Vitamins are invisible components that help your body function. They are the essential components of the cells required for generating energy, forming tissues, and shielding your nervous system.
Vitamin deficiencies typically don’t come on with a sudden, severe illness. They grow over time behind a daily complaint, such as being tired, getting older, or just being stressed. But Vitamin B12 deficiency is one of the few nutritional deficiencies capable of causing irreversible neurological damage. It is an essential nutrient for your brain and nervous system.
It’s so easy to say that being tired is part of the lifestyle, especially with a hectic career or a family schedule. However, if you know exactly which B12 deficiency symptoms to look for, you can catch this issue before it causes permanent nerve damage.
What is Vitamin B12?
Vitamin B12 (cobalamin) is a water-soluble vitamin that has a huge impact on your health. B12 is one nutrient that can’t be synthesized in the body and must be obtained from food sources.
It has three primary functions:
- To maintain the proper function of your neurological system
- To make healthy red blood cells
- To synthesize DNA
B12 protects your nerves to make sure that the chemistry of electricity flows from your brain to your body. It’s also the master key that unlocks your body’s ability to create healthy, complete red blood cells. If you don’t have adequate levels, your body isn’t able to produce energy at a cellular level.
The B12 Normal Range
The first and most important step is to know your B12 level. So if you visit a regular physician, they will take a blood sample. A normal range is between 200 and 900 picograms per milliliter (pg/mL) on the lab report.
If your test shows 250pg/m, your doctor will probably tell you you are just fine. In functional medicine, however, we understand that symptoms of B12 deficiency typically start when it falls below 450 or 500 pg/mL. You may be normal on paper, but deficient in your body. Your brain and nerves require more than the minimum; they require optimum levels.
Key B12 Deficiency Symptoms
B12 deficiency symptoms appear slowly and can affect several body systems. A lot of women suffer from several of these symptoms at a time without ever realizing that they have a common nutritional cause.
Nerve Tingling and Numbness
One of the most distinct vitamin B12 deficiency symptoms is a change in your sense of touch. Deficiency of B12 leads to the breakdown of the protective sheath around your nerves (myelin sheath). It may feel like pins and needles in the hands and feet or numbness that won’t subside.
A few women report electric shock or a sensation of walking on cotton wool or a loss of temperature sensation in the feet. People often confuse this with the fact of poor circulation, but if it continues, it is a big neurological red flag.
Unexplained Fatigue and Brain Fog
Fatigue is the most universal B12 deficiency symptom and is different from normal fatigue.
Without enough B12, your red blood cells can’t make healthy blood cells as you need to transport oxygen to your muscles, organs, and brain. This makes you extremely tired, struggle to concentrate, and you forget simple words.
Mood Changes and Depression
Serotonin and dopamine are synthesized directly with B12. These hormones make you feel happy and are responsible for your mood. These feel-good chemicals are directly reduced by a deficiency. When you all of a sudden feel anxious, irritated, or depressed for no apparent reason, it may be due to low B12.
Pale Skin and Sore Tongue
Glossitis is characterized by an enlarged, red, smooth, or tender tongue. It is a well-known symptom of B12 deficiency anemia. Other reported symptoms of B12 deficiency include mouth ulcers, sores at the corners of the lips (angular cheilitis), and overall mouth sensitivity.
If you have a B12 deficiency, there is Impaired red blood cell production can actually change your physical appearance. This makes your skin look unusually pale or have a slight yellow tint due to the rapid breakdown of fragile blood cells.
B12 deficiency can show up in ways you may not expect. Our Women’s Health team looks at your symptoms and labs together.
Symptoms of B12 Deficiency in Women
There are special risks for women when it comes to this nutrient. Signs of B12 deficiency in women often overlap with hormonal issues, making it even harder to diagnose.
- Reduced fertility
- Menstrual irregularities
- Brittle nails
- Reduced exercise tolerance
- Frequent infections
- Mouth ulcers
- Loss of appetite
- Poor balance
- Difficulty walking
- Cold hands and feet
- Weakness
- weight loss
- Slow wound healing
- Hair thinning or hair loss
- Pale or yellowish skin
- Confusion
- Depression
- Anxiety
- Irritability
- Poor sleep
Some research indicates that oral contraceptives affect B12 levels over time, and women on hormonal contraceptives may have lower levels of B12.
