Leg pain due to vitamin B12 deficiency
A vitamin deficiency is unfavourable for our body, especially a deficiency of B vitamins, as these support important processes. This is also a good reason to make sure we eat a balanced diet, as we can only replenish our vitamin B12 depot through food if we do not want to take vitamin B12 supplements in the form of vitamin B12 injections or oral intake.
Find out here what consequences a B12 deficiency also has for our nervous system, why our vitamin B12 status does not improve despite eating well or taking supplements and how the intrinsic factor is related to this.
We have summarised for you why a vitamin B12 deficiency in the body can also manifest itself as pain in the legs.
What do we need vitamin B12 for?
Vitamin B12, also known as cobalamin, is required for the formation of new red blood cells, DNA and neurotransmitters, among other things. A vitamin B12 deficiency can therefore also lead to neurological problems, as it is crucial for the transmission of nerve impulses [1]. Our body needs sufficient vitamin B12, particularly for the development of genetic material and the nervous system. Vitamin B12 is closely linked to folic acid (vitamin B9) in its mode of action in the body and both B vitamins are interdependent. They play an important role in detoxifying the body and converting harmful homocysteine into harmless methionine. A vitamin B12 deficiency can therefore also be the cause of other B vitamin deficiencies in the human body.
Patients with chronic inflammatory bowel disease are at increased risk of vitamin B12 deficiency, as this impairs the metabolism of the nutrient [2].
What causes a vitamin B12 deficiency?
The body's need for this vitamin is actually well covered by a balanced and varied diet, but there are certain groups of people who are often affected by a deficiency. These are, for example, vegans, vegetarians or patients who have to take certain medications as part of a therapy, such as acid blockers for the stomach. Excessive alcohol consumption can also be the cause of a B vitamin deficiency [3].
B12 deficiency can therefore occur for various reasons. On the one hand, it is possible that too little B12 is ingested through food, on the other hand, there may also be health reasons if the body cannot sufficiently utilise the vitamins ingested.
An increased need for vitamin B12 also exists, for example, during pregnancy and breastfeeding or in older people [1] [4]. These people have an increased risk of developing a vitamin B12 deficiency, which is why they should have their status regularly checked by means of diagnostics and, if necessary, treated as part of a therapy.
Insufficient supply
Vitamin B12 deficiency develops in people who do not consume any products of animal origin in their diet (vegetarians and vegans), unless they take supplements. It should also be noted that a mother who eats a vegan diet while breastfeeding puts her child at risk of developing a vitamin B12 deficiency [5].
Insufficient intake
The most common cause of vitamin B12 deficiency is insufficient intake (absorption), which can be caused by the following:
- excessive bacterial growth in the small intestine
- impaired absorption (malabsorption) due to coeliac disease [1] or a disease of the pancreas
- inflammatory diseases of the small intestine (vitamin B12 is absorbed in the small intestine)
- surgery on the gastrointestinal tract
- . intestinal tract
- medications such as antacids or metformin
- lack of intrinsic factor
- lack of stomach acid
- excessive alcohol consumption [3]
- diabetes [3]
Loss of intrinsic factor can occur, when an overactive immune system produces abnormal antibodies as a result of an autoimmune reaction, which attack and destroy the stomach cells that produce intrinsic factor. It can also be deficient if the part of the stomach where it is produced has been surgically removed.
In older people, absorption can be insufficient because the amount of stomach acid decreases in old age [1]. A lower level of stomach acid reduces the body's ability to break down vitamin B12 from meat protein. However, the vitamin B12 contained in food supplements can still be absorbed well even by people with reduced gastric acidity.
Insufficient storage
Diseases of the liver can disrupt the storage of vitamin B12, as the largest proportion of vitamin B12 is stored in the liver [6]. In principle, vitamin B12 stores in healthy people last for several years, so a deficiency may only become apparent after two to five years.
How does vitamin B12 deficiency become noticeable and what symptoms does it cause?
Vitamin B12 deficiency can manifest itself in two ways: Through anaemia or neuropsychiatric disorders.
The neurological symptoms are non-specific and can have lasting consequences. This is why it is crucial to also consider a vitamin B12 deficiency in the event of non-specific neurological symptoms. If the deficiency is corrected in time, irreversible damage can be prevented.
Anaemia, often colloquially referred to as anaemia, on the other hand, is a very late indicator. The red blood pigment (haemoglobin) and / or the red blood cells (erythrocytes) are missing in the blood of those affected.
Neurological or psychiatric symptoms can occur even before anaemia is diagnosed.
The following symptoms may indicate a B12 deficiency:
- Signs of anaemia such as pallor, tiredness, palpitations
- Skin and mucous membrane changes such as glossitis (inflammation of the tongue), smooth red tongue, tongue burning [7] and hyperpigmentation of the skin
- Neurological symptoms: Tingling in arms and legs (paraesthesia) to numbness, dizziness, depression, forgetfulness, unsteadiness in gait, listlessness to psychosis and paralysis
Why do you get nerve and leg pain with a vitamin B12 deficiency?
