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The risk for pernicious anemia from vitamin B12 deficiency is highest among the elderly, but a significant number of people begin to notice the first symptoms in their 30s, contrary to popular belief. Listed below are some common symptoms of pernicious anemia and explanations regarding your risk for developing pernicious anemia in middle age.
What is pernicious anemia?
Pernicious anemia is the final stage of vitamin B12 deficiency. Pernicious anemia used to be fatal until scientists figured out that death could be easily prevented by feeding patients high concentrations of Vitamin B12.
Vitamin B12 deficiency causes many debilitating health problems, including chronic fatigue, lethargy, weakness, memory loss and neurological and psychiatric problems – long before pernicious anemia sets in. These symptoms can be quite misleading, leading to incorrect diagnoses.
Autoimmune disease and immune dysregulation (unregulated immune response)
Male and female infertility
These diseases produce signs and symptoms that also occur with vitamin B12 deficiency – but are rarely diagnosed as such!
Pernicious anemia risk categories
The following groups are at greatest risk for vitamin B12 deficiency-pernicious anemia:
Anybody with a family history for autoimmune disorders or pernicious anemia
Vegetarians and vegans
People aged 60 or over
GERD patients using PPIs or acid suppressing drugs
Diabetics using drugs like metformin
Patients of Crohn’s disease, ulcerative colitis, celiac or IBS
Women with a history of infertility and miscarriage
Vegetarians and Vegans take note: Vitamin B12 is found ONLY in animal products! To prevent pernicious anemia, it is absolutely essential that you supplement with high doses of vitamin B12.
Treating pernicious anemia
If you think you might have a vitamin B12 deficiency or pernicious anemia, you should pursue blood testing immediately. If you are vitamin B12 deficient, then the next step would be to identify the source of the deficiency.
Once the source of vitamin B12 deficiency is identified, you can then begin vitamin B12 supplementation. The many, long-term or permanent vitamin B12 supplementation is required in order to prevent a relapse of symptoms.
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So, do you think you know all the symptoms of B12 deficiency? Well, one overlooked sign is eye problems like double vision, blurry vision, and nystagmus. Here are some common vision problems that accompany B12 deficiency.
Myelin and optic neuritis
Myelin is a fatty substance that sheathes and protects your nerve cells, including the ones that control your eyesight, sense of smell, taste perception, hearing, and touch. Demyelinating diseases like pernicious anemia, multiple sclerosis (MS), and diabetes may result in permanent nerve cell damage.
Optic neuritis (demyelinating optic neuritis) is irritation of the optic nerves that occurs when myelin is damaged or completely lost.
Vision symptoms from optic neuritis can include blurring and blind spots. You also may notice distorted vision, reduced color vision and pain when you move your eyes. These types of symptoms may precede vision loss due to optic neuritis.
Vitamin B12 is one of the most important nutrients for your nervous system, as it helps to maintain the myelin coating that protects your nerve cells. Insufficient vitamin B12 causes a slow erosion of myelin, as evidenced by delayed or malfunctioning nervous impulses.
Vitamin B12 deficiency symptoms often include:
Painful tingling or numbness (pins and needles) in your hands and feet
Sore, red tongue
Burning mouth syndrome
Eye problems with B12 deficiency
In addition to optic neuritis, other vision problems that may be related to vitamin B12 deficiency include:
Vitamin B12 deficiency causes pernicious anemia, which creates horrible symptoms like painful tingling in your hands and feet, numbness, chronic fatigue, memory loss, depression, and even chronic clumsiness. What’s really behind all these debilitating symptoms, you wonder? Deranged DNA…
You’re mad, I tell you- Mad!
Pernicious anemia (PA) tends to creep up on you, like a scary monster in a B movie. You might not even realize you have B12 deficiency until you start noticing weird symptoms. Your hands and feet fall asleep on you while you sit at your computer. It feels like thousands of fire ants are crawling up your legs. Sometimes, you could swear that your mouth was on fire, like you ate a red chili pepper.
Only you didn’t…
Then PA attacks your brain, causing brain fog. You struggle to find the right words in conversation, left hanging while you awkwardly try to remember what you were trying to say. You walk into a room and immediately forget what you came in for. You forget to buy things on your mental shopping list. You wake up feeling drugged, exhausted, even though you had plenty of sleep the night before.