B12 Deficiency and Pernicious Anemia Symptoms
Sometimes, eating the right foods is not enough. In Pernicious Anemia, your immune system attacks the proteins in your stomach that help you absorb B12.
You could be eating plenty of B12-rich food, but your body cannot pull the vitamin into your bloodstream.
The symptoms of specific B12 deficiency, pernicious anemia, are:
- Severe weakness
- Tingling
- a rapid heart rate
- shortness of breath
- Neurological problems, such as balance problems and memory loss
Standard oral supplements are not effective for people with pernicious anemia. You need to take high doses of B12, either as injections or special sublingual liquids, to overcome the faulty absorption system in your stomach.
How Much B12 Should You Take a Day?
The recommended dietary allowance for adults who have no absorption problem is 2.4 micrograms per day. This range is obtained naturally by most adults who are on a diversified omnivore diet.
But pregnant women need 2.6 mcg of folate a day, and breastfeeding women require 2.8 mcg a day, not only for their own health but also for their baby’s health.
For adults over age 50 or older, B12 supplementation may be recommended as absorption of food-bound B12 decreases with age, and a supplement or fortified food source will release B12 in a free form that can be absorbed.
For people with a diagnosed deficiency of vitamin B12, the typical dose is 500–2000 mcg per day of an oral supplement or 100–1000 mcg per day of a vitamin B12 injection.
It is important to take the vitamin in the correct dosage depending on your type of deficiency, symptoms, and how well your body absorbs the vitamin. So it is better to get medical advice from a trusted doctor instead of self-prescribing a high-dose supplement of the vitamin.
How Is B12 Deficiency Treated?
Treatment for B12 deficiency depends on the cause and severity of your deficiency. If you have:
- Mild to moderate deficiency with normal absorption: Oral supplementation of 500-1000 mcg/day is recommended. With adequate supplementation, most people notice improvements in their fatigue and cognitive symptoms in 4-8 weeks. However, neurological symptoms can take several months to completely resolve.
- Pernicious anemia or severe malabsorption: This is treated by injection of B12 directly into the muscles. It is administered daily for 1-2 weeks, then weekly and then monthly for continued maintenance. Some people with pernicious anemia require lifelong monthly injections, as there is no treatment for the loss of intrinsic factor production.
- Neurological symptoms: This should be corrected aggressively and as early as possible. Delay of treatment of neurological B12 deficiency symptoms will result in permanent damage. It is usually advisable to use B12 injection initially when there is clear neurological involvement in order to correct the situation quickly.
- Metformin-related deficiency: These deficiencies are treated with the addition of B12 supplementation and continued metformin therapy. Calcium supplementation has been shown to partially reverse the B12 malabsorption caused by metformin. For this reason, some providers recommend using calcium in conjunction with metformin.
How to Manage Your B12 Deficiency?
- Get tested to confirm a vitamin B12 deficiency and identify the underlying cause
- Take any supplements or B12 injection as directed by your healthcare provider
- Consume more foods that contain vitamin B12, including animal foods such as meat, fish, eggs, dairy products, and fortified foods like cereals
- If you are a vegetarian or vegan, eat fortified foods or take a vitamin B12 supplement on a regular basis
- Avoid alcohol
- Maintain physical activity and get a good night’s sleep
- Treatment should be continued as directed, even after symptoms are gone
- Keep monitoring your vitamin B12 levels with follow-up blood tests as recommended
Conclusion
B12 can affect many functions in your body, from your brain to your nervous system to your energy levels. You can maintain your levels through your diet, and the best sources are animal products like fatty fish, liver, and eggs.
If you think you may have B12 deficiency symptoms, you should definitely get a blood test. It is important to note that normal testing may not be adequate to detect a functional deficiency before neurological damage occurs.
At Kairos Health and Wellness in Texas, Lola, one of our functional medicine nurse practitioners, takes a comprehensive approach to identifying nutritional deficiencies and tests the full picture rather than the single marker, and builds a personalized repletion plan based on your actual results.
If you have any questions or concerns about your health, reach out to us. Don’t spend one more day feeling fatigued.