Vitamin B12 or B9 (commonly referred to as folate) deficiency anaemia happens when a lack of vitamin B12 or folate causes the body to generate abnormally large red blood cells that can’t operate properly.

Red blood cells convey oxygen around the body using a substance called haemoglobin.

Anaemia is the general word for having either fewer red blood cells than normal or having an abnormally low amount of haemoglobin in each red blood cell.

There are several different kinds of anaemia, and each one has a different cause. For example, iron deficiency anaemia, which happens when the body doesn’t contain enough iron.

Symptoms or signs of vitamin B12 or folate deficiency

Vitamin B12 and folate perform several vital functions in the body, including keeping the nervous system healthy.

A deficiency in either of these vitamins can create a wide range of problems, including:

  • extreme tiredness
  • a lack of energy
  • pins and needles (paraesthesia)
  • a sore and red tongue
  • mouth ulcers
  • muscle weakness
  • disturbed vision
  • psychological issues, which may include depression and confusion
  • issues with memory, understanding and judgement

Some of these issues can also occur if you have a deficiency in vitamin B12 or folate, but don’t have anaemia.

When to see your Doctor

See your doctor if you think you may have a vitamin B12 or folate deficiency. These health conditions can often be diagnosed based on your symptoms and the results of a blood test.

It’s vital for vitamin B12 or folate deficiency anaemia to be diagnosed and treated as soon as possible because, although many of the signs improve with treatment, some issues caused by the condition can be irreversible.

Causes of a vitamin B12 or folate deficiency

There are a wide range of problems that can lead to a vitamin B12 or folate deficiency, including:

  • pernicious anaemia – where your immune system attacks healthy cells in your stomach, stopping your body from absorbing vitamin B12 from the food you eat; this is the most common cause of vitamin B12 deficiency in the UK
  • a lack of these vitamins in your diet – this is not common, but can happen if you have a vegan diet, follow a fad diet or have a generally poor diet for a long time
  • medication – certain medications, including anticonvulsants and proton pump inhibitors (PPIs), can affect how much of these vitamins your body absorbs

Both vitamin B12 deficiency and folate deficiency are more common in older people, affecting around 1 in 10 people aged 75 or over, and 1 in 20 people aged 65 to 74.

How to treat vitamin B12 or folate deficiency anaemia

Most conditions of vitamin B12 and folate deficiency can be easily treated with injections or tablets to change the missing vitamins.

Vitamin B12 supplements are usually given by injection at first. Then, depending on whether your B12 deficiency is linked to your diet, you’ll either require B12 tablets between meals or regular injections. These treatments may be required for the rest of your life.

Folic acid tablets are used to restore folate levels. These usually has to be taken for four months.

In some situations, improving your diet can assist treat the condition and prevent it recurring. Vitamin B12 is found in meat, fish, eggs, dairy products, yeast extract (such as Marmite) and specially fortified foods. The best sources of folate include green vegetables such as broccoli, Brussels sprouts and peas.

What are Complications of vitamin B12 or folate deficiency anaemia

Although it’s uncommon, vitamin B12 or folate deficiency (with or without anaemia) can result in complications, particularly if you’ve been deficient in vitamin B12 or folate for some time.

Potential complications can include:

  • problems with the nervous system
  • temporary infertility
  • heart conditions
  • pregnancy complications and birth defects

Adults with severe anaemia are equally at risk of developing heart failure.

Some complications improve with appropriate treatment, but others – such as issues with the nervous system – can be permanent.


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