If you didn’t have your name printed clearly for you on your driver’s license, you just might forget it…
Pernicious anemia is an autoimmune disorder in which your body interferes with production of a very necessary protein- intrinsic factor. Intrinsic factor is produced in your stomach, and you need it to digest vitamin B12 (cobalamin). Without intrinsic factor, your body cannot extract vitamin B12 from food sources like beef, chicken, fish, and eggs. Instead, the vitamin B12 just passes through your intestines, without ever entering the blood stream.
Say goodbye to B12…
DNA production goes awry
If pernicious anemia sounds frightening, it’s because it does wicked things to your body. You need vitamin B12 for many important bodily functions, like protecting the nervous system, enhancing cognitive development, and maintaining adequate supplies of energy.
Most importantly, your red blood cells need vitamin B12 for DNA synthesis. With pernicious anemia, DNA synthesis in the red blood cells comes to a standstill, while RNA synthesis keeps chugging along.
And then, things get really weird…
Franken-DNA is born
The result is microcytic anemia, a type of megaloblastic anemia causing enlarged red blood cells. Not only are your blood cells too big to function normally, but they are also deformed. Your poor large red blood cells remain trapped inside your bone marrow, unable to leave because they have grown enormous in size.
Remember Alice, trapped in the White Rabbit’s house? Yeah, it’s kind of like that.
Hey, where’re all the red blood cells at?
Trapped in your bone marrow! And your body needs red blood cells to transport oxygen throughout the body. But with vitamin B12 deficiency, very few red blood cells manage to escape their “prison” in your bones, because they are too big to exit. Your red blood cell levels go way down, and you start to feel tired, anxious, and wiry.
Managing macrocytic anemia is simple enough if you know what’s causing it. Pernicious anemia from low B12 levels is just one cause. Other causes of enlarged red blood cells are alcoholism and chronic obstructive pulmonary disease (COPD), among others. With alcoholism, B12 deficiency symptoms can still be the underlying cause of macrocytic anemia.
Vitamin B12 deficiency can be treated with vitamin B12 supplements. However, if your body can’t digest vitamin B12 because of lack of intrinsic factor, then you will have to use vitamin B12 supplements that bypass the digestive system and go directly into the bloodstream.
Examples of vitamin B12 supplementation used for pernicious anemia are routine B12 shots and sublingual B12 pills. The B12 shots require a doctor’s prescription, and can be painful, as they have to be inserted into thick muscular tissue. B12 pills are readily available over-the-counter (OTC). Many patients have reported a burning sensation while using sublingual B12 tablets that dissolve under the tongue.
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Read more about pernicious anemia and vitamin B12 deficiency
What does Vitamin B12 deficiency have to do with movement disorders like Parkinson’s disease and restless leg syndrome? Vitamin B12 protects your nervous system, and many of the symptoms of pernicious anemia from B12 deficiency result in poor muscle control, including muscular spasms, nervous eye twitching, decreased motor skills, and difficulty walking.
Vitamin B12 benefits the nerves
Cyanocobalamin or Vitamin B12 benefits your body in many ways- it lends itself in red blood cell production, DNA synthesis, healthy cognitive functioning, energy production, and homocysteine control. Also, vitamin B12 helps your body produce myelin, a fatty substance that protects your nervous system’s sensitive nerve fibers in the brain and the spinal cord.
Without sufficient levels of vitamin B12, you may develop severe nerve damage- peripheral neuropathy.
Some symptoms of vitamin B12 deficiency- peripheral neuropathy include:
painful tingling and numbness in the hands, feet, and ankles
burning mouth syndrome
decreased motor control
frequent clumsiness and tripping
difficulty balancing on one foot
Vitamin B12 deficiency and other movement disorders
It should come as no surprise, then, that other movement disorders like Parkinson’s disease (PD) have close ties with vitamin B12 deficiency. Involuntary muscular movements may or may not be caused by low B12 levels, but
In some movement disorder cases, scientists have noted improvement with vitamin B12 supplements.
Even when pernicious anemia is not a cause of muscle spasms or walking difficulties, researchers sometimes notice a comorbid relationship with vitamin B12 deficiency.
Another occurrence in diagnosing movement disorders is a tendency for doctors to misdiagnose vitamin B12 deficiency as a more serious illness, such as multiple sclerosis (MS) or Parkinson’s disease.
