Warning Signs of Vitamin B12 Deficiency And Its Treatment

Warning Signs of Vitamin B12 Deficiency And Its Treatment - Palak Notes

B12 is one of the eight B Vitamin. B12 is called the "Energy Vitamin" because the very first signs of B12 deficiency is extreme fatigue. B12 influences every one of our cells throughout your brain and nervous system. One of the most crucial areas of B12 is the Brain. That's why a little deficiency of B12 Vitamin has a direct impact on our cognition ( Short-term memory, focus, mood, and concentration). Other than this B12 is used for:


  • Maintenance of the Nervous System: Protective covering of nerves, called the cell’s myelin sheath.
  • Proper Digestion: Food absorption, conversion of carbohydrates, proteins, and fat into energy
  • To make Red Blood cells - Anemia is caused due to B12 Deficiency.
  • Memory, Concentration, Fights Depression and for Mental clarity
  • Detoxification ( homocysteine, cyanide, nitrous oxide and much more )


Vitamin B12 deficiency can be categorized into Little Deficiency, Mild Deficiency and Severe deficiency.  


Symptoms of Little Vitamin B12 Deficiency


Anaemia or Fatigued

Every anaemic person is fatigued. The formula for energy is pretty simple. Glucose reacts with oxygen to produce energy. Now if Oxygen is not carried to the cells, no energy would be produced. Haemoglobin is the main protein our red blood cells use to transport oxygen. B12 is responsible for making Hemoglobin. Less haemoglobin, less oxygen, and hence less energy. Pretty simple.


If you are just fatigued: Iron, B12 and Folic acid deficiency If you are fatigued and have soared muscles - Magnesium and Potassium deficiency as well.   Constipation, Depression, Loss of appetite, PMS (premenstrual symptoms) and premature grey hair Yellow Skin ( If you have low red blood cells and you are anaemic, definitely you will look pale ). When I was a kid, I always looked pale. At that time we did not have the internet. Vitamins and Minerals test was also not very common.


I was a vegetarian and had no idea about B12. My energy levels were also very low. Violent behaviour and Depression: Stop blaming your loved ones if anyone having this kind of behaviour. Go and get their B12 tested. I am very close to my clients and if they share the violent behaviour or mood disorder of anyone in their family. I always tell them to get their B12 levels tested.  


Symptoms of Mild Vitamin B12 Deficiency



  • Nerve Damage: Reduced sensation, Numbness, and Tingling in the fingers and toes. Loss of Feeling Taste and Smell. Just tell anyone to touch your toe fingers very gently. Are you able to guess which toe finger are they touching?
  • Dizziness and Vertigo
  • Disorientation
  • Nervousness and Trembling
  • Menstruation cessation or reduced frequency
  • The inability of the body to regulate body temperature: If your hands and feet are cold all the times

Symptoms of Extreme Vitamin B12 Deficiency


1. Pernicious anaemia, a very serious type of anaemia where red blood cells are improperly formed and the white blood cell count is low. In pernicious anaemia, which is usually an autoimmune diseaseautoantibodies directed against intrinsic factor lead to an intrinsic factor deficiency, malabsorption of vitamin B12, and subsequent megaloblastic anaemia.


2. Damage to the brain and central nervous system (e.g., Alzheimer's, dementia, hallucinations and multiple sclerosis ). If B12 Deficiency stays undiagnosed or untreated long-term, permanent damage to the brain, spinal cord, and Vision can happen. This can affect people's ability to move, walk and think clearly, can happen.   


A vitamin B12 deficiency can exist for years without any noticeable symptoms. For Example, you will never get your B12 checked if you are depressed or have mild tingling in the body. By the time you start noticing its classic signs of fatigue, mental “fog,” forgetfulness, mood swings, and muscle weakness, you can be significantly deficient.


Who Is At Risk Of B12 Deficiency


40% of people between the age of 26 and 80 are vitamin B12 deficient, Meaning approx. every second of you are B12 Deficit. Deficiency occurs:
  1. If a person does not intake the daily RDA
  2. If a person is not able to absorb B12


Taking and absorbing vitamins are two different stories. You can take 10 pills, but if your body is not able to absorb the vitamin you have a deficiency. Here also comes stomach acidity in the picture. Stomach acid is responsible for breaking the food and absorbing nutrients from the food. I wrote a whole article regarding the same.


I was motivated enough to study about stomach acidity because I bought the most expensive Vitamins and Minerals in their highest bioavailable form, but I still had vitamins and minerals deficiency. I was literally in tears, after spending 1000´s of euros in supplements and later learning that my body was not absorbing it, the reason being antacids or too low stomach acid.


