Vitamin B12 deficiency symptoms: 8 warning signs of low levels ‘inside your mouth’

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

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Vitamin B12 makes many invaluable contributions to the body, such as supporting the nervous system and producing red blood cells. It’s little wonder that low B12 levels can prove ruinous. A lesser-known sign of B12 deficiency is oral lichen planus, concludes a 2020 study published in the Journal of Oral Biology and Craniofacial Research.

“Oral lichen planus is an ongoing (chronic) inflammatory condition that affects mucous membranes inside your mouth,” explains the Mayo Clinic.

The study was done to evaluate the serum levels of vitamin B12 in patients with symptomatic oral lichen planus and establish an association between reduced B12 levels and oral lichen planus.

Serum vitamin B12 was assessed in 60 symptomatic cases of oral lichen planus and 60 healthy age and gender matched controls.

What did the researchers find out? Serum vitamin B12 was significantly reduced in patients with oral lichen planus when compared to healthy individuals.

The researchers concluded: “Oral lichen planus causes serum vitamin B12 deficiency.

They attribute the association to restricted B12 intake hampering the “normal functioning of immune and neuropsychologic system”, which has a role to play in halting the development of oral lichen planus.

How to spot oral lichen planus

The Mayo Clinic explains: “Oral lichen planus may appear as white, lacy patches; red, swollen tissues; or open sores.”

According to the health body, the white, lacy patches may not cause discomfort when they appear on the inside of the cheeks.

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However, symptoms accompanying red, swollen patches and open sores may include:

  • Burning sensation or pain
  • Sensitivity to hot, acidic or spicy foods
  • Bleeding and irritation with tooth brushing
  • Inflammation of the gums (gingivitis)
  • Painful, thickened patches on the tongue
  • Discomfort when speaking, chewing or swallowing.

General symptoms of low B12 include:

  • Fatigue/exhaustion
  • Muscle weakness
  • Vision problems
  • Pins and needles
  • Sore tongue or mouth ulcers
  • Issues with memory
  • Depression.

Am I at risk?

According to Holland and Barrett, vitamin B12 is only naturally found in animal products such as meat and dairy, so vegans and vegetarians are at risk of low intakes.

“Older people and others who don’t produce enough stomach acid to absorb B12 properly, may also be at risk of deficiency,” warns the health body.

When to see a GP

The NHS says: “See a GP if you’re experiencing symptoms of vitamin B12 deficiency.”

According to the health body, these conditions can often be diagnosed based on your symptoms and the results of a blood test.

It’s important for vitamin B12 deficiency to be diagnosed and treated as soon as possible.

“Although many of the symptoms improve with treatment, some problems caused by the condition can be irreversible if left untreated,” warns the NHS.

The treatment for vitamin B12 deficiency 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.

“If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals,” adds the NHS.

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