Learn to recognize peculiar symptoms that are possibly indicative of even borderline B12 deficiency. Learn what to do about it.
If you have any unusual undiagnosed symptoms, perhaps you should consider whether you have a vitamin B12 deficiency. Chances are you don't, but many people do.
Could my symptoms be caused by B12 deficiency even if my blood tests have shown a normal range?
Possibly. A blood test may reveal that your B12 level is in or near the normal range. However, it may be just below or in the lower end of that range, otherwise sometimes known as borderline, or near borderline.
If I have B12 deficiency, wouldn't my doctor have diagnosed it already?
Not necessarily. B12 deficiency is sometimes overlooked by the medical profession even when you've had a blood test (actually two different tests are required to nail the deficiency down to B12).
Borderline B12 deficiency can sometimes cause symptoms so dramatic that B12 deficiency may be rejected as a possible cause because it may be thought that such symptoms wouldn't be caused by a mere borderline deficiency. B12 deficiency sometimes goes undiagnosed until the symptoms become moderate to severe, although this is not necessarily the fault of the medical profession. The symptoms often come on so slowly that a B12-deficient individual may become accustomed to them and not complain until the symptoms become severe.
Is there an alternative to taking B12 shots for deficiency?
Yes, if the deficiency is stabilized and not too severe. There are now available sublingual tablets, which will be discussed at the end of this article.
What are some of the symptoms of B12 deficiency?
First, bear in mind that each of these symptoms can be caused by something else, often something serious. It is probably safe to say that if you have a wide range of these symptoms, the cause is much more likely to be B12 deficiency than if you have a just a couple of similar symptoms. If you have any of these symptoms, you might actually consider yourself fortunate if the cause turns out to be B12 deficiency because it is easily treatable, at least if not so far advanced that it has done permanent damage.
An effort was made to put the following symptoms more or less in order, beginning with those perhaps most likely to be indicative of B12 deficiency.
1. Itchy or tingling tongue. The tongue suddenly itches from time to time without warning. This occurs on the edge of the tongue, along one side or the other or at the tip. There is an irresistible urge to scratch the tongue on the teeth to stop the itching. Some individuals experience stinging, pain, or tingling instead of itching.
2. White spots in the skin, resulting from melatonin becoming absent in the area. These often occur on the outside of the forearm, but may occur in other places. The longer these spots are there, the whiter they get. As time goes by, the spots become very dry and flaky to the extent that small raw spots of skin may be exposed.
3. Sharp stabbing, tingling pain in the palm of one or both hands. This occurs suddenly and for no apparent reason in a spot directly below the ring finger, approximately where the first palm crease is. If B12 deficiency is not treated, a tingling pain may begin to occur along the outside edge of the hand, starting from the wrist. This pain occurs when the wrist is flexed backward.
4. Sores at the corners of the mouth, sometimes extending along the edge of the lip. These are raw spots, not blisters, and they tend to come and go.
5. Nerve shock in the side of the body. It can be felt coming on a few seconds before it hits, and then it hits almost like a mild but deep electric shock and quickly subsides. It can occur at the side of either hip or on either side of the upper body, along the ribs. Worse yet, it can occur consecutively in at least two or three locations, one right after the other.
6. Shortness of breath, but without chest pain. This can occur when walking just a few yards.
7. Eye twitch, usually in one eye or the other. It can occur on the eyelid or just below the eye. This is not usually painful, just annoying.
8. Facial pain, usually on only one side of the face at a time. This pain varies so much that it would be difficult to describe all the possibilities. It can be a dull pain in the cheek bone right underneath an eye. It can also be a sharp shooting pain across the forehead, sometimes coming downward from the scalp to the edge of the nose by the eye. This pain can be excruciating but is usually fleeting.
9. Tingling along the back of one or both thighs, staring at the hips and shooting downward. This starts out as more an annoyance than pain, but can develop into pain if not treated.
10. Memory loss and/or disorientation. For borderline deficiency, these should be mild if they occur at all. They can be severe with extreme deficiency.
11. Migraine headaches. These may be preceded by a temporary blind spot in the center of the field of vision, usually lasting about ten minutes, and sometimes followed by facial pain under the eyes. After the blind spot vanishes, there may be zigzag streaks through the vision that may last up to hours. Even in the same person, there may be extreme variations in the headaches themselves. They may be quite severe with nausea or they may be virtually nonexistent. How can it be a migraine if there's virtually no pain? Doctors say it's a migraine if the described visual problems occur, whether there is significant pain or not.
(Migraines of most individuals have causes other than B12 deficiency, but migraines of certain individuals diminish or stop completely after they are treated for B12 deficiency.)
