B12 deficiency symptoms: The ‘unexplained’ sign on your foot that can be a ‘red flag’

Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency

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The old adage ‘you don’t know what you have until it’s gone’ rings particularly true with vitamin B12. The vitamin performs many important roles in the body, such as supporting the central nervous system and helping to form healthy red blood cells. Naturally, you don’t appreciate its impact until you become deficient in it.

This can cause the body to malfunction in ways that are both surprising and shocking.

A case report published in the Canadian Family Physician documents some of these disturbing effects.

In the report, skin lesions on the feet were the only clinical signs of vitamin B12 deficiency.

A skin lesion refers to any skin area that has different characteristics from the surrounding skin, including colour, shape, size, and texture.

The case report involved a 34-year-old woman who complained of skin lesions that had developed on both her feet over the past 1.5 months.

On examination, she had non-itchy, hyperpigmented lesions predominantly on the toes of both feet.

Hyperpigmentation, or skin pigmentation, is when certain areas of your skin are darker than the rest.

The woman’s vitamin B12 level was considered low. After receiving treatment for her deficiency, the “hyperpigmented lesions improved within two weeks”, stated the case report.

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“Unexplained and non-resolving skin lesions can be a red flag for vitamin B12 deficiency,” the case report concluded.

General symptoms of B12 deficiency

Other symptoms include:

  • A pale yellow tinge to your skin
  • A sore and red tongue (glossitis)
  • Mouth ulcers
  • Pins and needles (paraesthesia)
  • Changes in the way that you walk and move around
  • Disturbed vision
  • Irritability
  • Depression
  • Changes in the way you think, feel and behave
  • A decline in your mental abilities, such as memory, understanding and judgement (dementia).

How to respond

According to the NHS, you should see a GP if you’re experiencing symptoms of vitamin B12 deficiency.

“These conditions can often be diagnosed based on your symptoms and the results of a blood test,” explains the health body.

What causes B12 deficiency

Pernicious anaemia is the most common cause of vitamin B12 deficiency in the UK.

Pernicious anaemia is an autoimmune condition whereby the immune system mistakenly attacks the cells in your stomach that produce the intrinsic factor – a protein that helps your body absorb vitamin B12.

Some people can develop a vitamin B12 deficiency as a result of not getting enough vitamin B12 from their diet.

A diet that includes meat, fish and dairy products usually provides enough vitamin B12, but people who do not regularly eat these foods can become deficient.

How to treat B12 deficiency

The treatment for vitamin B12 deficiency anaemia depends on what’s causing the condition.

Most people can be easily treated with injections or tablets to replace the missing vitamins.

There are two types of vitamin B12 injections:

  • Hydroxocobalamin
  • Cyanocobalamin.

“Hydroxocobalamin is usually the recommended option as it stays in the body for longer,” explains the NHS.

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