A deficiency of vitamin B12 can sneak up on a person more easily than we think. It is considered a common nutritional deficiency with more than 3 million people developing it within the United States alone.

Vitamin B12 is required by the human body for many important functions. It is needed to make red blood cells, nerves, DNA, and to convert our food into fuel. Our blood cells are protected by sufficient vitamin B12 to prevent megaloblastic anemia, a condition that reduces the amount of oxygen the red blood cells carry throughout the body.

The recommended dietary allowance for B12 is 2.4 micrograms each day and generally most people are able to meet this requirement from their food choices.

There can be numerous reasons why a person may develop a deficiency to this B vitamin but unless you know what the signs of a deficiency of vitamin B12 are, you could be left in the dark risking serious issues to your health.

9 signs of a vitamin B12 deficiency

1. Feeling exhausted

Are you experiencing excessive tiredness, weakness or shortness of breath that is out of the norm for you? It could be traced back to a B12 deficiency. Megaloblastic anemia can develop if insufficient B12 is available. Without enough B12, the body will produce large, immature red blood cells that are unable to transport oxygen throughout the body. When cells don’t receive the oxygen they need, you will feel more tired than usual.

2. You’re a vegan

If you are going to embrace a vegan lifestyle you need to understand that vitamin B12 is only found in foods of animal origin – no plant-based foods contain it. Natural food sources of B12 include meat, eggs, poultry, fish, eggs, and milk products. Strict vegans who eliminate these foods are placing themselves at risk of a B12 deficiency.

Vegans need to make sure they are taking a B12 supplement and consuming foods fortified with B12 – some breakfast cereals, soymilk, and nutritional yeasts. Check the nutrition facts label looking for vitamin B12.

3. Medications for heartburn

People experiencing the uncomfortable burning feeling from heartburn will often medicate themselves with a prescription medication to reduce stomach acid brining relief. The problem though is vitamin B12 requires stomach acid to be absorbed. Here’s why – in our food, vitamin B12 is attached to a protein that must be removed in the stomach by gastric acid and an enzyme called pepsin. Once B12 is released, a binding protein attaches to it protecting it until it reaches the small intestine. In the small intestine, a substance called intrinsic factor takes B12 from the binding protein where it is absorbed into the bloodstream.

4. Tingling and numbness in hands and feet

One of the functions of vitamin B12 is to make myelin, the protective covering for nerves. If our nerves are not covered this exposes them to possible damage with one damage being shrinkage of the nerves. This shrinkage can cause a pins and needles feeling along with numbness. To rule out any other medical conditions, a person needs to see their doctor for a correct diagnosis.

5. Diabetes

Not all people with diabetes will automatically develop a vitamin B12 deficiency. But a 2016 study has shown that out of 283 type 2 diabetics prescribed a high dose of the diabetic medication Metformin, 33 percent had a vitamin B12 deficiency. Those with type 1 diabetes are also at risk as another study found that out of 90 individuals with type 1, 45 percent had deficiencies of vitamin B12.

6. Pale or yellowish skin

Having a vitamin B12 deficiency can reveal itself in how your skin color appears. This is because red blood cells that have become large and immature, are not able to carry necessary oxygen and that can bring a pale pallor to the skin.

A yellow hue to the skin can be due to jaundice which can be a symptom of a severe lack of vitamin B12. However, don’t assume that is what is causing jaundice as there can be other medical conditions such as liver cancer that can bring on this color. Always go to a doctor to look into the cause.

7. Depression

One function of vitamin B12 is to improve neurotransmitter production such as serotonin that keeps our brain and mood functioning properly. If serotonin has become deficient, this can cause depression. Insufficient B12 can result in reduced communication between nerves and the reduced serotonin is often due to there not being enough building blocks to make it and vitamin B12 is one of the building blocks.

8. Over the age of 50

Aging brings several changes with one of them being less stomach acid being produced by the body. Since stomach acid is necessary for vitamin B12 absorption, people over 50 are more at risk of becoming deficient in this nutrient. A discussion with their doctor whether they should take a supplement or not and foods containing B12 is important to avoid a B12 deficiency.

9. Being forgetful

Memory loss and even symptoms of dementia can be brought about by a B12 deficiency particularly in the elderly since vitamin B12 works with metabolic processes in the brain. As we age, we make less of intrinsic factor, the necessary compound needed to absorb vitamin B12.

Elderly individuals can avoid a B12 deficiency by eating good food sources and by possibly taking a B12 supplement. If an elderly person is showing signs of memory loss and forgetfulness, have their vitamin B12 status checked with a blood test to rule out a deficiency that could be causing this problem.