Information for the public

Vitamin B12 deficiency: the care you should expect

Vitamin B12 keeps us healthy in many ways, for example, by helping the body make red blood cells and by maintaining the nervous system. If you don’t get enough of the vitamin, this can lead to a range of health issues, such as extreme tiredness, or problems with your memory or concentration (sometimes called ‘brain fog’). You can also get pins and needles or can feel unsteady on your feet because of the way vitamin B12 deficiency can affect the nervous system. Some people with a deficiency have no symptoms. Others find their symptoms can affect their daily life and, in some cases, stop them from going out to socialise or attend work, school or college.

Some conditions, operations and medicines can prevent the body from absorbing vitamin B12 properly. Nitrous oxide can also cause vitamin B12 deficiency if it is used as a recreational drug. You can also get a deficiency if you don’t have enough of the vitamin in your diet.

Vitamin B12 deficiency can be hard to spot because its symptoms are common in other conditions too. This is why your doctor may use a blood test, as well as look at your symptoms, when checking for a deficiency. If you have a deficiency, you may need treatment with either vitamin B12 tablets or injections. For some, this treatment is for life, but others will need treatment for a shorter period, depending on the cause of the deficiency. You may not need treatment if the deficiency is linked to your diet, but your health professional will talk to you about some changes you could make to your diet.

We want this guideline to make a difference by making sure that:

  • healthcare professionals know when and how to test for vitamin B12 deficiency
  • the cause of deficiency is found, wherever possible, and you get the right treatment for you
  • you are followed up to make sure that the treatment is working as well as it should
  • if you have autoimmune gastritis, you are told about a slightly higher risk of developing gastric cancer and what to do if you get any potential symptoms.

Making decisions together

Decisions about treatment and care are best when they are made together. Your healthcare professionals should give you clear information, talk with you about your options and listen carefully to your views and concerns.

To help you make decisions, think about:

  • What matters most to you – what do you want to get out of any treatment?
  • What are you most worried about – are there risks or downsides to the treatment that worry you more than others?
  • How will the treatment affect your day-to-day life?
  • What happens if treatment is not working as well as it should be?
  • What happens if you don’t want to have treatment?

If you need more support to understand the information you are given, tell your healthcare professional.

Read more about making decisions about your care.

Where can I find out more?

The NHS website has more information about vitamin B12 deficiency.

The organisations below can give you more advice and support.

NICE is not responsible for the content of these websites.

To share an experience of care you have received, contact your local Healthwatch.

We wrote this guideline with people who have been affected by vitamin B12 deficiency, and staff who treat and support them. All the decisions are based on the best research available.

ISBN: 978-1-4731-5727-9

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