Risks, symptoms and ways to treat B12 deficiency

Vitamin B12, known as the energy vitamin, helps make DNA, nerve and blood cells, and is crucial for a healthy brain and immune system. Your metabolism wouldn’t run smoothly without it.

Vitamin B12 is only found in animal products like eggs, meat, shellfish, and dairy. Up to 15 per cent of people don’t get enough of it, and they’re more likely to be vegetarians, have celiac disease or other digestion problems, or be an adult over 50.

The signs of vitamin B12 deficiency include exhaustion, rapid heartbeat, brain fog, and other symptoms.

Vegetarians and vegans are at risk 

Vitamin B12 occurs naturally in animal products. So if your diet largely consists of plant-based foods such as fruits, veggies, beans and soy, you’re at risk for deficiency.

Vegans—who by definition consume no animal products—need to take a supplement or consume vitamin B12–fortified foods, such as breakfast cereal and grains. Other foods fortified with B12 include non-dairy milks and meat substitutes, but not all are, so check the label first to make sure.

Adults over 50 are also at risk

As you age, the stomach produces less acid, and stomach acid is key for B12 absorption. About one in 31 adults over 50 are deficient. Older individuals also often have poorer appetites and food intakes, and they may be on medications that can further reduce stomach acid levels.

In fact, some seniors actually lose the ability to absorb vitamin B12 from food at all, and must get it via supplements or, if the deficiency is severe, injections.

Early symptoms include weakness and fatigue

B12 isn’t nicknamed the energy vitamin for nothing. Inadequate B12 intake makes a dent in red blood cell production, and some of the earliest signs of a deficiency include feeling dragged, confused and weak.

If these symptoms hit and stick around for weeks, it’s best to consult your doctor and rule out other causes, she says. Similar tip-offs include dizziness, impaired thinking and confusion.

It can be mistaken for dementia

Symptoms of a B12 deficiency often mimic those of dementia, such as memory loss, disorientation and difficulty thinking and reasoning. It can be hard distinguishing deficiency from dementia, especially since older folks are at risk for both.

But even when a B12 shortage strikes younger people, it still typically resembles dementia. Experts aren’t exactly sure of the relationship between the two, but patients with unexplained cognitive decline should be tested for B12 deficiency.

Taking birth control pills sets you up for it

Women who have been on oral contraceptives for extended periods of time tend to have issues absorbing vitamin B12. Studies show that pills that are higher in estrogen are more strongly associated with B12 and folate (folic acid, or vitamin B6) deficiencies, leading to the assumption that the estrogen in the pill is the reason for this impaired absorption.

Fortified foods and supplements can help

Both can help vegans, vegetarians, older adults and others who are unable to absorb naturally occurring B12. When absorption is an issue, simply loading up on foods naturally high in B12 may not solve the problem. The synthetic form of B12 is more readily absorbed. Best places to find it in food: fortified cereals, many of which have 100 per cent of your RDA.

The best sources are meat and fish

Beef liver and clams are tops in B12. Beef, turkey, oysters, chicken, trout, and salmon are B12 superstars. Eggs and milk are also solid sources.

Heavy drinking increases your odds

More than a few drinks on average each day can cause gastritis, or irritation of the stomach lining, and this can lead to low stomach acid and reduced B12 absorption. Alcohol plays a role in deficiency in another way too. B12 is stored in the liver, and alcohol consumption can impair liver function and deplete B12 stores or make it harder for the liver to use it.

It’s linked to pernicious anemia

There’s a specific type of anemia that’s triggered by a B12 deficiency, called pernicious (which means ‘dangerous’, because it was potentially life-threatening in the past) anemia. It’s a red blood cell deficiency that happens when the stomach doesn’t make enough of a protein called intrinsic factor, which helps the intestine absorb B12. Pernicious anemia can be the result of an autoimmune issue, a problem with the stomach lining, or even a congenital condition passed down through families. Treatment usually involves B12 shots, possibly combined with supplements.

It can be hard to recognise a deficiency

Because the body can store B12 for three to five years, early symptoms of a deficiency usually appear gradually, so you’re unlikely to notice them. After initial clues like fatigue, weakness, and brain fog set in, more advanced tip-offs show up, such as numbness and tingling of the limbs, depression, and paranoia, even hallucinations.

A blood test is the only way to confirm it

Blood tests are generally accurate, but a false positive is possible related to certain cancers, oral contraceptives, folate (folic acid) deficiency, and pregnancy. False negatives are also possible, as sometimes seen in people with liver disease, poorly functioning kidneys, or certain blood cell disorders.

Your GP or primary care physician can take care of testing you.

It’s linked to immune system issues

B12 plays an important role in white blood cell production, and white blood cells are essential for proper immune system functioning. Not only can a lack of B12 lower your immunity, some immune system disorders can increase your likelihood of becoming deficient.

Digestive problems can cause it

People who deal with digestive issues are at a higher risk of a B12 shortage because digestive problems can make absorbing the nutrient more difficult

It can cause tingling, weakness and balance issues

Depletion of your vitamin B12 stores leads to nerve damage. No wonder pins and needles in your hands and feet, shaky body movements, and trouble walking are all consequences of long-term B12 deficiency. Like so many other B12 deficiency signs, these can be attributed to other causes, including old age. The only way to know for sure is to see your doctor for a test.

Babies can get it too

In infants, vitamin B12 deficiency is serious — it can lead to symptoms such as anemia, problems with movement, difficulty reaching developmental milestones, and failure to thrive, which may be fatal. Low B12 levels are rare in infants but it can happen if a baby is fed a strict diet free of any animal products or if a breastfeeding mom is a vegan who doesn’t take vitamin B12 supplements.

Visible signs include pale skin, a sore tongue and mouth ulcers

Paleness, mouth sores, a red swollen tongue — these are some of the visible signs of a B12 shortage. Caused by deficiency-related changes in blood flow, these signs can show up years after the depletion sets in. A rapid heartbeat or heart palpitations is another blood flow-related sign, and sometimes bruising easily is also a result of a longstanding deficiency. But these seemingly unrelated signs don’t show in all B12 deficient people, or they come on so slowly, it’s hard to notice them, says Middleberg.

It might cause permanent damage

Vitamin B12 deficiency that persists for years can cause severe, irreversible neurologic damage—think memory loss, disorientation, and an inability to concentrate. Other permanent side effects include nerve damage, insomnia, erectile dysfunction, even difficulty with bowel and bladder control, says Moon. The upside: “Many symptoms can be reversed if caught early and treated with B12,” she adds.

It’s hard to overdo vitamin B12

Unlike fat-soluble vitamins that accumulate in your body and can have side effects in excess, B12 is a water-soluble vitamin, meaning your body only absorbs a small amount and the rest is excreted through urine. Good news, if you need to refill your stores of this nutrient, but worry about taking too much. But keep in mind that large amounts of B12 at one time may cause diarrhea and all-over itchiness.

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