Vitamin B12 Deficiency: What Are the Risks?

Vitamin B12, or cobalamin, plays an indispensable role in our health. Our bodies require it to metabolise the nutrients we eat, create new cells, and ensure our brains stay healthy. If you have low vitamin B12 levels, you’re putting yourself at risk of suffering a variety of health problems.

Key Ideas

  • Vitamin B12 is an essential nutrient which helps create new cells, generate energy, and keep the brain and nerves functioning properly.
  • Low levels of vitamin B12 can make you predisposed to anaemia and neurological problems. Some experts also believe that B12 deficiency may lead to heart damage.
  • You can prevent cobalamin deficiency by eating animal products, vegan products enriched with B12, or relying on dietary supplements. For the latter, new liposomal supplements exist which leave traditional capsules far behind.

Vitamin B12 Deficiency: What You Need to Know

Symptoms of vitamin B12 deficiency may appear months or years after your reserves of the nutrient have been exhausted. Regardless, these symptoms are – in some cases – permanent. For this reason, the wisest strategy is to maintain high levels of cobalamin intake, whether through diet or by taking supplements.

girl doing yoga on a open field
Vitamin B12 is an essential nutrient which helps create new cells, generate energy, and keep the brain and nerves functioning properly. (Source: Yogpeeth: fljbxxgk/ Unsplash.com)

Could I Have Vitamin B12 Deficiency?

To keep our cobalamin reserves from falling below the recommended range, we need to get a sufficient daily intake (1, 2):

  • The NHS recommends approximately 1.5 micrograms (0.0015 milligrams) of vitamin B12 per day for adults aged 19 to 64.
  • The European Food Safety Agency (EFSA) places their recommended intake at 4 micrograms per day.

The further our intake strays from British and international recommendations, the more likely we are to eventually experience B12 deficiency. These requirements may also vary slightly according to your age and health; they will also vary if you’re pregnant. Ask your doctor if you have any uncertainty about your vitamin intake needs.

Who Is at Increased Risk for Vitamin B12 Deficiency (3, 4)?

Vegans

Vitamin B12 is found naturally in animal products. When you stop eating meat, eggs, and dairy, within a few months your B12 reserves lower and you may begin to experience symptoms.

Vegetarians

Those who eat dairy and eggs – but not meat – still have higher risk of B12 deficiency than an omnivore. To prevent vitamin deficits, vegetarians ought to be drinking at least four glasses of milk or eating at least four eggs per day. And that can become quite tedious!

healthy salad
Vitamin B12 is crucial for maintaining iron-clad health. (Source: Primeau: ftwfohtjnw/ Unsplash.com)

People with Unhealthy Diets

Some of us, whether through preference or sheer lack of time, have less-than-nutritious diets which include very few products high in B12. Plus, many weight loss diets forbid the foods which are highest in this vitamin, such as meat, for “high-calorie”. Don’t let yourself fall for that sort of “miracle diet”!

Seniors

As we grow older, our ability to absorb cobalamin diminishes. We also become more likely to suffer from various illnesses which affect our ability to acquire nutrients or lower our appetites.

People with Certain Illnesses

Certain illnesses and surgical procedures can affect our intestines’ ability to absorb nutrients. These include Crohn’s disease, atrophic gastritis, and bypass surgery to treat obesity. They may end up reducing our vitamin B12 levels.

People Who Take Daily Medication

Certain medications such as metformin (a drug used to control type 2 diabetes) and omeprazole (a treatment for stomach ulcers and heartburn) could interfere with how your body absorbs cobalamin, increasing your risk of deficiency.

If you belong to any of the groups we mentioned, we suggest you consult a doctor or nutritionist. They can advise you how to prevent vitamin B12 deficiency’s alarming consequences.

vitamin b12 capsules on a yellow background
Certain medications such as metformin and omeprazole could interfere with how your body absorbs cobalamin, increasing your risk of deficiency. (Source: Mathers: yy145j0ndoq/ Unsplash.com)

What Are the Symptoms of Vitamin B12 Deficiency?

When your vitamin B12 levels reach an unhealthy low, your cells lack enough “material” to divide themselves. They also cannot carry out their important functions and won’t even be able to keep your nervous system in good shape. As a result, you may experience a whole array of unwanted symptoms (5):

  • New blood cells cannot be created as normal, which leads to anaemia, pallid-looking skin, and fatigue.
  • Digestion suffers, with symptoms including diarrhoea, stomach pain, and loss of appetite.
  • Heart rate accelerates as a consequence of the anaemia, manifesting as tachycardia or heart palpitations.
  • Low mood, sadness, and irritability may be indicators that the vitamin B12 deficiency is affecting the brain.
  • Memory and concentration problems may also occur, because our neurons need cobalamin to function properly.
  • Loss of balance may result, and you may even feel tingling or numbness in your extremities. B12 deficiency wreaks havoc on the nerves!

