6 Symptoms Of Vitamin B12 Deficiency You Should Know
Vitamin B12 is a water-soluble vitamin that is important for human health. It is also known as cobalamin1.
This vitamin is important for producing red blood cells and DNA as well as working along with your nervous system. It is found in animal products, such as fish, meat, poultry, dairy, and eggs. There are also other products that may be fortified with B12, including some plant-based milk and bread.
Two varieties of edible algae (Dried green (Enteromorpha sp.) and purple (Porphyra sp.) seaweed (nori)) have been found to have active B12, but other algae have inactive B12-analog compounds that have no apparent benefit in animal metabolism.
Some varieties of mushrooms and some foods made with certain fermentation processes have very small amounts of active B12.
Having low levels of vitamin B12 is relatively common, especially as we get older. If you are getting enough in your diet and aren't absorbing the vitamin from the food you are eating, you run a higher risk of deficiency.
There are many people who have a higher risk of deficiency, including2:
- Elderly individuals - Surgical patients who lose part of their bowel - People who take Metformin for diabetes - Vegans that follow a strict diet - Anyone taking antiacid drugs for the long-term
A person may suffer from vitamin B12 deficiency for years before the symptoms begin to show. Even when they do show, it can be very difficult to diagnose. Some physicians may even mistake a vitamin B12 deficiency for a folate deficiency.
When you are low on vitamin B12, your folate levels may drop. Correcting the lower levels of folate if you are B12 deficient will likely only cover over the symptoms without treating the underlying issue3.
Watch for these 6 signs and symptoms of an actual vitamin B12 deficiency:
1. Pale/Jaundiced Skin
Many people who are B12 deficient may have a slight yellow coloring or a pale appearance. It could be seen in the whites of the eyes or on the skin and it is known as jaundice.
It occurs because the low levels of B12 reduce the production of red blood cells. That vitamin also plays an important role in DNA production that is responsible for producing red blood cells. Since the instructions for building those cells are not complete, they don't divide4.
This leads to a condition known as megaloblastic anemia, a condition that occurs when the red blood cells in your bone marrow are fragile and large.
Since those red blood cells are larger, they can't pass from the bone marrow into the circulatory system. That reduces the number of red blood cells in the body and your skin may look pale as a result.
Since those cells are fragile, it means that they break down quickly and you may have excessive bilirubin. That brown or slightly red colored substance, bilirubin, is produced in the liver when old blood cells break down.
Too much bilirubin gives your eyes or skin a yellow coloring5.
2. Fatigue and Weakness
As common symptoms of vitamin B12 deficiency, fatigue and weakness may show when symptoms first show. When you don't have enough B12 to produce red blood cells, you don't have what is necessary to transport oxygen to the other cells of your body.
Since your cells are lacking in oxygen, you may feel weak and tired. This is sometimes associated with an autoimmune condition in the elderly known as pernicious anemia. Those individuals don't produce enough of a protein known as intrinsic factor.
Having enough intrinsic factor can help to prevent a deficiency in vitamin B12. It combines with the B12 in your gut so that it is absorbed effectively6.
3. Pins and Needles
If you have been B12 deficient for an extended amount of time, nerve damage may occur. It takes place because B12 produces myelin, which is a fatty substance that surrounds the nerves and provides protection7.
Since you don't have enough B12, myelin is not produced in the proper way and the nervous system experiences problems. That is why you may experience the sensation of pins and needles, known as paresthesia.
In most cases, any neurological symptoms due to B12 deficiency will go hand-in-hand with anemia. On the other hand, One study showed that 28% of those who suffered from neurological symptoms due to B12 deficiency did not have signs of anemia8.
Even though there is a discrepancy, a common symptom of B12 deficiency is the sensation of pins and needles but it is not always a symptom that is experienced on its own.
4. Mobility Changes
B12 deficiency may eventually damage the nervous system and cause changes to how you move and walk. It could have an impact on your coordination and balance, making it more likely for you to fall.
This imbalance is an often underdiagnosed symptom in elderly people who are B12 deficient. Treating and preventing deficiencies in those who are over the age of 60 may help to improve mobility9.
It may also be seen in younger people who are severely deficient in B1210.
5. Inflamed Tongue and Mouth Ulcers
B12 deficiency can result in Glossitis, a term that is typically used to describe an inflamed tongue that changes both shape and color. It may appear red, swollen and could be painful.
The inflammation may also produce a smooth appearance to the tongue, as the bumps that house the taste buds may stretch out and disappear.
Glossitis can be painful but it can also change how you speak and eat. Studies have shown that a swollen tongue with long, straight lesions may be one of the first signs of a B12 deficiency11.
Other oral symptoms may also appear with a B12 deficiency. These could include a sensation of pins and needles in the tongue, burning and itching sensations in the mouth and mouth ulcers.
When a B12 deficiency results in anemia, it could leave you short of breath and dizzy. It is a problem that gets worse if you exert yourself.
Since your body is lacking sufficient red blood cells, it pulls oxygen from other cells in the body.
It is important to note that these symptoms may occur for many reasons. If you notice that you have a problem with breathlessness, it should be investigated with the help of a physician.
The Bottom Line
Vitamin B12 deficiency is a relatively common issue and can be difficult to identify. If you are at a higher risk for this deficiency, talk to your physician.
A problem with B12 deficiency is often easy to prevent or treat by simply ensuring that you get enough vitamin B12 in your diet.
References: 1. https://www.ncbi.nlm.nih.gov/pubmed/22116706, Cobalamin deficiency, 2012;56:301-22. doi: 10.1007/978-94-007-2199-9_16 2. https://www.ncbi.nlm.nih.gov/pubmed/23782218/, Biologically active vitamin B12 compounds in foods for preventing deficiency among vegetarians and elderly subjects, 2013 Jul 17;61(28):6769-75. doi: 10.1021/jf401545z. Epub 2013 Jul 2 3. https://www.ncbi.nlm.nih.gov/pubmed/17209196, Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification, 2007 Jan;85(1):193-200 4. https://www.ncbi.nlm.nih.gov/pubmed/16988104, Megaloblastic anemia and other causes of macrocytosis, 2006 Sep;4(3):236-41. 5. https://www.ncbi.nlm.nih.gov/pubmed/1109492, Clinical approach to jaundice, 1975 Jan;57(1):118-24 6. https://www.ncbi.nlm.nih.gov/pubmed/24424200, Diagnosis and classification of pernicious anemia, 2014 Apr-May;13(4-5):565-8. doi: 10.1016/j.autrev.2014.01.042. Epub 2014 Jan 11 7. https://www.ncbi.nlm.nih.gov/pubmed/24248213, Cobalamin deficiency: clinical picture and radiological findings, 2013 Nov 15;5(11):4521-39. doi: 10.3390/nu5114521 8. https://www.ncbi.nlm.nih.gov/pubmed/3374544/, Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis, 1988 Jun 30;318(26):1720-8 9. https://www.ncbi.nlm.nih.gov/pubmed/14695861/, Vitamin B12 and folate deficiency in later life, 2004 Jan;33(1):34-41 10. https://www.ncbi.nlm.nih.gov/pubmed/23536622, Vitamin B12 deficiency presenting as acute ataxia, 2013 Mar 26;2013. pii: bcr2013008840. doi: 10.1136/bcr-2013-008840 11. https://www.ncbi.nlm.nih.gov/pubmed/19231648/, Glossitis with linear lesions: an early sign of vitamin B12 deficiency, 2009 Mar;60(3):498-500. doi: 10.1016/j.jaad.2008.09.011