Low vitamin B12 symptoms: How to recognise the signs and when to get tested

Naturopathic doctor Janine Bowring recently discussed three facial signs that could indicate vitamin B12 deficiency: numbness, small red patches and dark spots or pigmentation. In a video, she also suggested improving gut health and getting natural sunlight exposure to address the problem. However, can these facial changes reliably indicate low vitamin B12 levels, and is there scientific evidence that sunlight or probiotics can correct the deficiency?

Vitamin B12 is essential for red blood cell formation, nerve function and DNA synthesis. A deficiency can develop gradually, sometimes causing symptoms that are easy to overlook. However, skin changes alone cannot confirm low B12 levels.

Dr Honey Savla, Consultant Internal Medicine, Wockhardt Hospitals, Mumbai Central, explains which symptoms may be associated with the deficiency, what other conditions can cause similar changes and when medical evaluation is necessary.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.

Can vitamin B12 deficiency cause facial numbness, red patches and pigmentation?

“Vitamin B12 deficiency occasionally leads to alterations in the skin and oral tissues, but these symptoms are not specific to B12 deficiency. In certain cases, individuals develop darker areas of pigmentation, especially on the hands and feet, whereas in others, the tongue may become smooth, sore or red,” says Dr Savla.

Facial numbness or tingling can occur when the deficiency affects the nervous system, although it is less common. Small red patches on the face, meanwhile, are not an established standalone indicator of low B12 levels.

“Numbness or a tingling sensation in the face is less frequent and could point to nerve involvement. It is not advisable to use these symptoms alone to diagnose a deficiency. If such changes continue, it is important to investigate the underlying cause rather than simply assume that the B12 level is low,” she adds.

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Therefore, while unusual pigmentation or nerve-related symptoms may warrant attention, they should not automatically be attributed to vitamin B12 deficiency. Persistent or unexplained changes need proper medical assessment.

What other symptoms can indicate low vitamin B12 levels?

According to Dr Savla, common symptoms include:

* Persistent fatigue and weakness: A person may feel unusually tired or lack energy even after adequate rest.
* Pale skin and breathlessness: A deficiency can contribute to anaemia, which may cause paleness, dizziness and shortness of breath.
* Numbness or tingling: Nerve involvement can cause unusual sensations in the hands and feet.
* Memory and concentration difficulties: Some people may experience problems with concentration or memory.
* Balance and walking difficulties: In more serious cases, nerve damage can affect coordination and the way a person walks.

These symptoms may develop slowly, making them easy to dismiss as signs of stress, ageing or a busy routine.

Dr Savla also cautions that it can be difficult to distinguish B12-related skin changes from those caused by other conditions simply by looking at them.

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“Iron deficiency too can result in fatigue and paleness, and folate deficiency may cause similar blood-related symptoms. Pigmentation can be brought about by skin disorders, hormonal changes and other medical conditions as well,” she explains.

Who is at risk of vitamin B12 deficiency?

“Individuals on vegetarian or vegan diets may be at a higher risk if they do not eat sufficient amounts of B12-fortified foods or take supplements. Older people and those who have conditions that affect nutrient absorption, or who are taking certain medications, may also be susceptible,” says Dr Savla.

A deficiency can also occur even when a person consumes B12-rich foods if an underlying condition affects absorption. This is why dietary intake alone may not explain every case.

When should you get your vitamin B12 levels tested?

“It may be suggested to carry out a full blood count and a serum B12 test, with further tests if the results are not clear. Early diagnosis, together with appropriate treatment, can help avoid complications,” says Dr Savla.

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The course of treatment will vary according to how severe the deficiency is and what is the cause of it. Doctors might prescribe oral supplements or give vitamin B12 injections, especially if absorption is poor or if there are neurological symptoms. People who have ongoing fatigue without knowing why, or who experience numbness, a tingling sensation, difficulty with balance, or unusual pigmentation should see a doctor. It may be suggested to carry out a full blood count and a serum B12 test, and further tests would be carried out if the results are not clear. Early diagnosis together with proper treatment can avoid complications, adds Dr Savla.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.