It’s often thought that only vegans and vegetarians need to worry about vitamin B12 deficiencies, but there are many ways to become deficient in this important nutrient.

Vitamin B12 deficiency can decrease your ability to make and repair DNA, increasing your risk for cancer. Vitamin B12 supports the myelin sheaths around your neurons, and a deficiency can cause anemia.

Early signs and symptoms of vitamin B12 deficiency include fatigue, weakness, pale skin, and tingling in the fingertips and toes.

Over time, you may notice more symptoms of B12 deficiency, including the following:

•Red, swollen, shiny tongue

•Mouth ulcers

•Out of breath easily

•Dizziness if you stand up too quickly

•Cognitive problems

•Anxiety

•Circadian rhythm issues

•Depression

•Vitiligo

If you have a severe B12 deficiency, you may have problems walking, severe muscle weakness, and severe psychiatric problems, such as hallucinations and paranoia. Severe B12 deficiency can also cause permanent, irreversible nerve damage.

If you don’t regularly consume animal products, you could become deficient in vitamin B12. Try incorporating vitamin B12 foods such as clams, liver, sardines, red meat, tuna, salmon, grass-fed dairy, and eggs into your diet.

If you have low stomach acid, you will have trouble absorbing vitamin B12. A genetic problem known as polymorphism can also interfere with vitamin B12 absorption.

If you take vitamin B12 supplements, take the natural form called methylcobalamin. A healthy liver, small intestine, and acidic stomach are vital for vitamin B12 to be absorbed and function properly in the body.