Vitamin B12 Deficiency, Causes, Symptoms, and Treatment

Anaemia or nervous system injury is most common these days caused by lower levels or insufficient amounts of vitamin B12 in the body. Vitamin B12 deficiency may cause a reduction in red blood cells thus anemia or it may affect nervous system functioning too.

Vitamin B12 (cobalamin ) is found in various food most commonly in animal foods and can be added to supplements. B12 is the most common vitamin needed for brain and nerve function and is also helpful in improving body energy.

Are you getting enough Vitamin B12 or you are suffering from Vitamin B12 deficiency? For sure, you might be interested to know about the importance of vitamin B12 to stay fit and healthy.


Quick Facts About Vitamin b12 Deficiency-

The prevalence of Vitamin B12 deficiency is like an epidemic in India. In the Indian population, it seems to be prevalent widespread.

According to the Indian Journal of Endocrinology and Metabolism, a study was carried out in a tier 3 city and among people living in an urban area with or without diabetes. The results showed the prevalence of B12 deficiency among 47%in the north Indian population. Though people with diabetes had a lower prevalence of deficiency than the general population.

According to the current study people with diabetes had a lower prevalence of deficiency of vitamin b12 the possible reason for this might be –

  • Being in constant touch with healthcare providers they are more likely supplemented with vitamin b12 during routine diabetic care.
  • People without diabetes might seek attention later as they are not into many regular health checkups.

Vitamin b12 deficiency is common in developing countries than in Western or developed countries since in low and middle-income countries there is inadequate intake of vitamins and folate and nutritional deficiencies are prevalent and common.


Vitamin B12
Vitamin B12

Source of Vitamin B12

Food –

Vitamin B12 is found naturally more in animal products and limited in plant based products. It is found in fish, meat, egg, milk products, and fortified cereals.Β 

Animal-Based Food

Meat – Animal meat is very rich in vitamin B12 especially liver and kidneys. Other than thatΒ  Lamb meat is a powerful source of vitamin B12. It is the tastiest meat and its high nutritional value makes it a great choice while considering a nutritional diet.

Eggs – Eggs are consumed worldwide and are a rich source of nutrients and vitamins. Eggs are a rich source of vitamin B12. Research shows 100 gm of eggs can provide 22 % of recommended daily intake value for vitamin B12.

Being rich in taste, healthy, filled with nutritional values they are consumed in various ways. However, eating boiled egg simply fulfill the requirements of protein and B12 together. The white part is abundant in protein and the yellow part is in the abundance of vitamin B12.

Fish – Tuna fish is an extremely delicious fish and is a good and potent source of vitamin B12. The dark muscles of this fish are rich in vitamin B12. According to few pieces of research 100 gram serving of tuna fish contains 160% of recommended daily intake value for vitamin B12.


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Vitamin B12 nonveg sources
Vitamin B12 nonveg sources


Plant-Based Food

Fortified cerealsIn-plant products Fortified cereals are one of the important cereals and most useful sources of vitamin B12 for vegetarians. Having fortified cereals in breakfast is a good source of vitamin B12, B6, A, and C . These cereals have high fiber and improve the overall nutrition of the body. If you are vegetarian with limited sources of vitamin b12, fortified cereals can act as a savior and fulfill your nutritional deficiency.

Milk and dairy products – Milk and milk products are an important source of Vitamin B12. It includes cheese, yogurt, raw milk these are a potent source of calcium, vitamin B12, and protein. Various studies recommend 240ml of milk per day can provide up to 18 % of the recommended daily intake value.

Fact – One of the easiest sources of vitamin B12 is Milk as research done on this aspect had shown milk is absorbed faster than meat products and fish.


Vitamin B12 veg source
Vitamin B12 veg source


Nutritional Yeast

It is famous among vegetarians because it can be added to a variety of dishes, it is favorable with a cheesy and nutty flavor. It can be added to a cooked meal or can be sprinkled on snacks.

Nutritional Yeast can be sprinkled over mashed potatoes, eggs, salads, pasta. Being a rich source of vitamin B12 it can fulfill the nutritional requirement with flavor and taste.


Dietary Supplements

Vitamin B12 is available as dietary supplements, tablets, lozenges and is prescribed as per the requirement of a particular person.

