Vegans & Vegetarians: Signs of B12 Deficiency and How to Avoid It

Did you know that 84% of vegetarians/vegans abandon their diet? About a third (34%) of lapsed vegetarians/vegans maintained the diet for three months or less. Slightly more than half (53%) adhered to the diet for less than one year. WOW! 


One of the most common reasons for abandonment is just not feeling good, or fearing deficiencies. And of course, one of the most common actual deficiencies for vegans and vegetarians is B12. And if you’re experiencing this, you definitely won’t feel “good”! 


This NB takes a look at signs and stages of B12 deficiency, so you can stay on top of it, and have that one more positive step towards staying on track with your dietary choices as a vegan or vegetarian.

What is Vitamin B12?

B12 deficiencyLike many other essential vitamins, B12 is water-soluble and can only be
obtained through diet or supplementing

It’s absorbed in the small intestine and stored in the liver over time in large quantities. It’s readily available in red meat, poultry, shellfish, and dairy products. This puts those on a vegan diet at a higher risk of B12 deficiency.

Vitamin B12 is vital to:

  • Synthesize DNA for cell development  
  • Produce red blood cells
  • Maintain neurological function

What are the Stages of B12 Deficiency?

Depletion of Stores
As your liver stores large amounts of B12, it is often difficult for clinicians to diagnose a deficiency. Many of the symptoms overlap with other illnesses and disorders, which can lead to late diagnosis.

The loss of B12 can happen gradually over the years. Autoimmune diseases and poor absorption from food are the primary causes of B12 deficiency.

Common symptoms of depleted B12 stores include:

  • A sore tongue and mouth ulcers
  • Pale or yellowing skin
  • Pins and needles in your limbs
  • Fatigue and weakness
  • Weight loss
  • Poor balance
  • Disturbed vision
  • Depression and irritability
  • A decline in cognitive and mental function
  • A decline in memory and rationalization

As a vegan, it is recommended that you discuss with your doctor if you are suffering any of the symptoms listed, as you may be at risk of a B12 dietary deficiency.

Metabolic-Functional Disorder
A metabolic disorder is the failure of the metabolic balance that keeps your body healthy and ready to fight off infection. Your body is sensitive to increased or decreased levels of vitamins, proteins, and other essential biological elements. The result of a metabolic function disorder can lead to the onset of neurological and physical disorders or diseases. 

Pernicious Anemia is a result of the immune system attacking the stomach cells that normally produce a protein called the Intrinsic Factor. The Intrinsic Factor allows the body to absorb B12 from food in the small intestine. It is more common in elderly people but can be caused by poor nutrition at any age.

Autoimmune disorders such as Celiac disease can prevent the absorption of B12 as the body is unable to absorb vitamins in damaged intestines. Stomach, intestinal, or bowel surgeries can also cause a deficiency, due to an inability to absorb B12 in the small intestine. Some say that leaky gut can also be a factor.

Other at-risk groups include:

  • Pregnant and Breastfeeding Woman
  • Adults over 75 years
  • Diabetics taking Metformin medication long term
  • Vegetarians
  • Vegans

Clinical Manifestation
Long-term low levels of B12 can lead to many irreversible conditions, including: 

  • Numbness and tingling in the hands and feet (nerve damage).
  • Difficulty walking
  • Muscle weakness
  • Memory loss
  • Irritability
  • Depression
  • Dementia
  • Psychosis

Many severe neurological disorders, as well as some psychiatric disorders, are now understood to be caused by a long-term lack of B12 absorption. While there are studies carried out to reverse the early stages of such disorders with B12 supplements, it has not proved successful.

In most cases of early clinical detection, you will be tested, then treated with oral supplements. If anemia is diagnosed, you might be prescribed monthly B12 shots. Most vegans who have lower dietary levels of B12 do not have a disorder preventing absorption, and can be treated with supplements.

What is the RDA for Vitamin B12?

The recommended dietary allowances (RDAs) of vitamin B12 are:

  • Adults 2.4 micrograms (mcg).
  • Pregnant or breastfeeding women 2.8 mcg.

How to add B12 to a Vegan Diet

One option is to ensure you are getting enough B12 is to add fortified foods to your daily diet. 

Cereals are often fortified with twice the recommended B12. If you look at the side of the packaging, you will see up to 6mcg of B12. The quantity of cereal required to meet the RDA is as little as ¾ of a cup. 

Another dietary option is fortified yeast. It’s available in health food stores and often added to bread.

While nut and oat milk have small amounts of B12, you shouldn’t rely on them as your only source of B12. Unlike dairy milk, you will need 4-5 servings a day to meet your RDA of B12.

The easiest option is buying vegan B12 supplements. It is possible to take the capsules daily or weekly, depending on the dosage. It’s unlikely that you will take too much B12; your body will only absorb what is necessary from B12 supplements and foods.

Note: It’s always wise to consult your healthcare provider before taking supplements if you are taking prescribed medication.

B12 is vital for your long-term physical and mental health. If you are concerned about your levels, talk to a doctor. 

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