If you are experiencing any of these symptoms and you believe you may have low vitamin B12 levels, don’t hesitate to visit a doctor as soon as possible!

How Is Vitamin B12 Deficiency Diagnosed?

If you’re looking to detect a B12 deficiency, do not wait until symptoms start to appear. Generally, anaemia and nervous system issues manifest after having lived with insufficient vitamin B12 levels for months and months. And once the deficiency reaches the point of affecting the brain, the symptoms that appear may be permanent and incurable.

For these reasons, we suggest that if you belong to a risk group for low vitamin B12 (vegans, vegetarians, the chronically ill and older adults, among other groups) you visit your usual doctor. A blood test (as well as other, more complex lab techniques, if necessary) will help you detect vitamin deficits ahead of time (6).

stethoscope on doctor's desk
Ask your doctor if you have any uncertainty about your vitamin intake needs. (Source: Oxford: 8u_2imjavqs/ Unsplash.com)

How Is Vitamin B12 Deficiency Treated?

If your vitamin B12 deficiency is severe and you’ve already experienced symptoms, rely on your doctor’s help to treat the problem. Your local clinic may prescribe supplements or even injections of a vitamin B12 “mega-dose” – 1,000 or more micrograms (7).

Anaemia and fatigue should desist after a few weeks. Unfortunately, neurological issues may take more time to resolve and could become chronic and permanent.

For this reason, the best strategy to treat low vitamin B12 levels is prevention: keeping our reserves from shrinking in the first place. We can meet that goal by following a healthy diet which includes animal products rich in vitamin B12, especially (8):

  • Clams (99 micrograms of vitamin B12 in every 100 grams)
  • Beef liver (80 micrograms in every 100 grams)
  • Mussels (24 micrograms in every 100 grams)
  • Pork (19 micrograms in every 100 grams)
  • Sardines (9 micrograms in every 100 grams)
  • Eggs (approximately 0.5 micrograms per egg)

If you are vegan or cannot include enough animal products in your diet, you could rely on foods artificially fortified with this nutrient, such as vegetable-based beverages like soy milk. However, the ideal option for consumers is – without a doubt – using vitamin B12 supplements.


What Supplements Should I Take?

If your diet does not provide the cobalamin you need from day to day, don’t wait until your nutrient reserves get low. You can stay ahead of vitamin B12 deficiency by taking supplements of this essential molecule. It’s another way to meet your daily nutrient needs.

Oral supplements are effective products which can be used in place of injections (7). However, we recommend you always run your usage of these products by your usual doctor. This is especially true if it’s your first time using them.

Traditional Vitamin B12 Supplements

The classic vitamin B12 supplements are capsules and tablets which can be taken daily or weekly. They’re often sold in chewable form, since their absorption increases when they stay in the mouth for a few minutes before being fully ingested. If used responsibly, you won’t need to worry about vitamin B12 deficiency any longer.

Products with moderate B12 doses (10-500 micrograms) are taken daily, while more potent versions (1,000-2,000 micrograms) tend to be taken once or twice a week.

Vitamin B12 Liposomal Supplements (Liquid)

Some of you out there hate swallowing pills, or don’t have the time to spend a few minutes slowly chewing chewable tablets. If you’re one of these people, you may want to opt for a liquid supplement. Plus, formulas with liposomes “envelop” the vitamin B12 molecules in organic substances similar to our own cell membranes to achieve a higher degree of absorption.

Try mixing your daily dose into water or juice. You’ll say goodbye both to pills and to low vitamin levels – two for the price of one!

Vitamin B12 Liposomal Supplements (Nasal Spray)

It may sound odd, but it’s true: liposomal B12 can be administered the same way allergy sprays are. The nasal spray form lets you take supplements in a matter of seconds. It will help raise your vitamin B12 levels without causing irritation or inconvenience (9).

There’s no need for capsules, pills, or liquids when you use this product, so it’s a fabulous option for people on the go. Pack it when you travel and stop B12 deficiency in its tracks!