The B vitamins are particularly responsible for the function of our energy metabolism, brain and nerves. If, for example, the nerve cells only have small amounts of vitamin B12 available, this can lead to tingling in the extremities and nerve pain. If a vitamin deficiency persists over a long period of time and remains undetected, nerve damage can occur, triggering neuropathies (nerve pain) [3].
Neuropathy in the limbs can also lead to polyneuropathy. Poly-neuropathy (poly = more) is a group of diseases in which there is multiple nerve damage in different areas of the body, which then occurs not only in the extremities. A typical clinical picture in this case is a tingling sensation in the hands and formication in the arms [8]. The body parts become numb and can feel weak. Those affected can no longer tell exactly how their extremities are positioned (sense of position) and cannot feel vibrations. Mild to moderate muscle weakness develops, reflexes may be lost and walking may be difficult. Some people become confused, irritable and easily depressed. An advanced vitamin B12 deficiency can even lead to delirium, paranoia and even impaired mental function, including dementia [1] [6].
The symptoms depend on which nerves are damaged: If there is damage to the motor nerves, disorders of the musculature are primarily observed. Autonomic nerves, on the other hand, control digestion and breathing. If symptoms occur in the gastrointestinal tract, including regular constipation or diarrhoea, it is highly likely that this group of nerve fibres has already been damaged and should be treated with a medical diagnosis.
Diabetes is considered one of the most common triggers of polyneuropathy [8]. The cause of the disease is poorly controlled blood sugar levels, which can cause pathological changes to the smallest blood vessels. These changes have a negative effect on the nerve cells and damage them [3].
The neurological disorders include symptoms such as sensory disturbances and even paralysis, a burning tongue [7], tingling extremities, unsteadiness when walking, an increased tendency to fall, muscle weakness, fatigue and poor concentration. Headaches, depression, confusion, hair loss and anaemia are also among the symptoms of vitamin B12 deficiency that should be treated by a doctor as part of therapy.
What pain is caused by vitamin B12 deficiency?
One crucial component that influences the development of pain, in addition to restricted posture patterns or lack of exercise, is our diet and the quality of our food. This is particularly true for leg pain that can be traced back to damaged nerve fibres. An insufficient supply of vitamin B12 and other B vitamins as well as other micronutrients could be behind the pain [1].
Vitamin B12 (cobalamin) is just as essential for the central nervous system as folic acid. Both nutrients can prevent disorders within the nervous system and research is continuing into the extent to which they contribute to the prevention of dementia and other cognitive disorders [1]. A sustained supply of both nutrients is necessary for the optimal functioning of the nervous system.
The symptoms of neuropathy vary depending on which nerves are damaged:
- Tingling extremities (like ants running in the legs or/and arms)
- An urge to move, as is typical of restless legs
- Sensory disturbances, for example when touching the extremities or in cold weather
- Numbness
- Vibration
- Muscle weakness
- Muscle cramps
- Paralysis
What can I do about constant nerve pain in my legs?
Pain caused by a vitamin B12 deficiency can be compensated for by oral, intravenous or intramuscular substitution with B12 to replenish the stores in the liver. Ideally, treatment is carried out in combination with vitamin B9 (folic acid) [1] and/or other B vitamins.
How quickly can a vitamin B12 deficiency be remedied?
A deficiency caused by a disease or impaired organic absorption can be treated as part of a therapy:
- Vitamin B12 supplements
- In people with nerve damage, the vitamin is administered as an injection
Food supplements can be helpful for older people with a B12 deficiency. In this case, the deficiency is often caused by a lack of stomach acid, which means that the vitamin cannot be absorbed from meat. Supplements make it easier for them to absorb the vitamin. As long as the deficiency is asymptomatic, the vitamin can be taken orally via high-dose vitamin B12 supplements. As part of the therapy, the levels are regularly checked via a blood test to ensure that the vitamin B12 level returns to normal.
In patients with very low vitamin B12 levels or symptoms due to nerve damage, vitamin B12 is often injected into a muscle via vitamin B12 injections.
Anaemia is then usually no longer present after around 6 weeks. However, if the symptoms are particularly severe and persist for months or years, the anaemia can become chronic. Even in many older people with a vitamin B12 deficiency and dementia, mental functioning often fails to recover after treatment [6].
Are you already familiar with our other articles on vitamin B12?
You can find these and other exciting topics at https://vita-world24.de/en/Magazine/Good-to-know/
Sources:
[1] https://www.sciencedirect.com/science/article/abs/pii/B9780702040870000607
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409721/
[3] https://www. aerzteblatt.de/int/archive/article/196150
[4] https://pubmed.ncbi.nlm.nih.gov/25586321/
[5] https://www. ncbi.nlm.nih.gov/pmc/articles/PMC7498377/
[6] https://www.msdmanuals.com/de-de/heim/ern%C3%A4hrungsst%C3%B6rungen/vitamine/vitamin-b12-mangel
[7] https://www.msdmanuals.com/de-de/heim/mund-und-zahnerkrankungen/erkrankungen-von-lippen-und-zunge/
[8] https://www.msdmanuals.com/de-de/heim/st%C3%B6rungen-der-hirn-,-r%C3%BCckenmarks-und-nervenfunktion/erkrankungen-der-peripheren-nerven-und-verwandte-erkrankungen/polyneuropathie?query=schmerz%20b12
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