Why Do I Need Vitamin B12 and What Are the Symptoms of Deficiency?

Vitamin B12, also known as cobalamin, is an essential water-soluble vitamin that plays a critical role in the production of your red blood cells and DNA, as well as the proper functioning of your nervous system.

Vitamin B12 is naturally found in animal foods, including meats, fish, poultry, eggs and dairy. However, it can also be found in products fortified with B12, such as some varieties of bread and plant-based milk.

Unfortunately, B12 deficiency can occur in vegans, some vegetarians and is especially common in the elderly. You’re at risk of deficiency if you don’t get enough from your diet or can’t absorb enough from the food you eat.

People at risk of a B12 deficiency include

• The elderly
• Those who’ve had surgery that removes the part of the bowel that absorbs B12
• People on the drug metformin for diabetes
• People following a strict vegan diet
• Those taking long-term antacid drugs for heartburn

Unfortunately, vitamin B12 deficiency symptoms can take a very long time to show up, sometimes years, and diagnosing it can be complex. A B12 deficiency can sometimes be mistaken for a folate deficiency (vitamin B9). Low levels of B12 cause your folate levels to drop. However, if you have a B12 deficiency, correcting low folate levels may mask the deficiency and fail to fix the underlying problem.

In a true vitamin B12 deficiency, you could see the following symptoms:

Pale or Jaundiced Skin

People with a B12 deficiency often look pale or have a slight yellow tinge to the skin and whites of the eyes, a condition known as jaundice. This happens when a lack of B12 causes problems with your body’s red blood cell production.

Vitamin B12 plays an essential role in the production of the DNA needed to make red blood cells. Without it, the instructions for building the cells are incomplete, and cells cannot divide and form properly. This causes a type of anemia called megaloblastic anemia, in which the red blood cells produced in your bone marrow are large and fragile. This makes them too large to pass out of your bone marrow and into circulation. Thus, you don’t have as many red blood cells circulating around your body, and your skin can appear pale in colour.

The fragility of these cells also means that many of them break down, causing an excess of bilirubin. Bilirubin is a slightly red or brown-coloured substance produced by the liver when it breaks down old blood cells. Large amounts of bilirubin are what give your skin and eyes a yellow tinge.

Weakness and Fatigue

Weakness and fatigue are common symptoms of vitamin B12 deficiency. They occur because your body doesn’t have enough vitamin B12 to make red blood cells, which transport oxygen throughout your body. As a result, you cannot efficiently transport oxygen to your body’s cells, making you feel tired and weak.

In the elderly, this type of anemia is often caused by an autoimmune condition known as pernicious anemia. People with pernicious anemia don’t produce enough of an important protein called intrinsic factor. Intrinsic factor is essential for preventing a B12 deficiency, as it binds with vitamin B12 in your gut so that you can absorb it. The quickest way to add Vitamin B12 into the body is with regular B12 injections, and people notice a boost in energy very quickly.

Sensations of Pins and Needles

One of the more severe side effects of a long-term B12 deficiency is nerve damage.

This can occur over time, as vitamin B12 is essential to the metabolic pathway that produces myelin's fatty substance. Myelin surrounds your nerves as a form of protection and insulation. Without B12, myelin is made differently, and your nervous system isn’t able to operate normally.

One common sign of this happening is paresthesia, or the sensation of pins and needles, which is similar to a prickling sensation in your hands and feet.

Interestingly, the neurological symptoms associated with B12 deficiency usually occur alongside anemia. However, one study found that about 28% of people had neurological symptoms of B12 deficiency without any signs of anemia. That said, sensations of pins and needles are a common symptom that can have many causes, so this symptom alone is not usually a sign of B12 deficiency.

Changes to Mobility

If untreated, the damage to your nervous system caused by a B12 deficiency could cause changes to the way you walk and move. It may even affect your balance and coordination, making you more prone to falling.

This is often seen in undiagnosed B12 deficiency in the elderly, as people over 60 are more prone to a B12 deficiency. However, preventing or treating deficiencies in this group may improve mobility 

Glossitis and Mouth Ulcers

Glossitis means an inflamed tongue. If you have glossitis, your tongue changes colour and shape, making it painful, red and swollen. Sometimes affecting the way you eat and speak. As all the tiny bumps on your tongue containing your taste buds stretch out and disappear, it can give your tongue an odd smooth appearance.

Some people with a B12 deficiency may experience other oral symptoms, such as mouth ulcers, feelings of pins and needles in the tongue or a burning and itching sensation in the mouth.

Disturbed Vision

Blurred or disturbed vision is a symptom of B12 deficiency that results because of damage to the nervous system at the optic nerve. The damage can disrupt the nervous signal that travels from your eye to your brain, impairing your vision. This condition is known as optic neuropathy.

Although alarming, it is often reversible by supplementing with a good quality B12.

Mood Changes

People with B12 deficiency often report mood changes. Low levels of B12 have been linked to mood and brain disorders like depression and dementia. 

The “homocysteine hypothesis of depression” has been suggested as a potential explanation for this link. This theory suggests that high levels of homocysteine caused by low levels of B12 could cause damage to brain tissue and disrupt the signals to and from your brain, leading to mood changes. Some studies suggest that supplementing with the vitamin can reverse symptoms in particular people who are deficient in B12.

It’s important to note that changes to mood and conditions like dementia and depression can have a variety of causes. Thus, the effects of supplementing alone in these conditions remain unclear and are not recommended. If you have a deficiency, taking a supplement may help improve your mood. However, it’s not a substitute for other proven medical therapies in treating depression or dementia.

Vitamin B12 deficiency is common and can present itself in various ways, making it challenging to identify.

A B12 deficiency should be easy to prevent for most people simply by ensuring you are getting enough B12 in your diet or supplementing with a good quality vitamin.

If you have questions about vitamin B12 deficiency, about purchasing quality B12 products, or about getting your B12 injection done by one of our pharmacists, call the Dispensaries Ltd. location near you.