Always Tired? It Could Be Vitamin B12 Deficiency (Signs to Check)

You sleep eight hours and still wake up tired. Your feet tingle at night. Maybe your tongue feels sore for no clear reason. Most of us blame work stress or the weather and move on.

Sometimes the real cause is vitamin B12 deficiency, and in India it’s far more common than people think. A national survey found it in nearly 1 in 3 teenagers. The tricky part is that it builds slowly for years before it shows, and some of the damage can be permanent if you leave it too long.

This article is for information only and isn’t medical advice. If any of this sounds familiar, please consult a doctor.

Why Vitamin B12 Deficiency Is So Common in India

Vitamin B12 is found naturally in animal foods: meat, fish, eggs, milk and cheese. According to the NHS, it isn’t found naturally in fruit, vegetables or grains. So a typical vegetarian plate of roti, dal, rice and sabzi gives you very little of it, however healthy it looks.

That matters in a country where a large share of people are vegetarian. The Comprehensive National Nutrition Survey, which tested blood samples from 33,880 Indian children and teenagers, found B12 deficiency in 13.8% of preschoolers, 17.3% of school-age children and 31% of adolescents.

Two common medicines also lower B12 levels, according to the NHS:

• Metformin, a common diabetes medicine
• Proton pump inhibitors (PPIs), the acid-reflux tablets many people take daily, such as pantoprazole and omeprazole

Don’t stop either medicine on your own. Just ask your doctor whether your B12 should be checked.

The Slow Build-Up Nobody Notices

Here’s why this deficiency catches people off guard. Your body keeps a store of B12, and the NHS says it can last 2 to 5 years. So if your diet changed years ago, the symptoms may only be appearing now.

By the time you feel it, the shortage has usually been building for a long time. The NHS also warns that the longer it goes untreated, the higher the chance of permanent damage, especially to the nerves.

Also readWhy Do We Feel Lazy in Winters? Know the Reason Behind It!

Vitamin B12 Deficiency Symptoms: Signs to Check

The NHS lists a wide range of symptoms. They usually come on gradually, so it helps to look at them in groups.

The signs that need a doctor soon

Tiredness alone could have many causes. But numbness, pins and needles, balance problems or memory changes point to the nerves, and nerve damage is the part that may not fully reverse. If you have any of these, book a doctor’s visit this week rather than “someday”.

Who Should Get Their B12 Tested

You don’t need a test just because you felt tired after a long week. But it’s worth asking your doctor about a B12 blood test if you:

• Are vegetarian or vegan and don’t take B12-fortified foods or supplements
• Take metformin for diabetes
• Have taken acid-reflux tablets (PPIs) for months
• Have had stomach surgery, or have a bowel condition like Crohn’s disease
• Have a family history of pernicious anaemia, an autoimmune condition that stops the body absorbing B12
• Notice any of the nerve-related signs above

The NHS says pernicious anaemia, the most common cause in the UK, is more common in women around 60 and in people with other autoimmune conditions such as vitiligo. So if you’re an older woman with these symptoms, don’t dismiss them as just age.

How Vitamin B12 Deficiency Is Diagnosed

A doctor usually starts with your symptoms and a blood test that measures your B12 level. They may also check your blood count, because B12 deficiency can cause a type of anaemia where red blood cells grow larger than normal.

Sometimes the doctor will look for the cause too. Is it diet, a medicine or an absorption problem? That decides the treatment.

Treatment: Tablets or Injections?

According to the NHS treatment guide, treatment depends on the cause.

1. Diet-related deficiency: often treated with daily B12 tablets taken between meals, or sometimes an injection twice a year.
2. Absorption problems (like pernicious anaemia): usually B12 injections, often every 2 to 3 months for life.
3. Nerve symptoms present: usually more frequent injections and a referral to a specialist.

Many symptoms improve once treatment starts. Vegetarians and vegans who can’t get enough B12 from food may need tablets long term. Your doctor will decide the dose. The NHS notes that 2mg or less a day from supplements is unlikely to cause harm, but more isn’t better, so don’t self-prescribe.

Vegetarian Foods That Help (and Myths to Drop)

Adults need about 1.5 micrograms of vitamin B12 a day, according to the NHS. That’s a tiny amount, but a vegetarian diet can still fall short.

Vegetarian sources:

• Milk, curd, buttermilk and paneer
• Cheese
• Eggs, if you eat them
• B12-fortified foods such as some breakfast cereals, yeast extracts and soy products (check the label)

If you drink milk and eat curd or paneer daily, you’re helping yourself. But food may not be enough to fix an existing deficiency, so that’s where your doctor comes in.

Myths to drop:

• “Spinach and dal are full of B12.” They’re healthy, but plant foods don’t naturally contain B12.
• “If I were low, I’d feel it right away.” Body stores can last years, so symptoms often arrive late.
• “Tiredness is just age.” Sometimes it is. Sometimes it’s a deficiency a blood test can catch.

Also readHow to Improve Your Sleep Quality and Wake Up Refreshed Every Morning

Frequently Asked Questions

What are the first signs of vitamin B12 deficiency?

Feeling weak or tired, shortness of breath, a sore or red tongue and pins and needles in the hands or feet are common early signs. They usually develop slowly, so many people don’t link them together at first.

Can vegetarians get enough vitamin B12?

They can, with regular milk, curd, paneer and cheese, eggs if they eat them, and B12-fortified foods. Many vegetarians and vegans still need a supplement, which a doctor can advise on after a blood test.

Is vitamin B12 deficiency serious?

It can be. Untreated, it can cause anaemia and nerve problems, and some nerve damage may be permanent. Diagnosed early, it’s usually easy to treat.

Does metformin cause vitamin B12 deficiency?

The NHS lists metformin among the medicines that can reduce B12 in the body. If you take it, ask your doctor whether you should have your B12 checked. Don’t stop the medicine on your own.

How long does it take to recover?

It depends on how low your levels were and whether your nerves were affected. The NHS says many symptoms improve with treatment, but some nerve damage may not fully reverse if it was left too long. Your doctor will track your progress with follow-up tests.

The Bottom Line

Vitamin B12 deficiency is common in India, easy to miss and simple to test for. If you’re vegetarian, take metformin or acid-reflux tablets, or keep feeling tired with tingling hands or feet, ask your doctor for a B12 test at your next visit. It’s one of the easiest health checks you can do, and it could save your nerves from damage that doesn’t heal.

Share this with someone in your family who’s always tired. It might be the nudge they need.

Sources

• NHS: Vitamin B12 or folate deficiency anaemia, symptoms
• NHS: Causes, including metformin, PPIs and body stores of 2–5 years
• NHS: Treatment with tablets and injections
• NHS: Vitamin B, daily need and food sources
• Nutrients (2023), via PMC: B12 and folate deficiency in Indian children and adolescents (CNNS 2016–18)