B12 Deficiency (7 Signs Doctors Miss)

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Feeling run down? Having trouble concentrating? Or perhaps you have a “pins and needles” sensation in your hands and feet? These could be symptoms of many things, including vitamin B12 deficiency.

You are probably aware of B12 (cobalamin)—it’s often discussed in health and fitness circles. The essential vitamin plays a crucial role in nervous system function, energy production, and DNA synthesis. [1]

Unfortunately, a significant number of people have insufficient or deficient levels of the crucial vitamin due to limited dietary intake, the use of certain medications, health conditions, and malabsorption. [2]

Signs Of Vitamin B12 Deficiency

The issue with vitamin B12 deficiency is that it tends to be misdiagnosed or overlooked—meaning countless people struggle with its adverse effect without knowing it. [3] So, how do you know if you have a potential vitamin B12 deficiency?

Board-certified family doctor and popular health YouTuber Ken D. Berry, MD, goes over some of the common telltale signs of vitamin B12 deficiency, why you should get checked, and what to do if your levels are dwindling.

Here are some signs of vitamin B12 deficiency that tend to be overlooked or misdiagnosed:

1: Paresthesia Or Burning / Tingling Sensation In Your Hands And Feet

A common and worrisome symptom of B12 deficiency that is sometimes misdiagnosed is paresthesia in your hands and feet. [3] It’s defined as numbness, burning, or tingling sensation in your extremities.

“Vitamin B12 is mandatory for the body to properly manufacture myelin, which is a protective sheath that wraps around your nerves and helps them transmit sensations and function more efficiently,” explains Dr. Berry. A lack of this essential vitamin deteriorates nerve cells since the body cannot produce enough myelin—leading to a pins-and-needles sensation in the peripheral nervous system. [4]

It should be noted that findings from an observational study by researchers from Lady Hardinge Medical College suggest that this symptom of vitamin B12 deficiency overlaps with the symptoms of peripheral neuropathy in diabetics. [5]

2: Smooth, Slightly Swollen Tongue

“Your tongue should be bumpy, irregular, and uneven,” insists Dr. Berry. If it is smooth or slightly swollen, this could be a sign of B12 deficiency.

In medical terms, a painful, red, or inflamed tongue is referred to as glossitis. It can appear alongside mucosal ulcerations or stomatitis, which is inflammation and sores in the mouth.

While there are numerous potential etiologies for glossitis—such as infections, anemia, and the use of certain medications [6] – it is recognized as an oral sign of undiagnosed vitamin B12 deficiency. [7]

3: Feeling Fatigued

Feeling sluggish, like you’re muscling through life? Or do you often feel lightheaded or dizzy when standing from a seated position? There are tons of potential reasons for this—and B12 deficiency could be one of them.

A study published in the journal Nutrients suggests that vitamin B12 deficiency impairs normal red blood cell production, negatively impacting oxygen delivery. [8] And without enough oxygen in your tissues, you’ll likely feel tired and sluggish.

According to Dr. Berry, lab work for someone reporting fatigue should include a full panel of vitamin B12, methylmalonic acid, and homocysteine.

4: Mental Impairment – Slow Thinking, Difficulty Concentrating, Fogginess

“Low Vitamin B12 Levels: An Underestimated Cause Of Minimal Cognitive Impairment And Dementia” was the title of a 2020 cross-sectional study on the impact of vitamin B12 deficiency on cognition. [9]

The researchers placed around 200 B12-deficient people on vitamin B12 replacement therapy. After 3 months of treatment, 84% of the participants reported improvement in forgetfulness, memory decline, and poor focus. The findings demonstrate the effects of vitamin B12 on mental impairment.

If you frequently feel forgetful, confused, or foggy, take it seriously and ask your doctor to check your vitamin B12 levels.

5: Problems With Balance And Gait

Vitamin B12 deficiency is linked to ataxia, which describes the impairment of muscle balance and coordination. [2]

You might be deficient in vitamin B12 if you frequently fall, are clumsy, have trouble with fine motor skills, or struggle to maintain a steady gait. The symptom is linked to nerve damage, which impacts motor and sensory function.

Dr. Berry marks this symptom as a major red flag necessitating relevant tests.

