Symptoms of Vitamin B12 Deficiency

The initial symptoms of vitamin B12 deficiency are insidious and could easily be overlooked. The classical symptoms of anaemia are by no means obligatory. Early symptoms/findings of anaemia may also be masked by excess folic acid, or concurrent iron deficiency. Diffuse neuropsychiatric symptoms may often be the earliest symptoms.

The commonest neurological symptoms in vitamin B12-deficiency are paraesthesia of the hands and feet, diminished perception of vibration and position, absence of reflexes, and unsteady gait and balance (ataxia), but the range of symptoms is broad.

The psychiatric symptoms associated with vitamin B12 deficiency are also varied and fall into several different clinical categories. Confusion and memory disturbances are the most common. Depression, with or without psychotic components, and cognitive decline are frequent. Swings in mood and personality changes may be early signs of what may later be manifested as psychiatric disease. Such vague symptoms of vitamin B12deficiency are easily overlooked, especially as the serum concentration of vitamin B12can lie within the reference range.

Many disorders in the gastrointestinal tract can give rise to a deficiency of vitamin B12. Symptoms from the gastrointestinal tract, more or less pronounced, may be present, as well as poor mucosal function with subsequent specific symptoms such as glossitis.

Elderly persons are especially at risk of developing a vitamin B12 deficiency. Age-related, often asymptomatic atrophic gastritis is common and may be enough to cause a patient to slide slowly into a negative vitamin B12 balance with depleted stores of the vitamin, giving rise to vitamin B12 deficiency.

Infants of vegetarian/vegan mothers are also in danger of developing vitamin B12deficiency, even though their mothers may not suffer from disorders of B12 absorption and do not show any deficiency symptoms. This is due to the relatively high requirement in the rapidly growing child.

Vitamin B12-deficiency concomitant with auto-immune diseases other than perniciousanaemia is often seen (eg. thyroid disease).

At risk groups

Patients at risk for B12 deficiency should raise the index of suspicion. These include the elderly, vegetarians and vegans, patients with intestinal disease and after surgery to stomach. Other groups include those with autoimmune thyroid disorders, hypothyroidism, patients on long term therapy with protein pump inhibitors and histamine receptor antagonists (particularly the elderly) and patients using biguanidesfor glycemic control.

Symptoms/conditions where vitamin B12 deficiency could be suspected

  1. Numbness in hands and feetNeurological Symptoms
    • Ataxia
    • Impaired reflexes
    • Gait disturbances
    • Impaired vibration perception
    • Positive Romberg’s test
    • Babinsky’s sign
    • Lhermitte’s sign
    • Optic atrophy
  2. Pyschiatric Symptoms
    • Concentration difficulties
    • Confusion
    • Irritation
    • Impaired memory
    • Dementia
    • Irritability
    • Depression
    • Personality changes
    • Psychosis
  3. Chronic fatigue syndrome/fibromyalgia
  4. Symptoms of anaemia:
    • Tiredness
    • Apathy
    • Effort dyspnoea
  5. Other symptoms
    • Aversion to meat
    • Impotence
    • Faecal/urinary incontinence
    • Infertility
  6. Patients compaining of:
    • Vertigo
    • Asthenia
    • Loss of appetite
    • Loss of weight
    • Impaired memory
  7. After resection of the stomach or ileum
  8. Gastrointestinal disease:
    • Atrophy of the mucosa
    • Gluten-induced enteropathy
    • Crohn´s disease
  9. After resection of the stomach or ileum
  10. Gastrointestinal disease:
  11. Inadequate nutrition
  12. Smoking
  13. High alcohol consumption
  14. Vegans/vegetarians
  15. Autoimmune diseases:
    • Diabetes
    • Rheumatoid arthritis
    • Hypothyroidism
  16. Previous pregnancy complications
  17. Anaesthesia with nitrous oxide
  18. Medication with drugs affecting B12
  19. Vitiligo
  20. Hair loss
  21. Marfanoid appearance
  22. Adverse reactions to anaesthesia / surgery