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Does B12 affect balance?

Vitamin B12 is an essential vitamin that plays many crucial roles in the body. One of the functions of vitamin B12 is to help maintain healthy nerves and blood cells. Given this important neurological role, some people wonder if vitamin B12 deficiency can affect balance and coordination.

Balance and coordination rely on input from multiple systems, including the inner ear, eyes, muscles, joints, and nerves. If any of these systems are disrupted, it can affect a person’s stability and synchronized movement. Some research has investigated whether vitamin B12 status has an impact on balance and fall risk.

What is vitamin B12?

Vitamin B12, also known as cobalamin, is a water-soluble essential vitamin. This means that the body requires it for normal functioning but cannot produce it on its own. Vitamin B12 must be obtained from food sources or supplements.

The primary functions of vitamin B12 in the body include:

– Red blood cell formation – Vitamin B12 is necessary for the production of red blood cells and prevention of anemia.

– DNA synthesis – Vitamin B12 is needed for cellular division and DNA replication.

– Neurological function – Vitamin B12 helps maintain the nervous system, including nerve conduction and myelin sheath integrity.

– Metabolism – Vitamin B12 is a cofactor for enzymatic reactions related to energy metabolism.

Vitamin B12 is naturally found in animal foods such as meat, fish, eggs and dairy products. It can also be found in fortified cereals and nutritional yeast. The daily recommended intake is 2.4 mcg for adults, increasing to 2.6-2.8 mcg for pregnant and breastfeeding women.

Causes of vitamin B12 deficiency

While vitamin B12 deficiency is relatively uncommon in developed countries, an estimated 6% of people under age 60 are deficient. Certain populations have a higher risk of deficiency.

Causes of vitamin B12 deficiency include:

– Pernicious anemia – This autoimmune condition impairs the absorption of vitamin B12 from food due to lack of intrinsic factor.

– Other malabsorption disorders – Celiac disease, Crohn’s disease, and intestinal surgeries can decrease B12 absorption.

– Vegetarian or vegan diets – As B12 is naturally found in animal products, plant-based eaters can be at risk if not consuming fortified foods.

– Medications – Long-term use of acid-reducing drugs, Metformin and other medications can impact B12 levels.

– Older age – Around 20% of adults over age 60 are deficient, due to decreased stomach acid production needed for B12 absorption.

Vitamin B12 deficiency often develops slowly, causing symptoms like fatigue, weakness, constipation, loss of appetite, weight loss, depression, confusion and vision changes. One of the hallmarks of deficiency is megaloblastic anemia.

How does vitamin B12 affect the nervous system?

One of the primary ways that vitamin B12 impacts the body is through proper nervous system functioning. B12 helps maintain the myelin sheath, the protective coating around nerves.

It also plays a role in nerve signal conduction. Additionally, vitamin B12 deficiency can cause neurological symptoms like numbness, tingling, balance issues, cognitive changes and vision loss.

The exact mechanisms by which vitamin B12 influences nerve function are complex. However, a few key processes have been identified:

Myelin sheath formation – Myelin is made up of lipids and proteins. Vitamin B12 is essential for lipid synthesis and myelin production. When B12 is low, demyelination of nerves can occur.

Nerve conduction – Vitamin B12 helps convert homocysteine to methionine. Elevated homocysteine can impair signaling between nerve cells.

Neurotransmitters – Vitamin B12 is involved in synthesizing brain chemicals like serotonin, dopamine and norepinephrine. Imbalances in these neurotransmitters can affect mood, cognition and coordination.

Neuronal health – Vitamin B12 deficiency causes abnormal neuronal metabolism. It may accelerate neuronal aging and degeneration.

Through these mechanisms, vitamin B12 helps maintain optimal nerve conduction, reflexes, sensations, cognition and balance.

What causes balance and coordination problems?

Balance, also referred to as postural stability, is the ability to maintain control of the body while standing or moving. Coordination involves integrating sensory input and motor activities.

Balance and coordination are complex processes that involve multiple bodily systems, including:

Vestibular system – The inner ear contains fluid and motion sensors that detect position and movement. Signals are sent to the brain.

Vision – Visual cues help orient the body in space. Vision loss can impair balance.

Musculoskeletal system – Proprioceptors in muscles, joints and tissues provide feedback on body position. Strength, flexibility and reflexes enable coordinated reactions.

Sensory nerves – Sensations in the hands, feet and body give input about external forces acting on the body. Neuropathy disturbs this input.

Motor nerves – Efferent nerves coordinate muscle activation patterns to maintain posture and gait.

Brain – The cerebellum and cortical areas receive and integrate all sensory information to modulate muscle responses.

If any part of this complex system is damaged, it can result in poor balance control, unsteadiness and fall risk. Common causes include:

– Inner ear disorders like benign paroxysmal positional vertigo (BPPV)

– Neurological conditions such as Parkinson’s disease, stroke, multiple sclerosis

– Muscle weakness due to aging, injuries or conditions like arthritis

– Peripheral neuropathy from diabetes, chemotherapy, toxins

– Migraines or medications that affect the brain and coordination

Does vitamin B12 affect balance and coordination?

