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B12 Vitamin Deficiency? Get Smartified

B12 deficiency and catching this common condition early is key to stopping damage and problems. Vitamin B12 keeps our blood and nervous systems healthy and is vital for manufacturing DNA. Most of us get enough from our diet; our stomach acid detaches it from proteins that stop us absorbing it, so it can reattach to intrinsic factor, a protein produced by the stomach. It then travels to the end of the small bowel, where it’s absorbed into the bloodstream for use by bone marrow and other cells.

Healthy adults need around 1.5mcg B12 daily, but we can store up to 3mg, so if we’re not absorbing enough, it takes over two years for anaemia to develop.

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Who gets B12 deficiency?

The commonest cause is pernicious anaemia (PA), an immune-system disorder that produces stomach inflammation, drying up the acid and stopping intrinsic factor production. It usually starts in late middle-age and affects around 50 people per million- one in 10 of us after the age of 75.

Other causes include dietary deficiency (more common in vegans), surgery to remove part of the stomach or small bowel, Crohn’s disease (bowel inflammation) and malabsorption (due to coeliac disease/gluten sensitivity). It’s also linked to some medicines, including colchicine, neomycin, metformin, anti-epilepsy drugs and possibly PPIs, such as lansoprazole. These conditions may also trigger deficiency of folic acid, another B vitamin essential for blood formation.


These develop slowly as you gradually run down your body stores. Anaemia can make you look pale/yellowish and feel weak, tired, breathless or faint. If severe, it can lead to palpitations, chest pain and heart failure. You may develop mouth ulcers and a smooth, red and sore/burning tongue.

Neurological symptoms include tingling/numbness and later, weakness or vision disturbance; you may notice irritability, thinking/memory problems, depression or even confusion and dementia. People with severe, untreated pernicious anaemia (PA), can lose the use of and feeling in their legs.

Early, symptomless B12 deficiency is often detected accidently by blood tests that have been performed for other reasons. If it’s detected in you, you’ll need more tests to confirm the diagnosis and rule out other conditions and may also need to be referred to a stomach/bowel or blood specialist.


B12 deficiency linked to diet can be cured by eating more meat, poultry and fish (especially beef, liver and clams), dairy foods (eggs, milk, cheese), fortified breakfast cereals, soya milk and yeast extracts (read the label).

Vitamin B12 tablets can help if you can’t manage this, but don’t take folic acid supplements until your B12 is treated, as this could trigger sudden spinal cord damage.

If you can’t absorb B12, you’ll need injections, usually given as five ‘loading’ doses over a couple of weeks. The bone marrow takes these up rapidly, so blood transfusions are rarely needed. Once levels are normal, you’ll need three-monthly ‘top-ups’ for the rest of your life.

6 Tests You May Need

1. Blood count. Both B12 and folic acid deficiency produce anaemia with overly large red blood cells (megaloblastic anaemia).

2. Blood tests that measure your B12 and folic acid levels. These can be falsely ‘normal’ or affected by pregnancy, the oral contraceptive pill and other medical conditions.

3. Blood test for intrinsic-factor autoantibodies and for other linked autoimmune disorders, such as diabetes and underactive thyroid.

4. Bone-marrow biopsy. A small sample taken using a fine needle and local anaesthetic to look for other causes  of megaloblastic anaemia.

5. Ultrasound/CT or MR scans of your liver, spleen, heart or other organs.

6. Endoscopies (telescope examinations) and other checks on your stomach or bowel.

E259 – Vitamin B12 Deficiency and Diabetes –

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