Symptoms of B12 deficiency – B12 institute (2024)

Introduction

Vitamin B12 deficiency in its early stages is asymptomatic. Afterwards macrocytic anaemia and/or a typical (neuro) psychiatric symptom pattern may arise (Carmel, 2000; Lindenbaum et al., 1988). Hence, the nature and severity of the symptoms are very diverse (Heil et al., 2012).

Diagnosing B12 deficiency is quite a challenge, since very often there is the (unjustified) assumption that anaemia is a required criteria for the diagnosis. A number of studies have shown, however, that neurological symptomology may be more severe among patients without anaemia (Healton et al., 1991).

There is a danger that the diagnosis – and thus B12 deficiency treatment – will be delayed, which may have a large impact on the patient. Consequently, rapid diagnosis and treatment are very important. There is a chance that a lot of people may have chronic symptoms, considering the severity of the disease (Hunt et al., 2014).

All symptoms listed below may occur. Sometimes one of the symptoms is clearly manifest, sometimes there are multiple, more or less severe, symptoms. Patients have told us that their condition has been gradually deteriorating over the years. As early as 1901 this was reported (Hunt et al., 2014), when nobody yet knew which illness they were dealing with.

General symptoms

Exhaustion (strange ‘drained’feeling), general unwellness
dizziness (alsof in upright position), fainting
headache, migraine
loss of hair, prematurely turning gray
brittle nails
increased susceptibility to infection (urinary system, sinuses)
shortness of breath or COPD-like phenomena (especially upon exertion), fast high intake of breath
hoarseness, signs of paralysis in vocal cords (seldom)
muscle weakness and pains
increased pulse (tachycardia)
palour
tinnitus
sensitiveness to cold (especially of hands and feet)
feverish symptoms, feelings of coming down with the flu
misunderstood fever

Neurological symptoms

Central nervous system

Neuropsychiatry (from the brain)

cognitive decline
- memory (especially short term memory)
- concentration problems
- problems in finding the proper words (aphasia)
- desorientation
(mild to severe) depression, moodswings, suicidal tendencies, lability (weeping a lot), quickly irritated, outbursts of anger
anxiety, delirium, delusions, paranoia, manic behaviour, hallucinations, psychosis, catatonia, bipolar disorder, obsessive-compulsive personality disorder
altered mental condition, personality changes, sense of alienation, brainfog
dementia (prefrontal cortex), Alzheimer-like symptoms

Neurological (from the spinal cord, a.o. subacute combined degeneration of the spinal cord)

tingling in hands and feet
disturbed perception of the skin, numbness of the skin (paresthesia)
spastic and instability of gait (ataxia), (e.g. coordination of walking movement, people may knock objects from tables, walk into doorposts; clumsiness)
muscle weakness arms and legs (collapsing)
symptoms of paralysis
spasticity
abnormal reflexes
- positive Romberg test
- positive signs of Lhermitte
- Babinski’s reflex
Parkinson-like symptoms
unvoluntary movements

Peripheral nervous system

Somatic nervous system (perception senses from the eyes, ears, skin (tactile) and sense of smell )

tingling hands and feet
numbness of hands and feet (feeling as if they are ‘asleep’)
muscle tremors on the skin (e.g. eyelid)
reduced capability to perceive the body position in a room
blurred vison (focus decreases), optic atrophia
infection and degeneration optic nerve
hearing problems, distortion, tinnitus
reduced sense of smell, taste, touch

Autonomous nervous system