How can I maintain adequate B vitamin levels when stopping my multivitamin (Multivitamin) for 5 days due to Mast Cell Activation Syndrome (MCAS) and a severely restricted diet?

From the Guidelines

To maintain adequate B vitamin levels during a 5-day break from your multivitamin due to MCAS with a restricted diet, focus on incorporating B vitamin-rich foods that are compatible with your dietary restrictions, and consider discussing hypoallergenic B vitamin supplements with your healthcare provider if necessary. When stopping your multivitamin for 5 days, it's essential to consider your severely restricted diet due to Mast Cell Activation Syndrome (MCAS) and potential risk factors for vitamin B12 deficiency, as outlined in the NICE guideline summary 1. Key points to consider include:

• A diet low in vitamin B12, which may be the case with your restricted diet
• Exclusion of animal source foods, which are rich in vitamin B12
• Difficulty consuming food or drinks fortified with vitamin B12
• Health conditions such as atrophic gastritis, coeliac disease, or other autoimmune conditions that may affect vitamin B12 absorption Given these considerations, incorporating B vitamin-rich foods into your diet, if tolerated, is crucial. Some options may include:
• Lean meats
• Eggs
• Leafy greens
• Nutritional yeast
• Fortified non-dairy milks For a short 5-day period, healthy individuals typically have sufficient B vitamin stores to prevent deficiency, as the liver stores several months' worth of vitamin B12, and other B vitamins have shorter but still adequate storage periods 1. However, if your diet is severely restricted, discussing potentially using hypoallergenic B vitamin supplements specifically formulated for MCAS patients with your healthcare provider may be necessary. Some patients find sublingual B12 or liquid B complex formulations with minimal additives more tolerable. It's also essential to stay hydrated and monitor for symptoms like fatigue, tingling in extremities, or mood changes that might indicate low B vitamin levels.

From the FDA Drug Label

A vegetarian diet which contains no animal products (including milk products or eggs) does not supply any vitamin B12. Patients following such a diet, should be advised to take oral vitamin B12 regularly The need for vitamin B12 is increased by pregnancy and lactation. Deficiency has been recognized in infants of vegetarian mothers who were breast fed, even though the mothers had no symptoms of deficiency at the time.

To maintain adequate B vitamin levels when stopping your multivitamin for 5 days due to Mast Cell Activation Syndrome (MCAS) and a severely restricted diet, consult your doctor. They may recommend:

• Alternative sources of B vitamins, such as oral vitamin B12 preparations 2
• Close monitoring of your hematologic values, including serum potassium, hematocrit, reticulocyte count, vitamin B12, folate, and iron levels 2
• Adjusting your diet to include foods rich in B vitamins, if possible, or considering supplementation under medical guidance 2
• Folic acid supplementation if needed, but with caution, as high doses may mask vitamin B12 deficiency 2

From the Research

Maintaining B Vitamin Levels with Restricted Diet and No Multivitamin

• When stopping multivitamin intake for 5 days due to Mast Cell Activation Syndrome (MCAS) and a severely restricted diet, it is crucial to explore alternative methods to maintain adequate B vitamin levels.
• There are no direct studies provided that address the specific scenario of stopping multivitamin intake for a short period due to MCAS and a restricted diet.
• However, a study on dietary vitamin B intake and its association with metabolic syndrome 3 suggests that higher intake of vitamin B1, B2, niacin, B6, and dietary folate equivalent is associated with reduced risk of metabolic syndrome.
• Considering the restricted diet, consulting a dietitian for personalized nutrition advice may be beneficial, as dietetic consultations have been shown to be effective in improving diet quality and health outcomes in primary care settings 4.
• It is essential to note that herbal supplements, which may be considered as an alternative, have limited scientific evidence supporting their efficacy and safety, and may interact with other medications or have adverse effects 5, 6, 7.
• Given the potential risks associated with herbal supplements, it is recommended to approach their use with caution and consult with a healthcare professional before adding any supplements to the diet.