6: Tinnitus – Ringing in the Ear

Tinnitus is a problem in the inner ear that may sound like buzzing, screeching, low-pitch roaring, humming, chirping, or high-pitch hissing. According to observations by a study published in the American Journal of Otolaryngology, there could be a “relationship between vitamin B12 deficiency and dysfunction of the auditory pathway”. [10]

The study also found that increasing vitamin B12 intake improved tinnitus-related complaints [10] and may also help reduce the odds of developing the ear problem. [11]

7: Depressive Symptoms

Vitamin B12 is crucial to the proper function of the central nervous system. A deficiency in this essential nutrient may manifest as irritability, changes in mood, anxiety, and other depressive symptoms. [12]

A 2020 study in the Child and Adolescent Mental Health journal suggests that low levels of B12 and elevated homocysteine levels are associated with depression and other psychiatric disorders. [13]

According to Dr. Berry, depression should be a diagnosis of exclusion. “Before you ever diagnose someone with depression, there should be a lot of lab work that you’ve checked. And among that lab work should be a test for vitamin B12 levels.”

Managing Your Vitamin B12 Levels

If you have any of these symptoms, Dr. Berry recommends you talk to your doctor about having your B12 levels checked.

For most people, vitamin B12 deficiency can be prevented. Dr. Berry is a proponent of increasing your B12 levels naturally through diet. He recommends eating foods rich in vitamin B12, mostly animal products such as meats and dairy. But if you are a vegan and vegetarian, B vitamin supplements are available to boost your B12 levels.

B12 Deficiency (7 Signs Doctors Miss)
B12 Deficiency (7 Signs Doctors Miss) Graphic © healthpowerboost.com.
Background photo: Pixabay (PD)


[1] National Institutes of Health Office of Dietary Supplements: https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

[2] National Library of Medicine: https://www.ncbi.nlm.nih.gov/books/NBK441923/

[3] Wolffenbuttel, B. H., Wouters, H. J., Heiner-Fokkema, M. R., & van der Klauw, M. M. (2019). The many faces of cobalamin (vitamin B12) deficiency. Mayo clinic proceedings: innovations, quality & outcomes, 3(2), 200-214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543499/

[4] Serin, H. M., & Arslan, E. A. (2019). Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta Clinica Croatica, 58(2), 295. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884369/

[5] Gupta, K., Jain, A., & Rohatgi, A. (2018). An observational study of vitamin b12 levels and peripheral neuropathy profile in patients of diabetes mellitus on metformin therapy. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 12(1), 51-58. https://pubmed.ncbi.nlm.nih.gov/28882470/

[6] National Library of Medicine: https://www.ncbi.nlm.nih.gov/books/NBK560627/

[7] Field, E. A., Speechley, J. A., Rugman, F. R., Varga, E., & Tyldesley, W. R. (1995). Oral signs and symptoms in patients with undiagnosed vitamin B12 deficiency. Journal of oral pathology & medicine, 24(10), 468-470. https://pubmed.ncbi.nlm.nih.gov/8600284/

[8] Tardy, A. L., Pouteau, E., Marquez, D., Yilmaz, C., & Scholey, A. (2020). Vitamins and minerals for energy, fatigue and cognition: a narrative review of the biochemical and clinical evidence. Nutrients, 12(1), 228. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019700/

[9] Jatoi, S., Hafeez, A., Riaz, S. U., Ali, A., Ghauri, M. I., & Zehra, M. (2020). Low vitamin B12 levels: An underestimated cause of minimal cognitive impairment and dementia. Cureus, 12(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077099/

[10] Shemesh, Z., Attias, J., Ornan, M., Shapira, N., & Shahar, A. (1993). Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss. American journal of otolaryngology, 14(2), 94-99. https://pubmed.ncbi.nlm.nih.gov/8484483/

[11] Dawes, P., Cruickshanks, K. J., Marsden, A., Moore, D. R., & Munro, K. J. (2020). Relationship between diet, tinnitus, and hearing difficulties. Ear and hearing, 41(2), 289. https://pubmed.ncbi.nlm.nih.gov/31356390/

[12] Young, L. M., Pipingas, A., White, D. J., Gauci, S., & Scholey, A. (2019). A systematic review and meta-analysis of B vitamin supplementation on depressive symptoms, anxiety, and stress: Effects on healthy and ‘at-risk’individuals. Nutrients, 11(9), 2232. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770181/

[13] Esnafoglu, E., & Ozturan, D. D. (2020). The relationship of severity of depression with homocysteine, folate, vitamin B12, and vitamin D levels in children and adolescents. Child and adolescent mental health, 25(4), 249-255. https://pubmed.ncbi.nlm.nih.gov/32304285/

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