- The symptom of a vitamin B12 deficiency can feel so debilitating that people have described it as feeling as though they’re dying.
- Common symptoms of a B12 deficiency include fatigue, heart palpitations, headaches, depression, and more.
- If you are B12 deficient, supplementing can reduce symptoms and help you feel better.
Ask someone with a vitamin B12 deficiency to describe how it feels, and you’re bound to encounter some hyperbole: After all, just as many people Google “B12 deficiency symptoms” as “B12 deficiency feel like i am dying.”
This could have something to do with the fact that the water-soluble B vitamin is vital to, well, vitality. Vitamin B12 is essential for producing red and white blood cells, as well as platelets (colorless blood cells that help blood clot).
It also contributes to the health of your immune system: B12 also jacks up the activity of certain immune cells, contributing to your body’s defense against chronic diseases and viral infections (1).
B12 is also a key player in the development and function of brain and nerve cells says Richard Foxx, M.D., a board-certified physician who treats hormonal disorders and nutritional deficiencies.
It makes sense then that if you have low B12 to the point of a deficiency, it can cause a myriad of physical and mental symptoms that can zap your energy and make you feel like you have one foot in the grave.
While a B12 deficiency isn’t exactly ideal, it is treatable. Here’s what you need to know about the symptoms of a vitamin B12 deficiency, and how B12 supplementation can help you feel like yourself again.
What Are The Signs and Symptoms of a Vitamin B12 Deficiency?
Due to its vague nature, “I feel like I’m dying” isn’t an incredibly helpful way to explain a set of symptoms to your doctor. However, Dr. Foxx understands why patients default to this verbiage: B12 deficiency symptoms, as it turns out, are considered “non-specific,” meaning they’re quite subjective and not exactly measurable, he says. And many symptoms overlap with other conditions.
Symptoms—which can develop slowly over time or come on more quickly—may (or may not) include:
- Pale skin
- Heart palpitations
- Loss of appetite
- Weight loss
- Pain, inflammation, and/or soreness in the mouth or tongue
- Erectile dysfunction
- Tingling of the hands and feet
- Trouble balancing
- Confusion or memory issues
How do you test for a B12 deficiency?
If you’re experiencing the above symptoms, schedule an appointment with your doctor. They can order a blood test to measure your B12 levels. If it reveals that your total B12 level is lower than 200 picograms per milliliter (pg/mL), you may be diagnosed with B12 deficiency.
If your B12 levels are in the intermediate range, your doctor may order other tests that are more sensitive predictors of deficiency than your serum level of the vitamin.
- Methylmalonic acid (MMA). This test measures the amount of MMA in your blood. It tends to rise when your B12 level is low.
- Homocysteine. Homocysteine is an amino acid. If your levels are high, it’s a sign that your B12 levels are low.
- Intrinsic factor (IF). IF is a protein made in your stomach that helps your body absorb vitamin B12. If you have a condition called pernicious anemia, your stomach doesn’t make enough intrinsic factor.
Why a B12 Deficiency Can Make You Feel Like You’re Dying
If you have a vitamin B12 deficiency—a total vitamin B12 level under 220 pg/mL—the symptoms can come on slowly or quickly, and include headaches, weakness, depression, weight loss, fatigue, pain, inflammation, and more. The symptoms can be severe, and develop rapidly or over time.
What Causes Low Vitamin B12 Levels?
Your body doesn’t actually make B12; you need to get it from food or supplements. Certain circumstances can interfere with your ability to get enough of the vitamin:
1. You don’t get enough B12 from food
Found in animal products ranging from meat, poultry, eggs, and milk to clams and liver, plus fortified plant-based foods such as breakfast cereal, Vitamin B12 is available in many foods. However, since many of the sources are animal products, those who adhere to a strict vegetarian or vegan diet could come up short on the nutrient.
2. You have gut issues that hamper B12 absorption
While it’s true you need to consume vitamin B12 to benefit from it, the truth is that vitamin B12 deficiency often stems from difficulty absorbing the nutrients you eat due to conditions such as celiac disease, Crohn’s disease, thyroid disease, or gastric abnormalities.
3. You have pernicious anemia
This common autoimmune disease impacts the stomach’s ability to produce intrinsic factor (IF), the protein that helps your intestines absorb vitamin B12. If your body doesn’t make IF, you can eat endless amount of foods rich in B12 without absorbing a jot.
Undiagnosed (your doctor can tell whether you have it with a blood test), pernicious anemia can cause gut issues, heart problems, and overall weakness and fatigue.
4. You’re on a medication that limits B12 absorption
A wide range of common meds can mess with your body’s ability to absorb vitamin B12 including
- Antibiotics such as neomycin
- Diabetes medications such as metformin
- Gastric acid inhibitors such as the proton pump inhibitors omeprazole (Prilosec) and lansoprazole (Prevacid)
- Antihistamines and antacids such as cimetidine (Tagamet) and ranitidine (Zantac)
5. You’ve over 40
More birthdays can also set you up for a B12 shortage since absorption naturally declines as you age (3). It’s one reason why Foxx recommends supplementation for patients beginning at age 40.
How to Treat B12 Deficiency
The best treatment for a B12 deficiency depends in part on the cause.
Vitamin B12 injections
When absorption is the issue, the best way to get the vitamin B12 your body needs is via injections that bypass the gut. Subcutaneous (under the skin) or intramuscular injections are available via prescription.
In those who struggle with B12 absorption, a B12 nasal spray can also deliver large doses of the vitamin directly to your blood stream via your nose. This course of treatment is typically reserved for maintaining B12 levels after injections bring particularly low levels back to normal (2).
Daily vitamin B12 supplements can be swallowed or dissolved under the tongue.
Because gastric absorption rates are unpredictable compared to vitamin B12 injections, according to Foxx, most oral vitamin B12 supplements provide much more than the recommended amount to account for the discrepancy between the dose you take and benefit from (1). It could take longer for B12 levels to rise if you choose this approach over injections or nasal spray.
How to Prevent a B12 Deficiency
1. Eat more B12-rich foods.
- Animal food products. Liver, fatty fish like salmon, beef, eggs, and cheese are solid B12 sources.
- Fortified Foods. Some breakfast cereals, plant-based meats and nutritional yeast have added B12 and are good choices if you don’t eat meat.
2. Cut back on booze.
Knocking back too many cold ones too often can damage your gut, making it harder for your body to absorb B12.
3. Manage gut conditions
If you have celiac disease, Crohn’s, pernicious anemia, or any other condition that messes with your gut’s ability to absorb nutrients, follow your doctor’s orders about medications and diet changes.
What if You Feel Worse After Taking B12?
If you have a B12 deficiency, common sense dictates that supplementation should make you feel better. However, consuming particularly high doses of vitamin B12—that is, more than the recommended 2.4 micrograms per day—can cause side effects headaches, fatigue, weakness, and tingling in extremities to gastrointestinal symptoms such as diarrhea, nausea, and vomiting. (4)
The good news is that despite these symptoms, there’s no actual danger of toxicity since your body will only absorb what it needs, regardless of dosage.
Of course there’s also a chance that your body isn’t absorbing enough B12 to absolve the symptoms of deficiency. A blood test can confirm if absorption is an issue and help your doctor adjust your dose or treatment approach to ensure your B12 levels right themselves.
The Bottom Line