Our Conclusions

Vitamin B12 is crucial for maintaining iron-clad health. Low levels can lead to a variety of physical and mental issues, including anaemia and memory problems. As such, both vegans and omnivores (but especially vegans) are advised to pay close attention to their B12 levels.

To meet your daily vitamin B12 needs, you can eat meat and dairy, rely on fortified vegan foods, or take dietary supplements. And if you’re not a fan of taking pills, remember that you can always opt for liposomal supplements in liquid or spray form. With all these options at your disposal, there’s no excuse for vitamin B12 deficiency!

Are you vegan, vegetarian, or a meat-eater? Does the possibility of vitamin B12 deficiency worry you? What’s your opinion of vitamin B12 supplements with liposomes? Feel free to tell us about your experiences, and don’t forget to share this article!

References(9)

  1. Calleja CA, Cámara M, Daschner Á, Fernández P, Franco CM, Giner R, et al. Informe del Comité Científico de la Agencia Española de Seguridad Alimentaria y Nutrición (AESAN) sobre Ingestas Nutricionales de Referencia para la población española. In Cambridge: Cambridge University Press; 2019. p. 1–30. Available at:
  2. Scientific Opinion on establishing Food‐Based Dietary Guidelines. EFSA J. 2016 May 23;8(3).
  3. Guía de Suplementos. Todo sobre la falta de vitamina B12. Available at:
  4. Ankar A, Bhimji SS. Vitamin B12 Deficiency (Cobalamin) . StatPearls. StatPearls Publishing; 2018. Available at:
  5. O’Leary F, Samman S. Vitamin B12 in Health and Disease. Nutrients . 2010 Mar 5;2(3):299–316. Available at:
  6. Rizzo G, Laganà AS, Rapisarda AMC, La Ferrera GMG, Buscema M, Rossetti P, et al. Vitamin B12 among vegetarians: Status, assessment and supplementation . Vol. 8, Nutrients. MDPI AG; 2016. p. 767. Available at:
  7. Mariño Suárez JE, Monedero Recuero I, Peláez Laguno C. Deficiencia de vitamina B12 y tratamiento por vía oral. Una opción tan eficaz como (todavía) poco utilizada. Atención Primaria. 2003;32(6):382–7. Available at:
  8. FoodData Central. Available at:
  9. Van Asselt DZB, Merkus FWHM, Russel FGM, Hoefnagels WHL. Nasal absorption of hydroxocobalamin in healthy elderly adults. Br J Clin Pharmacol . 1998;45(1):83–6. Available at:
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OFFICIAL DOCUMENT
Calleja CA, Cámara M, Daschner Á, Fernández P, Franco CM, Giner R, et al. Informe del Comité Científico de la Agencia Española de Seguridad Alimentaria y Nutrición (AESAN) sobre Ingestas Nutricionales de Referencia para la población española. In Cambridge: Cambridge University Press; 2019. p. 1–30. Available at:
Go to source
OFFICIAL DOCUMENT
Scientific Opinion on establishing Food‐Based Dietary Guidelines. EFSA J. 2016 May 23;8(3).
SUPPLEMENT GUIDE
Guía de Suplementos. Todo sobre la falta de vitamina B12. Available at:
Go to source
E-BOOK
Ankar A, Bhimji SS. Vitamin B12 Deficiency (Cobalamin) . StatPearls. StatPearls Publishing; 2018. Available at:
Go to source
SCIENTIFIC ARTICLE
O’Leary F, Samman S. Vitamin B12 in Health and Disease. Nutrients . 2010 Mar 5;2(3):299–316. Available at:
Go to source
SCIENTIFIC ARTICLE
Rizzo G, Laganà AS, Rapisarda AMC, La Ferrera GMG, Buscema M, Rossetti P, et al. Vitamin B12 among vegetarians: Status, assessment and supplementation . Vol. 8, Nutrients. MDPI AG; 2016. p. 767. Available at:
Go to source
SCIENTIFIC ARTICLE
Mariño Suárez JE, Monedero Recuero I, Peláez Laguno C. Deficiencia de vitamina B12 y tratamiento por vía oral. Una opción tan eficaz como (todavía) poco utilizada. Atención Primaria. 2003;32(6):382–7. Available at:
Go to source
OFFICIAL USDA WEBSITE
FoodData Central. Available at:
Go to source
SCIENTIFIC ARTICLE
Van Asselt DZB, Merkus FWHM, Russel FGM, Hoefnagels WHL. Nasal absorption of hydroxocobalamin in healthy elderly adults. Br J Clin Pharmacol . 1998;45(1):83–6. Available at:
Go to source