In a scientific report on Parkinson’s and neuropathy, researchers confirmed a high rate of vitamin B12 deficiency in patients with Parkinson’s disease, and recommended close monitoring of B12 levels and routine administration of vitamin B12 supplements. Results were published in Neurology.
Chorea- focal dystonia
Chorea is an abnormal involuntary movement disorder, part of a group of neurological disorders called dyskinesia. Chorea is a symptom of Huntington’s disease, but it can also occur in other illnesses, including focal dystonia. In one of many studies on vitamin B12 deficiency and focal dystonia, scientists saw favorable results with cyanocobalamin supplementation, attributing it to decreased homocysteine levels.
Restless leg syndrome
The most common symptom of restless leg syndrome is the urgent need to shake your leg to relieve “creeping, crawling” sensations, usually between the kneecap and ankle.Restless leg syndrome occurs often with peripheral neuropathy, a symptom of pernicious anemia. Other possible causes are kidney disease, diabetes neuropathy, Parkinson’s disease, and drug interactions.
Stiff person syndrome
Stiff-person syndrome (SPS) is a rare neurological disorder that occurs with autoimmune disease. Symptoms of SPS are muscle spasms in the limbs and trunk, hypersensitivity to touch, noise, and stress, and stiff posture. People who often suffer stiff person syndrome are patients of pernicious anemia (vitamin B12 deficiency), diabetes, thyroiditis, and vitiligo.
Ataxia is an inability to control muscular movements used in walking, jumping, balancing, or holding objects. Chronic ataxia is one of the earliest symptoms of vitamin B12 deficiency, along with muscular weakness, poor reflexes, spasticity, vision impairment, dementia, and psychosis, according to a Columbia-Presbyterian Medical Center study of 153 patients suffering from cobalamin deficiency neuropathy.
Eye movement disorders
Nystagmus, uncontrollable movements of the eyeballs, might be caused by low vitamin B12 levels, according to a study focusing on downbeat nystagmus and vitamin B12 deficiency. Another phenomenon common with B12 deficiency is myokymia- eyelid twitching.
Read more about B12 deficiency and your nervous system:
If your body stores vitamin B12 in the liver for years, how does vitamin B12 deficiency happen? Even if you eat plenty of foods that supply vitamin B12 (cobalamin), such as meat and fish, you might still run the risk of developing severe vitamin B12 deficiency that can culminate in pernicious anemia or nerve damage. What conditions and lifestyle choices affect your B12 levels?
Vitamin B12 helps your body protect the nervous system’s myelin sheath; as a result, B12 deficiency symptoms may include painful tingling or numbness in the hands, feet, and tongue, muscular weakness, difficulty walking, frequent clumsiness, altered sense of taste, burning mouth syndrome, and eye twitching.
Vitamin B12 is a water-soluble nutrient that occurs exclusively in animal-based food items. The basic food sources of vitamin B12 are meat, poultry, fish, eggs, and milk. Contrary to popular opinion, brewer’s yeast does not contain vitamin B12, although it does supply other essential B vitamins. Purple and green seaweed are the only naturally rich vegan sources of B12. So, if you follow a vegan diet and do not eat generous portions of nori every day, then you are likely to develop B12 deficiency over the course of several years.
If you’re over 50, there’s a 30% chance that you suffer from atrophic gastritis, a general wearing down of your stomach lining. As a result, your body doesn’t produce enough stomach acids to fully absorb vitamin B12 and deliver it to the small intestines. Insufficient stomach acids may also lead to bacterial overgrowth, which also interferes with vitamin B12 absorption.
Other people at risk include individuals taking protein pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD), ulcers, Zollinger-Ellison syndrome, and long-term antibiotic use.
Another chemical the stomach produces for digesting vitamin B12 is intrinsic factor. Certain autoimmune disorders may inhibit your body’s ability to absorb vitamin B12 by attacking stomach cells before they have a chance to produce this necessary protein. Regardless of how many vitamin B12 supplements you swallow, the B12 never reaches the small intestines, so it never enters the bloodstream. Pernicious anemia, resulting in diminished red blood cell production, is a common occurrence when intrinsic factor is lacking.
The ileum of the small intestine is responsible for digesting vitamin B12. Located at the very bottom of the intestinal tract, the ileum grabs vitamin B12 and dispenses it to your blood supply. But if your ileum is not working properly, then you cannot derive the many benefits of vitamin B12.
