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Symptoms of Vitamin B12 Folate Deficiency

By Dr. Tina M. St. John

Vitamin B-12 and folate, or vitamin B9, are essential nutrients. Eating a well-balanced, healthful diet that includes an array of fruits, vegetables, dairy products, grains, protein-rich meats, fish, seafood or beans provides you with natural sources of vitamin B-12 and folate. A vitamin B-12 or folate deficiency commonly causes anemia, or a low red blood cell count, which leads to characteristic symptoms. Vitamin B-12 deficiency may also cause nerve-related symptoms. Awareness of the symptoms of a vitamin B-12 or folate deficiency can help you identify a possible problem and seek early treatment.


The red blood cells transport oxygen to the body. The body tissues require oxygen to generate energy efficiently. With vitamin B-12 or folate deficiency-related anemia, the oxygen-carrying capacity of the blood decreases, commonly leading to tiredness, or fatigue. The National Heart Lung and Blood Institute reports that fatigue is the leading symptom experienced by people with anemia of all types. You may find your overall energy level reduced or notice you tire more easily when engaging in your usual activities. Because anemia-related fatigue typically develops gradually, you may not notice a change until the symptom becomes severe.


Muscles function best when they receive an abundant supply of oxygen. Anemia caused by a vitamin B-12 or folate deficiency can reduce muscle performance by limiting the oxygen supply to the tissue. Your strength and muscular endurance may gradually decrease with a vitamin B-12 or folate deficiency.


The skin derives its pink or reddish hue from the red blood cells flowing through the minute blood vessels within the tissue. A vitamin B-12 or folate deficiency-related anemia commonly causes paleness. You may notice your nail beds, gums, lips and the insides of your eyelids appear less pink than usual. The skin tone of your face may appear slightly gray or blue.

Numbness or Tingling

An insulating material called myelin covers the nerves. Myelin protects the nerves and facilitates the rapid transmission of messages between the brain and body. Vitamin B-12 supports the formation and maintenance of myelin. A vitamin B-12 deficiency may cause loss of myelin and an associated disruption in nerve signaling, notes the University of Virginia School of Medicine. You may notice numbness or tingling of your feet or, less commonly, your hands. A long-standing vitamin B-12 deficiency may cause walking difficulties and reduced coordination and balance.

Vegans have an increased risk for developing a vitamin B-12 deficiency because the nutrient occurs most commonly in animal-derived foods. Adding nutritional yeast or vitamin-fortified cereals or grain products to your vegan diet typically prevents the development of a vitamin B-12 deficiency, notes nutritionist Reed Mangels, Ph.D., in the book "Simply Vegan: Quick Vegetarian Meals."

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