ± 101 pg/ml). B12 in breast milk decreased as time on the macrobiotic diet increased. Infant urinary MMA levels were inversely related to milk B12 levels for those below 489 pg/ml.


Dagnelie, 1989. Dagnelie PC, van Staveren WA, Vergote FJ, Dingjan PG, van den Berg H, Hautvast JG. Increased risk of vitamin B-12 and iron deficiency in infants on macrobiotic diets. Am J Clin Nutr. 1989 Oct;50(4):818-24.

Dagnelie, 1994. Dagnelie PC, van Dusseldorp M, van Staveren WA, Hautvast JG. Effects of macrobiotic diets on linear growth in infants and children until 10 years of age. Eur J Clin Nutr. 1994 Feb;48 Suppl 1:S103-11; discussion S111-2.

Dwyer, 1982. Dwyer JT, Dietz WH Jr, Andrews EM, Suskind RM. Nutritional status of vegetarian children. Am J Clin Nutr. 1982 Feb;35(2):204-16.

Miller, 1991. Miller DR, Specker BL, Ho ML, Norman EJ. Vitamin B-12 status in a macrobiotic community. Am J Clin Nutr. 1991 Feb;53(2):524-9.

Schneede, 1994. Schneede J, Dagnelie PC, van Staveren WA, Vollset SE, Refsum H, Ueland PM. Methylmalonic acid and homocysteine in plasma as indicators of functional cobalamin deficiency in infants on macrobiotic diets. Pediatr Res. 1994 Aug;36(2):194-201.

Specker, 1988. Specker BL, Miller D, Norman EJ, Greene H, Hayes KC. Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B-12. Am J Clin Nutr. 1988 Jan;47(1):89-92.

Specker, 1990. Specker BL, Black A, Allen L, Morrow F. Vitamin B-12: low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic aciduria in their infants. Am J Clin Nutr. 1990 Dec;52(6):1073-6.

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