Peripheral neuropathy is a condition that affects people in a “stocking and glove” pattern, meaning the hands and feet. This can cause numbness and tingling, and/or loss of sensation. As it progresses, it can lead to balance problems as the sensation in your feet help you stay balanced. There are many things that cause this such as diabetes, peripheral artery disease, smoking, alcoholism, and certain viral infections. However, one under-appreciated cause is B12 deficiency. The good news is it’s treatable.

Vitamin B12, also known as cobalamin, is a water-soluble vitamin that plays a key role in nerve function, red blood cell production, DNA synthesis, and brain health. In fact, you can develop anemia from B12 deficiency due to its role in red blood cell production. But it’s role in nerve function is what can mimic peripheral neuropathy.

B12 deficiency can cause demyelination, which means the protective coating (myelin sheath) around your nerves starts to break down. Without that insulation, nerve signals misfire, causing symptoms almost identical to those of peripheral neuropathy.

In severe cases, it can even lead to cognitive decline, mood changes, or difficulty walking.

There are several reasons why your B12 levels might drop:

• Dietary deficiency: Especially in vegans or vegetarians, since B12 is found mainly in animal products.
  
  

• Malabsorption issues: Conditions like pernicious anemia, celiac disease, or Crohn’s disease can prevent proper B12 absorption.
  
  

• Medications: Long-term use of drugs like metformin or proton pump inhibitors (PPIs) can interfere with B12 absorption.
  
  

• Age: Older adults often produce less stomach acid, which is needed to absorb B12 from food.
  
  

The tricky part is that B12 deficiency can either cause peripheral neuropathy or mimic it so closely that doctors may miss the root cause. That’s why it’s essential to check B12 levels, especially in people experiencing new or worsening neuropathy symptoms.

A simple blood test can measure your B12 levels. It’s also a good idea to check methylmalonic acid (MMA) and homocysteine, which can indicate deficiency even if B12 levels are borderline.

B12 deficiency may be a silent impostor, hiding behind the mask of neuropathy, but it’s also one of the most treatable causes of nerve symptoms out there.

If you’re experiencing strange sensations, fatigue, or balance issues, don’t just assume it’s “just getting older” or jump straight to a diagnosis of peripheral neuropathy. Check your B12 status. Sometimes, a small vitamin can make a massive difference.