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PEPTIDES & WELLNESS

B12 Deficiency: Signs to Watch

Dr. Alexander Landfield

Board-Certified Neurologist & Medical Director

January 20, 2026
Peptides & Wellness

Vitamin B12 deficiency is surprisingly common, affecting an estimated six percent of adults under age 60 and up to 20 percent of those over 60. Because B12 is essential for nerve function, red blood cell formation, and DNA synthesis, deficiency can produce a wide range of symptoms that often mimic other conditions. At Rani Beauty Clinic in Renton, WA, Dr. Alexander Landfield sees B12 deficiency regularly and emphasizes the importance of early recognition and treatment.

The most common signs of B12 deficiency include persistent fatigue and weakness, even with adequate sleep. Neurological symptoms are particularly concerning and can include numbness or tingling in the hands and feet, difficulty with balance and coordination, brain fog and difficulty concentrating, and memory problems. Mood changes including depression and irritability can also be related to low B12 levels. Some patients experience a sore or swollen tongue, mouth ulcers, or a pale or slightly yellow skin tone.

Certain populations are at higher risk for B12 deficiency. Vegetarians and vegans are at significant risk because B12 is found almost exclusively in animal products. Older adults often develop reduced stomach acid production, which impairs B12 absorption from food. Patients who take metformin for diabetes or long-term proton pump inhibitors for acid reflux may also develop deficiency. Individuals who have had gastrointestinal surgery, including bariatric surgery, often require lifelong B12 supplementation.

Diagnosis at Rani Beauty Clinic involves a simple blood test measuring serum B12 levels and, when indicated, methylmalonic acid and homocysteine levels for a more complete picture. Treatment with B12 injections is highly effective and produces rapid improvement. Most patients notice increased energy and mental clarity within the first one to two weeks of treatment. Dr. Landfield determines the appropriate injection schedule based on the severity of deficiency and underlying cause, typically starting with weekly injections and transitioning to monthly maintenance.

FREQUENTLY ASKED QUESTIONS

Common Questions

Early signs include unexplained fatigue, weakness, and brain fog. Neurological symptoms like tingling in hands and feet, balance issues, and memory problems can develop as deficiency progresses. A simple blood test confirms the diagnosis.

Higher-risk groups include vegetarians and vegans, adults over 60, patients taking metformin or proton pump inhibitors, and anyone who has had gastrointestinal or bariatric surgery. Regular screening is recommended for these populations.

For patients with absorption issues, confirmed deficiency, or neurological symptoms, injections are significantly more effective because they bypass the digestive system entirely. Oral supplements may be adequate for mild deficiency in patients with normal absorption.

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