Gastrointestinal factors that interfere with B12 absorption are:
Inflammatory bowel disease (IBD) such as Crohn’s and colitis
It’s simple. If you are unable to get your vitamin B12 from dietary sources, then the only other option is to bypass the digestive system and redirect B12 directly to your bloodstream. Below are some popular methods of supplementing vitamin B12 without using the stomach.
Vitamin B12 shots: B12 require a prescription from a doctor. Because of the size of cobalamin molecules, B12 shots are usually painful, and must be inserted into thick muscular tissue, such as the thigh or buttock. Even if you have a high threshold to pain, the idea of having to take vitamin B12 injections for the rest of your life can be worrisome.
Sublingual B12 pills: The jury’s still out on the effectiveness of sublingual vitamin B12 tablets that dissolve under the tongue; whether they actually enter the bloodstream or just travel through the digestive system is under debate. Your physician might prescribe B12 pills to be taken three times per day.
Vitamin B12 sprays and creams: There is insufficient data to support the use of nasal sprays or lotions as a means of combatting vitamin B12 deficiency.
Are constant eyelid twitching and eye spasms driving you batty? Myokymia might be a sign of pernicious anemia caused by low vitamin B12 levels. Learn how to stop eye twitching by halting vitamin B12 deficiency in its tracks.
What is myokymia?
Myokymia is a disorder that causes muscles in your body to twitch involuntarily. Myokymia twitches can affect any groups of nerves or muscles in your body, including your arms, legs, fingers, and back.
It can also occur on your face- hemifacial spasms are muscular twitches that begin on one side of your face, usually the eye. Over time, hemifacial spasms can expand to include the rest of your face, on one side.
Myokymia is a type of nerve damage called trigeminal neuralgia. When your eyelid keeps twitching out of control, it is because the nerves that control the opening and closing of your eyes have been damaged. Eye twitches can occur in either the lower eyelid or upper eyelid,
Causes of myokymia
Causes of eye twitching may include stress, excessive alcohol usage, and staring at a computer screen for long periods of time. Eye spasms can also be a reaction to caffeine, or may signify low levels of cobalamin- vitamin B12.
B12 deficiency symptoms
Vitamin B12 benefits include red blood cell production, protection of the nervous system’s myelin sheathe, cognitive functioning, DNA synthesis, and lowered homocysteine levels.
If your body does not store adequate amounts of vitamin B12, you may get B12 deficiency, and ultimately severe pernicious anemia, a type of megaloblastic anemia blood disease.
B12 deficiency causes emotional and cognitive disorders such as:
If you suspect that you have vitamin B12 deficiency, then consult your physician and request a blood test for B12 levels. If diagnosed with low B12, then your doctor will prescribe vitamin B12 supplements.
If you have pernicious anemia, then you might have to get routine B12 shots indefinitely. Once you start taking vitamin B12, you will notice a decrease in pernicious anemia symptoms immediately, and total reversal of symptoms by the time your B12 levels return to normal.
If you’re planning a pregnancy, you might want to check your B12 levels- numerous reports link vitamin B12 deficiency during pregnancy with miscarriage, spontaneous abortion, and other fertility problems. B12 deficiency anemia- pernicious anemia- makes it harder for women to conceive, as well as for men to produce fertile sperm.
Medical research proves the fertility-B12 deficiency link
One of the most famous studies on fertility and B12 deficiency examined fourteen women of childbearing age who suffered vitamin B12 deficiency:
All women who participated in the study suffered severe vitamin B12 deficiency anemia in addition to low fertility- Four had been trying unsuccessfully to conceive for two to eight years, and eleven experienced repeated miscarriages and spontaneous abortions.
Dr. Michael Bennett, hematologist of the Ha’Emek Medical Center in Afula, Israel, implemented vitamin B12 supplementation to see if it would have any effect on their ability to conceive and have healthy pregnancies.
If fetal loss were to continue despite elevating B12 levels, it would prove that infertility was unrelated to B12 deficiency or pernicious anemia symptoms.
Instead, result showed that ten out of the fourteen test subjects experienced favorable results from vitamin B12 supplements. The results can be found in this study on vitamin B12 and fertility.
Dr. Bennett explains the connection
Bennett notes that B12 deficiency, combined with folate deficiency, led to thrombophilia (blood clotting) in seven of the women studied, thus increasing their risk for miscarriage.