  1. Vegetarians: B12 is the only vitamin that has cobalt in it. Cobalamin is produced in the gut of animals only. 50 to 80 percent vegetarians are B12 Deficient. Plants don’t make vitamin B12.  
  2. Weight Loss Surgery: Because weight loss operation interferes with the body’s ability to extract vitamin B12 from food. This means even if they eat, they cannot exact from the food sources.
  3. Antacid Drugs - Suppress the stomach acid. Stomach acid is required to get B12 from the food. You can read more here how to get off your Antacid medication.
  4. Drinking too much coffee. Heavy Coffee drinkers have generally 15% fewer B vitamins.
  5. Regular alcohol consumers, as B12 is stored in the liver
  6. H.Pylori infection destroys Intrinsic factor, a protein produced by stomach cells to absorb B12.
  7. Having an autoimmune disease: Some autoimmune diseases can damage the stomach lining (including pernicious anaemia) where intrinsic factor is produced. It is an arguable comment if B12 deficiency occurs due to Preniuos anaemia or vice versa.
  8. People with Gastrointestinal diseases that impair normal nutrient absorption, such as Crohn's disease and Celiac Disease.

Natural Sources Of Vitamin B12


 B12 an energy vitamin is found mostly in animal products. Vitamin B12 cannot be made by the body. Instead, it must be gotten from food or supplements.  
  1. Shell Fish (Cooked Clams) :  3 Ounce: 84 mcg
  2. liver of Beef: 3 ounces: 70 mcg
  3. Mackerel: 3 Ounce: 16 mcg
  4. Sardines: 3 ounces: 6.6 mcg
  5. Lamb: 3 ounces: 2.7 mcg
  6. Wild-caught salmon: 3 ounces: 2.6 mcg
  7. Nutritional yeast: 1 tablespoon: 2.4 mcg
  8. Feta cheese: Half cup: 1.25 mcg
  9. Grass-fed beef: 3 ounces: 1.2 mcg
  10. Cottage Cheese: 1 cup: 0.97 mcg


(3 ounces is approx. 84 Grams) Probiotics also increase B12 absorption. The B12 molecule breaks down at 250o C. Thus B12 is destroyed on the surface of the grilled meat, but not in the interior. Thus, gentle braising or cooking steaks to rare or medium-rare best preserves B12 in meat. For vegetarians, nutritional yeast is gaining popularity for healthy B Vitamins.  


Daily B12 Requirement 


  • 2.4 micrograms for people age 14 and older
  • 2.6 micrograms for pregnant women
  • 2.8 micrograms for breastfeeding women


This means if you eat 100 grams of beef, lamb or fish every day as a source of animal protein, you should be actually not B12 deficient.


Test for B12 levels 


  1. Blood Test or Urine Test: A vitamin B-12 blood test checks the amount of B-12 in your blood. It can be taken at your doctor’s office, through a blood draw, or at home with a urine test kit.
  2. Schilling Test: This test can help them determine whether your stomach is producing “intrinsic factor.” Intrinsic factor is a type of protein required for vitamin B-12 absorption.


As we have discussed earlier that B12 deficiency is caused either due to low intake of B12 or due to poor absorption. But, It is common for blood tests to reveal inaccurate information regarding B12 levels since a high percentage is stored in the liver and not in the blood. Also taking large amounts of folic acid has been found to mask vitamin B12 deficiency in some patients. Studies show that about 50 per cent of patients with diseases related to vitamin B12 deficiency have normal B12 levels when tested.


I am giving you this information, not to scare you guys, but if you have symptoms but the tests are showing its fine, you can always supplement with B12 or eat liver for some days and see if the symptoms improve. Don't worry you cannot overdose on B12 since it is water-soluble, you will anyway excrete the excess in the urine. Still, if the symptoms do not disappear, speak to your doctor about more precise screening tests. That is available but not very common. I do not have any more B12 deficiency because I eat liver and shellfish once in a week. There is yet another point to be considered.  


Labs call B12 levels between 200 pg/ml to 350 pg/ml normal. Which is not true, because the deficiency symptoms start showing up in this range. Less than 450 pg/ml is considered as deficient. 

  Continous levels under 450 pg/Ml have signs of cognitive decline, dementia, and memory loss. In Japan, less than 500pg/ml is considered a deficit. Maybe this could be the reason that Japanese population has fewer cases of Alzheimers and Dementia. Physicians in these countries consider blood levels of 500-1300 to be the normal range


Treating B12 Deficiency 



Cyanocobalamin is the most frequently used form of B12 supplementation. Cyanocobalamin is a synthetic and inexpensive form of vitamin B12 that is converted in the body to its bioactive forms, methylcobalamin, and cobamamide. Recent evidence suggests that hydroxycobalamin (frequently used in Europe) is superior to cyanocobalamin, and methylcobalamin may be superior to both.


This is probably because methylcobalamin bypasses several problems in the B12 absorption cycle and it easily crosses blood-brain barrier B12 and Folate together undergo a chemical reaction called transmethylation which is responsible for making neurotransmitter Serotonin. Serotonin is also called "Happy Neurotransmitter". It is responsible for keeping you happy.