Prescription Medication –

Vitamin B12 as prescription medication is administered parenterally, usually by intramuscular injection. It is used to treat severe vitamin B12 deficiency.

It is also available as nasal gel spray, as an alternative to vitamin B12 injections.


Vitamin B12 Deficiency
Vitamin B12 Deficiency


Groups at Risk of Vitamin B12 Deficiency

Vegetarians – People who are strict vegans or follow an only vegetarian diet are at risk as compared to animal-based food the plant-based food has less amount of Vitamin B12 naturally. Fortified cereals, Nutritional yeast, milk are the only sources of B12.

Pernicious Anemia – Individuals with pernicious anemia are not able to absorb vitamin B12 properly thus they are treated with intramuscular vitamin B12.

Gastrointestinal disorders – Individuals with gastrointestinal disorders of the small intestine and stomach such as Crohn’s disease unable to absorb enough vitamin B12 from food thus leading to deficiency followed by megaloblastic anemia and dementia.

Gastrointestinal surgery – Surgeries like weight loss surgery, part of the stomach removed often lead to an inability to absorb vitamin B12. Such individuals should be monitored for several nutritional deficiencies such as vitamin B12.

Older adults – Some older adults with atrophic gastritis require a much higher dose of recommended daily dose to avoid the clinical deficiency.

Diabetes medicine – People on diabetes drug Metformin are usually at risk of B12 deficiency.


Vitamin B12 source
Vitamin B12 source


Symptoms of Vitamin B12 Deficiency

Enough vitamin B12 is not absorbed in the following conditions

Intestinal diseases such as Crohn’s disease, Celiac disease, or other infections

Surgical removal of some part of the intestine.

Tapeworm infections

How can you find you are deficient in Vitamin B12?

  • Color of skin changes looking pale or yellow
  • Dizziness
  • Rapid heartbeat
  • Confusion
  • Low appetite or reduced hunger
  • Unintentional weight loss
  • Numbness / Tingling sensation in hands
  • Numbness / Tingling sensation in feet thus trouble walking
  • Muscle weakness
  • Fatigue and tiredness
  • Shortness of breath
  • Glossitis (swollen, red tongue )
  • Mouth ulcers or burning sensation in the mouth
  • Nausea
  • Diarrhea
  • Dementia and depression
  • Irritability


immunity boosting and vitamin b12 source
immunity boosting and vitamin b12 source

Prevention of Vitamin B12Β Deficiency

Vegetarians must include an adequate amount of vitamin B12 in their diet in the form of milk, cheese, yogurt, nutritional yeast to compensate for the shortage in their diet.

However, the people who are unable to absorb vitamin B12 despite proper diet cannot be prevented. Thus they require proper diagnosis and thus intramuscular injections of vitamin B12 to prevent the symptoms of deficiency.


Replacing the deficiency with an ideal approach is the only treatment that could help. Treatment depends on the cause of the deficiency whether it is due to poor diet or some neurological problems that have occurred such as dementia, memory loss due to prolonged Vitamin B12 deficiency.


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Diet Related

source of Vitamin B12
source of Vitamin B12

If a vitamin deficiency is due to a lack of vitamins in the body, Supplements in the form of tablets are prescribed every day between the meals.

In some cases when supplements are not sufficient intramuscular injections of hydroxycobalamin are given as per the requirement.

Prolonged poor diet leading to vitamin deficiency could be improved by tablets and are advised to stop the supplements once the B12 requirements in the body are fulfilled.

However, people who consume meat products can fulfill the nutritional requirement by Meat, Tuna fish, Eggs, and other dairy products.

Vegans can look for an alternative such as yeast, cheese, milk, paneer, fortified breakfast cereals, and soy products.

You can look for nutrition labels while shopping for food products and can look at how much vitamin B12 a particular food item is having.


Non – Diet-related

If your deficiency is not a food-related or poor diet you would require an intramuscular injection of hydroxocobalamin as per the requirement.

In neurological deficiency that causes numbness in hands and feet due to damage to the nervous system caused by prolonged B12 deficiency, you might require to consult your physician for regular injections as according to their advice you need to take the injections. Hydroxocobalamin is usually recommended by doctors since it stays for a longer time in the body.

Vitamin B12 source for deficiency
Vitamin B12 source for deficiency


Frequently Asked Questions

What are medically valid uses?