He believes that taking large amounts of folic acid, a nutrient prescribed to women of childbearing age, often masks B12 deficiency symptoms, making it harder to diagnose and treat.
In his conclusion, Dr. Bennett attributes raised homocysteine levels, a symptom of vitamin B12 deficiency, with repeated fetal loss, and over time, ovulation disorder.
“Correcting this deficiency can rapidly lead to a normal pregnancy,” states Bennett. “This study illustrates the importance of measuring B12 levels…in every patient investigated for infertility or recurrent (miscarriage).”
Vitamin B12 benefits your body in many ways- it helps to produce red blood cells, promotes DNA synthesis, guards the nervous system’s myelin sheath, maintains cognitive functioning, lowers homocysteine levels, and supports metabolism.
Left untreated, vitamin B12 deficiency can cause severe nerve damage, cognitive disorders, and increased risk for heart disease and stroke.
What symptoms are associated with vitamin B12 deficiency?
Since vitamin B12 interacts with so many different areas of the body, many seemingly unrelated symptoms indicate vitamin B12 deficiency. Pernicious anemia masks itself as mood disorders, diabetes, celiac disease, fibromyalgia, hypothyroid, and other chronic conditions.
Some common symptoms of B12 deficiency:
Painful tingling, numbness or “prickly” sensations, mainly in the hands and feet
Sore, swollen tongue
Altered sense of taste
Loss of balance while walking, running, or jumping
Did you know that Vitamin B12 is one of the most important vitamins for bones? Osteoporosis is one of many illnesses triggered by vitamin B12 deficiency. Studies prove that elderly individuals who maintain high levels of vitamin B12 are less likely to suffer from fractured or broken bones than those who neglect to supplement with vitamin B12 shots.
What is the cause of osteoporosis?
Osteoporosis happens with age for millions of Americans- there exist many factors that cause loss of bone mass, brittle bones, and other symptoms of osteoporosis. Low calcium absorption is one cause of broken bones and fractured hips in old age, but other causes include:
Estrogen deficiency in women
Testosterone deficiency in men
Smoking and alcohol use
Vitamin deficiency, including calcium, vitamin D and vitamin B12
What is B12 deficiency?
Vitamin B12 deficiency occurs from neglecting to eat a diet rich in sources of vitamin B12, such as meat, fish, poultry, eggs, and milk, but it can occur if your body is unable to extract vitamin B12 from foods that you eat. Such is the case for millions of individuals, either because
(a) they lack “intrinsic factor,” a protein required for digesting vitamin B12 naturally from foods
(b) because of drug interactions, such as metformin for diabetes, or
(c) because of post-gastrectomy complications that resulted in pernicious anemia.
Unless treated, B12 deficiency causes red blood cell depletion, neurological damage, dementia, osteoporosis, malnourishment, and increased risk for heart attack, stroke.
Symptoms of vitamin B12 deficiency are:
Numbness and tingling sensations in hands and feet
Altered taste perception
Red, swollen tongue
Unusually pale complexion
What do studies say about the benefits of vitamin B12?
In a study conducted by Tufts University that focused on low-plasma vitamin B12 and bone mineral density (BMD), researchers found that men who had the lowest levels of B12 in their blood also had the lowest bone mineral density, particularly in their hipbones. Similarly, women who suffered vitamin B12 deficiency exhibited severely low BMD in their spine.
They concluded that vitamin B12 deficiency is a significant risk factor for osteoporosis, which explains why the loss of bone mass occurs so frequently among the elderly:
As you age, your body produces fewer stomach acids needed for digesting vitamins and minerals.
As a result, many senior citizens develop vitamin deficiencies, including B12 deficiency. Since they are unable to absorb B12 through the digestive system, they must therefore deposit it directly into the bloodstream.
Another study by the University of Michigan recognized severe osteoporosis as correlating strongly with pernicious anemia-vitamin B12 deficiency.
What are the best vitamins for osteoporosis?
It is crucial to eat a diet rich in all essential vitamins and minerals, in addition to taking regular vitamin supplements. The best vitamins for bonesare vitamin D and vitamin B12.
If you suspect you have vitamin B12 deficiency, then ask your doctor for a blood test. If diagnosed, then you will require routine vitamin B12 supplements until your B12 levels are back to normal.
