My dad took up car racing when he retired. About a year into it, I got a phone call that went like this: “Daughter, I need some health advice. When I’m pressing the accelerator on the turns I can’t feel the pedal very well, like my toes are numb. It’s going to lose me a race one of these days. My doctor tells me I’m just getting old. What can I do?”
After asking a few more questions, it sounded like a B vitamin deficiency to me. Today we’re going to focus on symptoms of low B12.
Symptoms of B12 deficiency are tricky, as they can be explained away by normal events of life or mimic more serious conditions. Someone might think their fatigue is from missing a good night’s sleep or that their memory difficulties such as recalling people’s names is “just what happens after a certain age.”
Problems with learning are excused as “being out of school too long.” Motivation can wane, tasks can pile up and even feelings of sadness can arise, leading folks to think they may be depressed or just not organized enough.
Numbness or tingling of the lips, hands and feet may come from B12 deficiency or from other conditions, such as diabetic neuropathy or other nerve conditions. Not to be taken lightly, but symptoms of B12 deficiency are also shortness of breath or inability to exercise. Newly appearing sallow or paler skin, or easy bruising and bleeding can also indicate low B12 as it serves, in part, to hold red blood cells together.
In the case of my dad, he began taking heartburn medication prescribed by his doctor a few years before his symptoms appeared. The proton pump inhibitors block stomach acid which help with heartburn symptoms, but also decrease absorption of B12. Eventually he became more tired, taking a nap each day and finally spoke up when he noticed numbness in his toes.
The average adult needs about 2.4 micrograms of B12 per day. Since we don’t make any B vitamins in our bodies, we must get it from food or supplementation. Here is where the problem lies. While many people don’t consume enough foods with B12 on a regular basis (remember, we don’t make it in our bodies so we must replenish it regularly), others don’t absorb the nutrient well enough to make it count. This is particularly true with older people or anyone who has had gastric or small intestine surgery.
Health care providers often check B12 levels in people with blood disorders, neurological conditions that cause numbness and tingling, some psychiatric abnormalities, gastric surgery, prolonged use of PPIs or H2receptor blockers and in people greater than 65 years old.
Strict vegan and vegetarians have a harder time getting B12 through their diet, but supplementation (sublingual, liquid or injection) can help improve B12 levels and thus reduce symptoms. Dairy, meat, eggs and poultry are all good sources of B12. Optimizing your stomach absorption with the guidance of your health care provider can help as well.
As with most symptoms, it takes broad clinical judgment to determine what the cause of your issue is. Here are a few of the other conditions that can cross over B12 deficiency symptoms: circulatory issues such as Raynaud’s Syndrome, neuropathies, heart disease, multiple sclerosis, chronic fatigue syndrome, folate deficiency, anemia (including pernicious), mania, depression or psychosis.
My dad no longer races stock cars. He took up flying airplanes instead. He started getting B12 injections and manages his heartburn, most of the time, with a better diet and his heart burn medication when needed. His doctor no longer mentions his advanced age.