 Hello everyone, this is Dr. Ahmed Ergin. I'm an endocrinologist, a diabetes education specialist. I do diabetes every day, but I'm an internist as well. And today, we are talking about something that's not frequently talked about, especially for diabetics, that is B12 deficiency. Now, a lot of you may be B12 deficient, and you may not be even knowing it. So as a result, today, I'm going to talk to you about why you could be B12 deficient and the eight signs that you could be B12 deficient. So why do we talk about the signs? First of all, you need to know that this could be B12 deficiency. Second of all, it gives you a good reason for your doctor to check B12 levels, because with other reason, sometimes you get a bill at your door saying that your doctor ordered this for no reason. Well, it's not for a reason, but you have to give a doctor to a good reason for him to order instead of just ordering without a good reason. That's called coding, which politics, but whatever it is, it's important to talk with your doctor about your symptoms, and then let your doctor figure it out. All right, guys, before we get started, please make sure you write a comment, ask questions, be part of the community, share these videos, and more importantly, give a thumbs up and we'll talk about it more. Let's get started. All right, guys, so if you have diabetes and you have been taking metformin for a while, again, we have metformin videos, side effects, we have all this in a separate video, you can definitely find that out. And the bottom line is if you're taking metformin for a long time, your B12 levels may be low. Well, that happens because metformin in the long term, slowly, but surely, it reduces the absorption of B12. So you may be getting B12 in your diet, and B12 is a stored vitamin, so you're not going to lose your vitamin very quickly. If you are introducing vitamin B12 in your diet, you will be able to keep up with about within years, chronic metformin exposure can definitely drain your B12 levels. That is more important for people who are at the older ages, they may be having problems like absorption problems already, so it's more prevalent in older individuals. But also, if you are a vegan, if you're not eating a lot of animal products that also can contribute to a rapid reduction in your B12 levels. All right, so now let's get started on eight signs that you could be B12 deficient. So B12 is very important. Number one is the pale and jaundiced skin. So why would you look pale and jaundiced? Well, B12 is very important in actually making red blood cells. Now red blood cells are important. Why? Because they are the ones that carry oxygen to your tissues. So if you do not have enough carriers of oxygen, then you're not going to really look right, you're going to look pale. And some of these red blood cells are also, they tend to die early, they look a little weird even under the microscope. They we call them megaloblastic. They're like a little large, a little fat, and they tend to go early. Now, when that happens, when the red blood cells get destroyed, they, you know, turn into Blurubin, and Blurubin is the one that gives you this yellowish tint on your skin or your eyes. So you may have a pale and yellow looking appearance, which makes you look like sick. All right, so if they, if they're telling you that you look sick, you better get checked that you make sure that you're not anemic, first of all. And then anemia can have multiple reasons. Iron deficiency is definitely common, but B12 deficiency is something that's not commonly checked. So definitely look into that. Number two would be weakness and fatigue. Again, if you are not having enough red blood cells, then you are not going to feel well because you're not going to have enough oxygen in your tissues and your muscles. So as a result, you're going to feel weak and tired. Now, there is a common practice. If you go to your primary care doctor and then you tell him that you're tired, they just throw B12 on you without checking anything. And just, they just think that, oh, here you go. You know, it will work. Now, half the time it works. Why? Because they tell you it will work. It's like a placebo effect. But if your vitamin B12 levels are already like 600, 800, and you start taking B12, your levels maybe actually end up being about 1000, then that actually has side effects. Then you may actually retain water. Things go the other way. Remember, in life, everything is about moderation. Too little or too much of anything is not going to be good for you. So it's always good to get checked first before you start taking B12. Now, number three, you may start developing neuropathy. Now, this is a nightmare for any diabetic. We know that because it is going to hurt you, it's not going to let you sleep. So whatever you can do to avoid neuropathy, do it. We had a Benphotiamine video, which is a great, great vitamin, thiamine or Benphotiamine. We have a link about that below. Make sure you watch that video as well. Very helpful for neuropathy. But if you have B12 