5 min learnFeb 12, 2026 09:05 AM IST
When a 50-year-old diabetic got here to see me the opposite day, he complained of severe exhaustion at first. He blamed it on lengthy workplace hours, mounting deadlines, poor sleep and stress, all of which appeared cheap explanations for the fatigue that clung to him every day. Till he froze whereas strolling to the session chair in entrance of me. His stroll grew to become unsteady, he staggered. “My ft are burning, changing into numb, I really feel dizzy,” he mentioned earlier than collapsing in a heap. Neither was it a low sugar episode, nor was it a stroke. So, what was the set off?
As we attended to him within the emergency, the explanation stared again at us from his blood report. He was severely poor in vitamin B12, at 95 pg/ml (picograms per millilitre), far under 200 pg/ml. Optimum ranges are thought-about to be larger, between 400 and 600 pg/mL. Residing with diabetes, a strict vegetarian (plant meals don’t have sufficient vitamin B12), and surviving on Metformin (blood sugar drug which suppresses absorption) and antacids (which intrude with absorption by decreasing abdomen acid wanted to launch B12 from meals), his deficiency had developed and gone undetected over time.
But B12 is one of crucial nutritional vitamins that’s wanted for DNA synthesis, mind perform, sustaining wholesome nerves and forming pink blood cells. Whereas the liver can retailer B12 for 3 to 5 years, deficiencies happen when consumption or absorption fails. People should receive B12 by means of eating regimen (meat, fish, dairy) or dietary supplements, because the physique can’t create it.
Why men are inclined to ignore vitamin B12 deficiency
It began subtly. A tingling sensation in his toes. Occasional dizziness. Rising forgetfulness. His household seen temper swings and uncharacteristic irritability. “I thought I was simply burdened,” he would later recall.
Men are least more likely to get themselves examined for vitamin B12 deficiency in comparison with girls as a result of they don’t think about it to be a critical well being challenge. They go to medical doctors much less continuously, delay routine bloodwork and keep away from reporting temper or cognitive signs. So, vitamin B12 deficiency can go undetected for years. Moreover, they have a tendency to attribute the plain symptom of fatigue to stress, despair, low testosterone, diabetes, ldl cholesterol, weight problems and stress. Even medical doctors could verify testosterone or glucose ranges first — not B12.
What are indicators and signs?
By the point my patient was admitted to hospital, he was struggling to stroll in a straight line. He had problem recalling latest conversations. Blood exams revealed profound megaloblastic anaemia, a situation of enlarged, dysfunctional pink blood cells related to critically low B12 ranges. An MRI scan confirmed what I had feared, early indicators of subacute mixed degeneration, a critical neurological complication the place the spinal wire begins to deteriorate. With out B12, the nervous system actually begins malfunctioning.
In excessive circumstances, deficiency can result in psychosis, paralysis, everlasting nerve harm, sudden weight reduction and really poor urge for food. Alcohol use can additional complicate issues by contributing to thiamine (vitamin B1) deficiency, rising the danger of mind issues. Sore tongue, mouth ulcers, decreased vibration and place sense, resulting in poor stability, reminiscence issues and mind fog, are pretty noticeable. Vitamin B12 ranges decrease than 100 can push up ranges of homocysteine, a half damaged down amino acid that may thicken the blood and type clots. Then sufferers may develop pernicious anaemia, an autoimmune situation that forestalls your physique from absorbing vitamin B12 and damaging the nervous system irreversibly if left untreated.
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What about remedy?
I began my patient on high-dose injectable B12 and dietary remedy. In severe deficiency circumstances, we suggest every day photographs for a week, then taper it out to weekly and month-to-month jabs. A poor particular person wants over 4 weeks to report regular blood counts.
His anaemia improved inside weeks. His cognitive readability slowly returned. However some nerve harm lingered as a consequence of delayed analysis.
These at highest danger embrace strict vegans with out supplementation, older adults with absorption points, people with gastrointestinal issues, and folks with persistent alcohol dependence.
My patient’s story serves as a stark reminder that generally probably the most harmful well being threats will not be dramatic sicknesses, however silent deficiencies hiding in plain sight.
(Dr Tickoo is Director, Inside Drugs, Max Healthcare)
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