Vitamin deficiencies often go unnoticed until they begin to affect daily life. One such common but under-recognised issue is Vitamin B12 deficiency, a condition that can quietly impact the blood, brain, and nerves.
How common is vitamin B12 deficiency in India, and why?
Vitamin B12 deficiency is very common in India, with studies suggesting that 40–70 per cent of people may have low levels.
Why is the prevalence so high?
A large proportion of Indians follow vegetarian diets (plant-based diets have zero vitamin B12). Indians consume limited amounts of animal-based foods, which are the primary sources of vitamin B12. Some suffer from the deficiency due to poor absorption (due to stomach or intestinal issues).
Finally, long-term use of certain medications like acid suppressants (such as proton pump inhibitors) or anti-diabetic drugs (metformin) can increase the risk of vitamin B12 deficiency.
What are the common symptoms?
B12 deficiency can affect multiple systems:
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Neurological symptoms
• Tingling or numbness in hands and feet
• Burning sensation in feet
• Difficulty walking or imbalance
• Memory problems or confusion
• Mood changes, depression
Hematological symptoms
• Fatigue and weakness
• Pale skin
• Shortness of breath
• Enlarged red blood cells (a type of anemia)
Important: Sometimes nerve symptoms appear even without anemia, making it easy to miss.
Skin clues you should not ignore
Certain skin changes can hint at B12 deficiency:
• Darkening of skin, especially over knuckles
• Hyperpigmentation on palms or soles
• Mouth ulcers
• Glossitis (a smooth, red, painful tongue)
These are often subtle but can be early warning signs.
Who is at higher risk of developing vitamin B12 deficiency?
• Strict vegetarians or vegans
• Elderly individuals
• People with gastrointestinal disorders
• Those on long-term medications like metformin or anti-acidity medications
Why do non-vegetarians also develop Vitamin B12 deficiency?
This surprises many. Even people who eat meat can develop B12 deficiency due to poor absorption (e.g., gastritis, low stomach acid, presence of certain antibodies that interfere with vitamin B12 absorption), intestinal problems affecting absorption, chronic illnesses and use of certain medications as mentioned above. So, diet alone does not guarantee adequate B12 levels.
How much vitamin B12 do we need?
The daily requirement is small: Adults need about 2–2.5 micrograms per day. Good dietary sources of vitamin B12 include milk and dairy products, eggs, fish and meat and fortified cereals. Vegetarian sources are limited, hence the higher risk of developing vitamin B12 deficiency.
How is vitamin B12 deficiency diagnosed?
Diagnosis is simple. A blood test for serum B12 levels is usually enough. Additional tests (if needed) include complete blood count, homocysteine or methylmalonic acid (in doubtful cases).
How is vitamin B12 deficiency treated?
Treatment is simple and highly effective. Oral vitamin B12 supplements (tablets) are used in mild cases. Vitamin B12 injections are prescribed in moderate to severe cases or if absorption is poor. Treatment usually continues for a few weeks to months, depending on severity.
What is the outcome after treatment?
The good news is that most patients improve significantly. Fatigue improves within weeks. Blood parameters normalise sooner; however, neurological symptoms may take longer to improve.
It should be noted, however, that long-standing nerve damage may not fully reverse if treatment is delayed. Early diagnosis, therefore, is crucial.
Should you take vitamin B12 supplements without testing?
This is a common question. Vitamin B12 is generally safe, and excess is usually excreted. However, routine supplementation without testing is not always necessary. This is because it may mask underlying problems. Moreover, unnecessary long-term use adds cost without benefit. The best approach is to test if symptoms or risk factors are present. Supplementation should be based on medical advice.
Vitamin B12 deficiency is common, often missed, but it is easily treatable. If you experience unexplained fatigue, tingling, memory issues, or skin changes, don’t ignore them. Sometimes, a small vitamin deficiency can mimic a major neurological disease, but with timely treatment, it can be completely reversed.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.