deficiency, definitely you will feel it. The reason is B12 is a very important cofactor in producing a substance called myelin. Myelin is the sheet on your nerves that protects your nerves, but also allows the transmission of electrical signals. So it's like you have a wire with no plastic covering on it and all the wires are exposed. What happens when that happens? You'll get electro shocked, right? And then the transmission of the electricity is not be as smooth. So our body is just like that. Our nerves are covered with a sheet. If that sheet is not right, then there will be a lot of interruptions and misfiring and so forth. So when you're B12 deficient, you may get pins and needles sensation. That's most commonly that happens in your feet first and it can happens in your hands as well. If you have that, definitely get your vitamin B12 checked. Now, sometimes, you know, people come to conclusion very quickly just because you have pins and needles in your fingers doesn't mean that you're B12 deficient. You have to check it because there are a lot of other reasons to get pins and needles. So always, you know, have an idea of what's going on, but do not treat yourself. Make sure you get checked because if you do not have B12 deficiency, you may be calcium deficient, you may be magnesium deficient, but you don't want to overload yourself without knowing that you're really deficient, but it's a good reason to get your B12 checked. Number four is your balance may not be that great. So again, that's more common in elderly because they already have some degeneration in their nervous system. But again, like we said, it's all about the nerves. We have the vertebra that pretty much controls our sensations of in your, for example, on your feet, your nerve endings at the bottom of your feet keeps sending signals up to the nervous system to tell you where you are in space. So some of you, for example, may be walking or putting your feet down, you may not feel the ground, or you may feel like you have gravels under your feet, because your nervous system is not functioning properly. Now that could be a direct damage from high glucose and neuropathy. But if you have B12 deficiency on top of that, especially if you have been on metformin for a long time, definitely you will double the damage. So make sure your B12 is okay if you have neuropathy. Number five, you can have lesions on your tongue, some sort of like irritable or tender spots on your tongue. If you are experiencing that, again, I'm not saying there's always B12 deficiency, but B12 deficiency can be a reason. It could be a fungal infection. It could be any other dermatologic condition, such as lichen planus or anything like that. But if you have B12 deficiency, if you have other signs of B12 deficiency, like we discussed, this could be another one on your list. Now, number six, you may also feel like you're short of breath. And again, that boils down to anemia. So if you have anemia due to B12 deficiency, then you will gasp for air, just because your body wants that oxygen. And you do not have enough hemoglobin cells or red blood cells to carry that oxygen. So as a result, you're going to feel like you're short of breath. So don't assume you have a lung disease. You know, you don't assume you have B12 deficiency either, but make sure your doctor includes B12 in the workup if you have that problem. Now, number seven is the blurry vision. Again, blurry vision can happen from a lot of things, especially if your blood sugars are up and down all the time, you will have a blurry vision from changes in the thickness of your lens in your eye. That's very common. You're seeing because you haven't something called optic nerve. And optic nerve is a thick nerve. It's right behind your eye goes all the way the back of your brain to transmit those signals. But if you do not have that myelin sheet we discussed about that is intact. And if that's because of B12 deficiency, you will have visual disturbances as well. Last but not least, the mood disorders and depression can also happen B12. So if you go to a neurologist or a psychiatrist, two things they're going to check right away. Number one is your thyroid levels. Number two is your B12 levels. It's interesting that B12 levels can mess with your homocysteine levels. And that can trigger a depressive reaction as well. So again, B12 is involved in many ways in your nervous system. It can affect your balance, it can affect your mood, it can affect the sensations in your hands and feet. So especially if you have been on metformin for such a long time for years, you need to get checked for B12 deficiency. If you're a vegan, get checked for B12 deficiency. If you are elderly, your stomach may be developing something called prognosis anemia, which can lead to B12 deficiency as well. So even if you don't have diabetes and you're experiencing these symptoms that we discussed about, definitely get checked for B12 deficiency. Guys, please leave a comment, please give a like, and share this video. We'll appreciate it. See you in the next one.