Vitamin B12 is used to treat pernicious anemia by lack of an intrinsic factor. Supplements or intramuscular injections are also used if required. Deficiency can happen from any of the following causes – Poor diet, Excessive bleeding, Vegan diet, Liver disease, Tapeworm infections, Gastrointestinal surgery.


Tests for Vitamin B12 deficiency?

It requires a simple blood test to check vitamin B12 status and no fasting is required for this test so can be done anytime. However, if the doctor is looking for other components, fasting may be required. One must always inform the doctor about any medication or supplements they are taking to prevent abrupt test results.


stay healthy and take vitamin b12
stay healthy and take vitamin b12

The link between depression and B12 deficiency?

Vitamin B12 plays an important role in producing brain chemicals that can affect mood as well as brain functions. Low levels of B12 and other B vitamins may be linked to depression.


The link between diabetes and B12 deficiency?

Diabetes mellitus could increase the risk of deficiency of having B12 deficiency. It may be due to the side effect of metformin, a common medication given for the treatment of diabetes mellitus.


Severe consequences of B12 deficiency?

Chronic and prolonged deficiency could increase the risk of neurological and psychiatric problems and can also result in nerve degeneration and muscle weakness.


How can you tell you are deficient?

Since the signs and symptoms of B12 deficiency are vague so you might not be able to realize the deficiency. Few common symptoms you might experience are muscle weakness, tiredness, fatigue, irritability, decreased appetite. A simple blood test would determine whether you are getting sufficient vitamin b12.


Who should get regular testing?

If you have a chronic illness such as diabetes, you are vegetarian, above the age of 55 years, have celiac disease or Chron’s disease you must get regular testing done.


Should I start a vitamin B12 supplement myself?

It is not recommended to start any supplement without asking your physician. You must consult your doctor if you are suffering from any signs and symptoms related to deficiency. Depending on the cause, symptom, and requirement your doctor would advise you of your ideal treatment.


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dairy products for vitamin b12
dairy products for vitamin b12

Normal ranges of vitamin B12?

Understand the results as follows –

Normal – Normal range for B12 in the blood is 200 – 900 nanograms per milliliter (ng/ml). Indication of insufficiency may require further testing to identify the cause especially if they have symptoms.

Low – Low levels means below 200 nanograms per milliliter (ng/ml). This may indicate pernicious anemia. People with much lower levels may show neurological symptoms too

High – Abnormally high B12 is above 900 nanograms per milliliter (ng/ml). This may be due to kidney, liver diseases, diabetes, or a certain form of blood disorders such as Leukemia.

However, the result ranges a little different from one laboratory to another, so you must always discuss your results with your doctor. These laboratory values are highly beneficial during the early stage of deficiency.


What is the cost of Vitamin B12 test ? Is it affordable?

The price range different from one laboratory to another . Usually the price is between 500 INR to 1000 INR. It ranges different from one city to another . Few expensive laboratories cost higher price too. Some common laboratories which facilitate the test are – Dr Lal Path labs that are available at almost most of the cities .The price of the test is usually affordable , done with simple needle prick , blood sample is withdrawnΒ  and report is usually given within 24 hours.

Vitamin B12 home remedies
Vitamin B12 home remedies

Does a high level of vitamin B12 also require treatment?

High levels of Vitamin B12 though does not cause any problem but having naturally high levels of vitamin B12 is a cause of concern because it may be due to severe medical condition. Rather than treating the elevated high levels of vitamin B12, your doctor would concentrate on treating the underlying medical condition that increased the B12 levels.


Concluding Thoughts

Vitamin B12 also called cobalamin is very important to create Red blood cells for normal functioning of the nervous system and overall body as well as to build up the energy of the body.

Regular testing as a part of regular health checkups rules out the cause of anemia in case of deficiency as well as in cases when the signs and symptoms are identified. A simple blood test could help in ruling out the deficiency if present.

The prognosis is excellent since early diagnosis and this form of anemia responds really well to treatment. However, if the treatment is delayed some damage in the nervous system may be permanent.

It is treatable by medical professionals and deficiency resolves within months.

Dr Jyotsana Anand

Dr Jyotsana Anand

Myself Dr Jyotsana Anand, a Dental Surgeon by profession and Writer by passion. I am an avid reader so in my meantime you may find me reading books, novels and researches.
Dr Jyotsana Anand
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