Signs and Symptoms of Vitamin B12 Deficiency
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Medically reviewed by Steffini Stalos, DO
Vitamin B12 plays a major role in producing DNA and red blood cells, metabolizing protein, and protecting the nervous system. If you don’t get enough vitamin B12—or if your body doesn’t absorb it properly—you may develop a vitamin B12 deficiency. Common symptoms include weakness, fatigue, difficulty concentrating, and shortness of breath. Over time, you may also develop changes in mood, memory, and/or personality.
Adults should have around 2.4 micrograms (mcg) of vitamin B12 per day (or more if they’re pregnant or breastfeeding).
Because vitamin B12 plays such a vital role in the production of healthy red blood cells, B12 deficiency often leads to anemia (a low red blood cell count). This type of anemia is known as megaloblastic anemia. However, you can start experiencing symptoms of vitamin B12 deficiency before you get to the point of developing anemia.
Physical Symptoms
B12 deficiency symptoms often start off mild and gradually worsen over time. Physical symptoms of a vitamin B12 deficiency may include:
Bowel changes such as diarrhea or constipation
Loss of appetite
Unwanted weight loss
Lightheadedness, especially upon standing
Pale skin
Difficulty breathing, especially after exercising
Swollen tongue, bleeding gums, and mouth ulcers
Nausea and vomiting
Neurological Symptoms
If left untreated, a prolonged vitamin B12 deficiency can lead to nerve damage and problems with the central nervous system. This is partly because vitamin B12 usually breaks down an amino acid called homocysteine. High levels of homocysteine put you at risk for a number of medical problems, including dementia.
Neurological symptoms associated with vitamin B12 deficiency may include:
Dementia
Auditory and/or visual hallucinations
Psychosis (mental state characterized as a "break from reality")
Problems with balance
Tingling or numbness in the hands or feet (peripheral neuropathy)
Confusion, difficulty concentrating, and problems with thinking and/or memory
Personality changes
Loss of sense of taste or smell
Vision loss
Psychological Symptoms
Vitamin B12 deficiency can also affect your mood, emotions, and mental state. Psychological symptoms include:
Apathy
Agitation
Depression
Irritability
Anger
Anxiety
Disorganized thoughts
In addition to increasing your risk of developing depression, vitamin B12 deficiency can exacerbate existing symptoms among people with major depressive disorder (MDD).
Symptoms in Children
Like adults, children who aren’t absorbing enough vitamin B12 may have either mild symptoms that resolve quickly or severe, ongoing complications. However, vitamin B12 deficiency sometimes presents differently in infants and children.
Signs of a B12 deficiency during infancy or childhood may include:
Syncope (fainting)
Headache
Dizziness
Developmental delays
Hypotonia (low muscle tone)
Tremors
Memory problems
Paresthesia (a “pins and needles” feeling)
Fatigue
Myoclonus (involuntary muscle twitching)
When to Contact a Healthcare Provider
If you notice any symptoms of vitamin B12 deficiency, contact a healthcare provider. They can recommend dietary changes, supplements, and/or vitamin B12 injections to resolve your symptoms.
It’s particularly important to reach out to a healthcare provider if you have any risk factors for B12 deficiency. People who follow vegetarian and/or vegan diets are more likely to develop a B12 deficiency because the vitamin is found naturally in many animal-based foods like meat, fish, eggs, and milk.
Other risk factors for vitamin B12 deficiency include:
Pernicious anemia
Alcohol use disorder (AUD)
Certain medications
Weight loss surgery
Finally, seek emergency medical help if you notice any sudden changes in your:
Vision
Gait
Balance
Ability to control your muscles
Personality or mood
Ability to speak clearly and understand others
Memory
Sensation
Alertness
A Quick Review
Vitamin B12 deficiency can lead to physical, psychological, and neurological symptoms. Physical symptoms of B12 deficiency may include diarrhea, fatigue, muscle weakness, lack of appetite, unintended weight loss, and more. Meanwhile, psychological and neurological symptoms range from problems with moving, walking, and speaking to changes in personality, mood, and emotions.
Vitamin B12 deficiency can be effectively treated if diagnosed and addressed early. However, some neurological symptoms may be permanent if the problem persists for a long period of time. Talk to a healthcare provider if you notice any signs of vitamin B12 deficiency anemia.
Frequently Asked Questions
Can you reverse B12 deficiency symptoms?
In most cases, vitamin B12 deficiency can be treated with B12 shots and/or oral supplements, as well as dietary changes. However, nerve damage from long-term vitamin B12 deficiency may be irreversible.
What triggers symptoms of B12 deficiency?
Vitamin B12 deficiency symptoms are often caused by anemia, meaning a lower-than-normal red blood cell count. People who don’t consume meat products have a significantly higher risk of developing vitamin B12 deficiency anemia. Excessive alcohol use, taking antacids, and undergoing weight loss surgery can also lead to a B12 deficiency.
How long after taking vitamin B12 will my symptoms improve?
After a vitamin B12 injection, your body should start to make new red blood cells within just a few days. Typically, you’ll notice improvements in your symptoms within a few weeks or up to a month. However, if your symptoms persist, you may need to regularly get a B12 shot.
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