Happiness is anyways the mother of all medicines. Also, if you are low on B12, your body will use folate to complete the reaction and you will become folate deficient as well. That's why I advise taking both the supplements together. Folate and B12  


B12 Injections




Due to genetic conditions and low absorption of B12 patients are prescribed B12 injections. B12 injections definitely increase B12 levels immediately, but it was observed that taking 1,000–2,000 micrograms orally in properly timed doses helped improve levels as much as injections If you have stomach acid problems, then of 500 mcg, only 10 mcg will be absorbed by the body.


This is very common how our medical mainstream works. They will see a B12 deficiency, inject you will B12 without analyzing the underline cause. Here I have written a full article on how to fix your acidity problems.   Vitamin B12 can also be taken in lozenges or in oral spray form. Sometimes people do better with drops and oral spray forms of vitamin B12 because they have trouble absorbing the vitamin from the stomach. You can follow this table for self-help:


B12 and Pregnancy


Folic acid is an essential vitamin for pregnant women because the fetus needs large amounts for brain and nervous system development. Almost every pregnant lady is now consuming folate as prescribed by the doctor. But, what about B12? I was all-time tired during my pregnancy and when asked around, everyone emphasized its normal. I used to sleep a lot. Then symptoms of depression, loss of appetite, muscle weakness kicked in. My doctor ever smiled and said it's normal. I changed the doctor and thank-god! she tested my B12 levels. But by then I was already severely B12 deficient. I did not trust animal products in my pregnancy, so I was a pure vegetarian without B12 supplementation.


My symptoms were diagnosed at the right time and my baby was normal. Doctors emphasize only on folic acid only in the pregnancy, I don't know why they do not ask us about Vitamin D, Magnesium, Omega 3 and B12 that according to me is absolutely necessary. That tiredness, we start thinking is part of the pregnancy, is not true. Most pregnant women are B12 deficient.


Please get your B12 levels checked as soon as you get pregnant. If you see any pregnant women around, who is sleeping a lot, please tell her to check her B12 levels immediately. Babies whose mothers have a B12 deficiency during pregnancy may have increased odds of developing type 2 diabetes, as well as other serious metabolic problems, later in life.   


B12 Level in India (Where most of the population is vegetarian)


Vegatarian Food


My dad is a vegetarian. I respect his concern about animal welfare and since he is a Hindu, due to religious reasons he does not eat Beef anyways. He had major symptoms of B12 deficiency. I told him to get his b12 levels checked. He told his ancestors never ate meat and lived 90 years without any diseases. They were all vegetarians. First of all, we can never compare ourselves with our ancestors because they moved a lot. We have so much comfort at our disposal, that we hardly move


  • Industrialization and population have depleted our soil of important minerals.


Still, this argument of his intrigued me to do some research, why Indians, although they were vegetarians, did not have any B12 deficiency. I know that B12 is produced by bacteria. This bacteria is present in animals only. Now, I have to look at if this bacteria was in the soil earlier. And I was right. It was found that in the earlier days people actually got their hands dirty in the soil and this was probably a source of this nutrient for them. Industrialized agriculture has also sterilized our soils. We also now live in a bacteriophobic culture. Undoubtedly in the past times, soil bacteria was an important source of B12.


Dirt on the hands, under the nails, and on the food that was eaten would be enough to supply adequate B12. This does not mean we should start eating unwashed vegetables now because if they are not washed properly, they are contaminated with pesticides. The research shows that now 8 out of 10 Indians are B12 Deficit. We emphasize a lot on sterilization these days. There are multiple studies showing that children using hand sanitizers have weaker immune systems. Another aspect is, high levels of folic acid can accelerate neuropsychiatric complications in persons with B12 deficiency. 


Since folic acid intakes of vegetarians tend to be high (from green vegetables and from grain products that have been fortified with folic acid), those following a vegetarian lifestyle may be at increased risk of neurological and psychological problems. Although Folate and B12 work together in the body for so many chemical processes. A deficiency of B12 should never be tried to cover with high Folate, as it can cause permanent brain damage. I write folic acid as folate because Folate is the right form to take and not folic acid.  




  • 40% of people above 18 years of age are suffering from B12 deficiency.
  • Anaemia or Pale looking complexion is mostly due to vitamin B12 deficiency.
  • A B12 blood test does not always show the deficiency.
  • A deficiency of B12 is due to low intake of B12 in the food or due to low absorption in the body.
  • In most countries, a level of  300 pg/ml is considered normal, which is totally untrue. B12 deficiency symptoms could be seen below 450pg/ml levels.
  • There are no good natural sources of B12 for vegetarians till now.
  • The most common prescribed B12 supplement is Cyanocobalmin, while the research indicated it should be Methylcobalamin, as it is easily absorbed by the body.


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