12. General feeling of fatigue. Although listed last, this may be the most common symptom, but it is also a symptom of many, many other ailments.
Are there any other possible symptoms?
This list is certainly not all-inclusive. There are other possible symptoms deliberately omitted here because they're relatively rare and/or debatable as to the actual cause. The symptoms listed here are for a borderline to mild deficiency. Extreme B12 deficiency can cause very extreme symptoms, including mental dullness, coma, and even death.
If I have some of these symptoms what should I do about it?
First of all, discuss your symptoms with your physician or other health care provider if you haven't already. Don't try to make your own diagnosis because you may have an entirely different problem that needs to be treated. If no satisfactory diagnosis is reached, you may want to broach the subject of a possible B12 deficiency with your doctor. If you've been given blood tests, find out whether your B12 level is near borderline or lower. Bear in mind, that even a near borderline B12 level can cause symptoms.
Keep in mind that even if you have another long term physical problem, if you acquire new symptoms they may be caused by a new problem. In other words, if you have another ailment, actual symptoms of B12 deficiency might erroneously be blamed on that other ailment.
What could cause me to be B12 deficient?
There are several possible reasons. If you're in your fifties or older your stomach may have lost its ability to process B12 from the food you eat. This could also happen at a younger age, but it is not likely unless you have a genetic defect. In either case, a needed protein called gastric intrinsic factor would be lacking in the stomach. In this situation, a dangerous condition called pernicious anemia can develop if B12 deficiency is not treated.
Another possible reason for B12 deficiency is that you simply may not be eating enough meat or animal products, or not any if you're a vegetarian. If this is the case, you must take B12 supplements or injections.
There is an additional less widely known reason for B12 deficiency for those who have multiple sclerosis (or MS). MS causes nerve myelin to be destroyed and B12 is used in the manufacture of myelin as the body struggles to replace the lost myelin. MS can contribute toward B12 deficiency if the body uses up B12 in manufacturing myelin.
If I'm found to be deficient in vitamin B12, what should I do about it?
Your doctor will probably prescribe a series of B12 injections, likely starting daily, then going to weekly and then monthly. You may be told that you'll have to take B12 shots regularly for the rest of your life. B12 tablets exist, but they don't help all who are B12 deficient. If your stomach little or no ability to process B12 from food, then it won't be able to process B12 from swallowed tablets either.
If I start receiving B12 injections for deficiency, how soon can I see an improvement?
You may feel a difference in as little as 12 hours. If you start out with daily shots, your milder symptoms may disappear completely within a few days. Some may take a few months or longer to completely clear up, especially white spots. On the other hand, some symptoms, such as nerve shock or eye twitch, may quickly vanish temporarily but then try to emerge again at times. Extra B12 taken when this happens may eliminate the emerging symptoms.
Is there a way I can avoid taking B12 shots for the rest of my life?
There is now available a sublingual B12 tablet, or nugget, with as high as 5000 mcg of B12. You hold these under your tongue or in the side of your mouth until they dissolve and are absorbed into your bloodstream. As they dissolve, they turn into a pleasant-tasting bright red liquid (cobalamin) which looks the same as the B12 used in injections. In a study, these nuggets have been shown to be effective in some people in overcoming B12 deficiency and maintaining a sufficient level of B12 in the body.
Anecdotal evidence suggests that if taken daily, sublingual nuggets can maintain a constant level of B12 in the body and constantly hold off symptoms, whereas with B12 injections, the symptoms sometimes creep back between injections. Periodic injections keep some people on a rollercoaster but nuggets, when taken daily, tend to create a steady condition of B12 adequacy.
You should consult your doctor before taking B12 nuggets, especially substituting them for B12 injections. There may be a reason why you should not in your particular case. Another possibility is that you may be given injections until you recover from your deficiency and then permitted to take nuggets to maintain a normal B12 level. Your doctor may or may not recommend that you take certain other oral supplements along with B12 nuggets. This is one reason why you should ask your doctor before switching from shots to nuggets.
Where can I get B12 sublingual nuggets?
They are available on the internet, but still very difficult to find in stores, especially outside of metropolitan areas. Even in metropolitan areas, they don't seem to be widely distributed.
Are B12 nuggets more expensive than shots?
At the usual dosage of one nugget per day, they are generally much less expensive then one injection per month given in a clinic.
Should I worry about taking too much B12?
Apparently not. Unlike certain other vitamins, B12 reportedly has no known side effects even when taken in large quantities. It is water soluble and doesn't accumulate in the body over a long period of time.
Note: This article is intended as general information which may or may not be pertinent to a particular individual. It is accurate to the best of this writer's knowledge, based on experience and research. It is not medical advice. It is strongly recommended that you consult your physician for medical advice if you suspect you may have B12 deficiency.