Read more about preventing vitamin B12 deficiency:
If you’ve had bariatric surgery (gastric bypass surgery, lap band surgery), then you’re at risk for vitamin B12 deficiency. Weight loss surgery causes vitamin B12 malabsorption, in addition to difficulty absorbing other vitamins and minerals. Learn about vitamin B12 deficiency symptoms, and ways to get your B12 levels back to normal.
How many types of bariatric surgery procedures are there?
There are many types of weight loss surgeries, including gastric bypass and lap band surgery, but there are two general categories:
Malabsorptive surgery rearranges and/or removes part of your intestines so that you are unable to absorb vitamins from foods, thus bypassing the digestive process. There are no longer any strictly 100% malabsorptive weight loss surgeries, but many such as the Roux-en-Ygastric bypass include a combination of (mostly) malabsorptive and restrictive techniques.
Restrictive surgery shrinks your stomach, thus causing you to feel full earlier and avoid overeating. Examples are the gastric sleeve and gastric banding (lap band surgery).
Why do I need to take bariatric vitamins and minerals after having bariatric surgery?
If you’ve had weight loss surgery, then you are at a high risk for vitamin deficiencies, particularly vitamin B12 deficiency. There are two reasons for this:
If you’ve had malabsorptive surgery, such as a mini-gastric bypass or duodenal switch, then your body is unable to digest water-soluble vitamins such as vitamin B12 from food sources.
One of the procedures of malabsorptive bariatric surgery is the removal of the ileum, the part of your small intestine responsible for digesting vitamin B12.
The only way for you to receive enough B12 to avoid vitamin deficiency is to put it directly into your bloodstream, through vitamin B12 shots (Sublingual B12 pills are not your best option for absorbing vitamin B12.)
With restrictive surgery, such as gastric sleeve, your stomach is unable to contain enough food at one time to avoid vitamin deficiency.
What are the symptoms of vitamin B12 deficiency, and why should I be worried?
Vitamin B12 supports many important functions in your body- B12 boosts energy and mental clarity, aids in producing red blood cells, maintains your metabolism, protects your >nervous system, strengthens cognitive functioning, and reduces your risk of heartattack or stroke.
Having a hangover is not fun- Hangovers signal alcohol-poisoning symptoms resulting from vitamin B12 deficiency. For that reason, many hangover remedies include vitamin B12 and folate, another member of the B complex vitamins.
It’s best to avoid drinking too much alcohol, and chronic alcohol abuse is detrimental, not only for your health, but for the mental health of your loved ones. If you suffer from alcohol addiction, please seek help from a professional, or call your local Alcoholics Anonymous.
What is a hangover?
A hangover(medical term: Veisalgia) is the aftereffect of your body’s reaction to sudden vitamin B12 deficiency symptoms, in addition to intoxication, hypoglycemia, and dehydration.
Hangovers are symptoms of alcohol poisoning that many happen after binging on alcoholic beverages. Certain factors affect your chances of suffering a hangover after drinking, such as body weight, amount of alcohol consumption, and emptiness of stomach.
A hangover can last for several days following an alcoholic binge.
Common symptoms of a hangover may include throbbing headache, nausea, fatigue, anxiety, increased sensitivity to bright light and loud noise, and severe thirst.
Vitamin B12- one of many essential B vitamins
Vitamin B12 is crucial for healthy brain development and functioning, in addition to stabilizing the nervous system, producing red blood cells, and reducing your risk for heart attack or stroke. Vitamin B12, or Cobalamin, is part of the family of B-complex vitamins.
B12 deficiency symptoms include fatigue, loss of energy, “brain fog,” short-term memory loss, increased risk of early-onset dementia, and neurological damage.
Vitamin B12- a hangover cure?
Scientists have noted a strong correlation between hangover symptoms and low B12.
According to Dr. David Katz of the Yale Prevention Research Center, drinking excessive amounts of alcohol inhibits your body’s ability to absorb nutrients such as vitamin B12 and vitamin B6.
Depending on your level of intoxication, B12 deficiency could be mild- resulting in tiredness, disorientation, and dizziness- or severe, causing extreme depression, nervousness, paranoia, and neurological disorders.
Taking extra doses of B-complex vitamins, especially vitamin B12 and vitamin B6, before drinking alcohol and the following day, are excellent ways of avoiding vitamin B12 deficiency. Also, remember to drink plenty of water throughout the day and evening.