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This, in turn, has led to delayed diagnosis, notably in people presenting solely with neurological symptoms.68232425 However, in many people, neurological and neuropsychological or cognitive symptoms (box 1, fig 1) are the main presenting symptoms.23 Anaemia is present in fewer than 20% of people with B 12 deficiency.26 Cobalamin analogue formation maybe related to more prominent neurological manifestations.30 Frequently reported signs and symptoms of B 12 deficiency Brain function: Brain fog, memory problems, cognitive impairment, insomnia, headaches (especially migraine), behavioural changes, learning problems, nominal aphasia Mood: Mood swings, irritability, depression, anxiety, hallucinations, delusions, psychosis Sensory: Peripheral paraesthesia (pins and needles), numbness, neuropathic pains, poor balance, reduced vibration sense or proprioception (joint position sense), tinnitus, ataxia, taste impairment, sometimes myelopathy Constitutional: Fatigue, anaemia (either macrocytic, or normocytic when also iron deficient or associated with thalassaemia minor), other cytopenia, abdominal complaints, malabsorption, failure to thrive, weight loss, diarrhoea, hyperpigmentation, glossitis, (aphthous) stomatitis, infertility, urinary tract infections Motor: Muscle weakness, altered reflexes (increased in degeneration of the spinal cord, reduced when peripheral neuropathy dominates), spasticity, seizures, cardiomyopathy Autonomic: Urinary and/or faecal incontinence, postural hypotension or dizziness, erectile dysfunction Fig 1 Vitamin B 12 : Functions, deficiency and treatment Diagnosing B 12 deficiency can be challenging because no single specific measurement exists to reliably diagnose or refute the presence of B 12 deficiency11122627 (box 2)

Whilst many GPs will not treat patients according to individual need (or feel their hands are tied), then it is essential to allow patients the ability to look after themselves

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Summary B12 is not common in plant-based foods, so vegans not supplementing with B12 are more likely to be deficient Meeting your daily B12 intake is vital to remaining healthy on a vegan diet B12 can be found in a few vegans foods like nutritional yeast and fortified foods but arent very common or in a high dosage Its recommended to supplement with 1000-2500 mcg of B12 twice weekly from any B12 type and method of delivery FAQs Where do vegans get B12 from

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"Associations of Maternal Vitamin B12 Concentration in Pregnancy With the Risks of Preterm Birth and Low Birth Weight: A Systematic Review and Meta-Analysis of Individual Participant Data"