Given the importance of vitamin B12 for neurological function, researchers have investigated if B12 deficiency or low levels could contribute to balance problems and falls.

So far, studies show conflicting evidence on the role of vitamin B12 and effects on balance, stability and coordination:

– A cross-sectional study in 122 older adults found that low vitamin B12 levels (Potential mechanisms relating vitamin B12 and balance

There are a few ways in which low vitamin B12 could hypothetically contribute to poor balance and coordination:

– Demyelination – Damage to the myelin sheath around nerves slows conduction between the inner ear, muscles, and brain pathways important for balance.

– Peripheral neuropathy – Decreased sensations in the legs and feet could diminish input needed to orient and steady the body.

– Cognitive changes – Confusion and slowed thinking makes it harder to integrate sensory information and plan coordinated movements.

– Visual problems – Vision loss from B12 deficiency reduces visual cues that provide orientation information.

– Orthostatic hypotension – Low B12 is linked to low blood pressure upon standing, which can cause lightheadedness and dizziness.

– Cerebellar dysfunction – High homocysteine levels with B12 deficiency may impair cerebellar function necessary for integrating balance and coordination.

However, other causes beyond vitamin B12 likely play a larger role in most cases of balance problems. Further research is needed to understand if B12 deficiency contributes directly to balance disorders for some individuals.

Diagnosing vitamin B12 deficiency

Vitamin B12 deficiency is diagnosed through a combination of blood tests, medical history and neurological evaluations.

Common lab tests ordered to assess B12 levels include:

– Serum B12 level – Normal range is 200-900 pg/mL (150-650 pmol/L). Levels below 200 pg/mL indicate deficiency. Borderline low is 200-300 pg/mL.

– Methylmalonic acid (MMA) – Elevated MMA indicates functional B12 deficiency. Levels above 0.4 micromol/L are concerning.

– Homocysteine – High levels can mean B12 deficiency. Above 10-13 micromol/L is considered abnormal.

– Complete blood count – B12 deficiency causes macrocytic anemia.

– Intrinsic factor antibodies – If present, indicates pernicious anemia.

In addition to lab work, a physician will obtain a detailed history of symptoms, perform a neurological exam, and look for clinical signs of deficiency like pale skin or a smooth tongue.

Test Normal Range Concerning Level
Serum B12 200-900 pg/mL Below 200 pg/mL
Methylmalonic acid (MMA) 0.0-0.4 micromol/L Above 0.4 micromol/L
Homocysteine 5-10 micromol/L Above 10-13 micromol/L

Balance testing may include assessments of posture, gait, stability and coordination. Examples include the Berg Balance Scale, Timed Up and Go test and posturography. Response to vitamin B12 therapy provides more evidence of a possible causal deficiency.

Treating vitamin B12 deficiency

Addressing an underlying vitamin B12 deficiency is crucial. Treatment for B12 deficiency involves:

– **B12 injections** – Cyanocobalamin or hydroxocobalamin given by intramuscular injection, often weekly at first. This bypasses poor absorption.

– **High-dose oral B12** – Large oral doses of 1,000-2,000 mcg daily of B12 tablets or sublingual drops. This flooded dose overcomes low absorption.

– **Improved dietary intake** – Foods high in B12 like meat, fish, eggs, dairy and fortified foods. Sublingual tablets provide efficient absorption.

– **Treat malabsorption issues** – For pernicious anemia, lifelong B12 injections are needed. Other absorption disorders are managed with diet and medications.

– **Monitor with lab testing** – Levels are rechecked after a few weeks to ensure B12 is replenished in the body along with MMA and homocysteine normalization.

With prompt diagnosis and treatment of B12 deficiency, neurological symptoms often improve. However, some nerve damage can be irreversible if deficiency is long-standing.

Other ways to improve balance

While treating any underlying vitamin B12 deficiency is important, other interventions can also help improve balance and coordination in older adults.

Strategies to reduce fall risk include:

– **Exercise programs** – Strengthening leg muscles, tai chi, yoga and other exercise regimens build stability, posture and navigation skills.

– **Assistive devices** – Canes and walkers provide physical support and aid navigation.

– **Home modifications** – Railings, improved lighting, removing rugs and clutter all create a safer environment.

– **Vision assessment** – Addressing cataracts, glaucoma and other vision issues improves visual input.

– **Medication adjustment** – Reducing or changing drugs that cause dizziness, drowsiness or confusion.

– **Physical therapy** – Customized balance and gait training exercises tailored to the individual.

A multifactorial fall prevention approach is best, given that many factors beyond B12 contribute to balance and coordination disorders in older populations.


Vitamin B12 is clearly essential for neurological function. However, current evidence regarding its role in balance and coordination is inconclusive.

While severe B12 deficiency can certainly affect nerve conduction and cause sensory issues, it is likely not a primary cause of most balance disorders. Mild B12 deficiency may potentially contribute to or exacerbate balance problems in some older people but definitive causation has not been established.

Nonetheless, identifying and treating any underlying vitamin B12 deficiency is worthwhile, as correcting levels may support neurological health. Along with managing B12 status, comprehensive fall prevention strategies aimed at strength, flexibility, vision, home safety and medication risks provide optimal protection against balance impairment and falls.