B12 deficiency: Pain in one body part ‘at rest’ may signal ‘significantly’ low B12 levels

Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency

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Vitamin B12 is critical for supporting the production of DNA and red blood cells. When the nutrient cannot be absorbed by the body, a deficiency ensues. This shortfall usually prompts an increase in homocysteine, which in turn may interfere with tendon integrity. Eventually, this could lead to a tear in the rotator cuff.

According to High Mountain Orthopaedics: “The rotator cuff (RC) is responsible for stabilising and moving the shoulder.

“When patients tear their RC, they typically experience pain, instability, and have a difficult time performing day-to-day activities.”

The condition may also cause “pain that keeps coming back, especially when doing certain things, such as lifting your head,” according to the Cedars Sinai. This may prevent you from sleeping.

The two main causes of tears in the RC are injury and degeneration, but some studies have suggested low B12 levels may be related too.

READ MORE: B12 deficiency symptoms: ‘Tired all the time’? Expert details the ‘easy to ignore’ sign

A study published in the journal of BMC Musculoskeletal Disorders in 2021, investigated the relationship between vitamin b12 levels and degenerative rotator cuff tear in a small sample of participants.

The study looked at 87 consecutive patients with or without the shoulder injury and had all possible risk factors assessed.

“The group of patients with degenerative RC tear had […] significantly lower [b12 levels] than the healthy control group,” noted the study authors.

They concluded: “Low serum levels of vitamin B12 were independently related to degenerative RC tear.”


The findings, however, warrant further research to elucidate the role of vitamin B12 in preventing the condition.

According to Harvard Health, recovery time from rotator cuff tendonitis generally ranges between two to four weeks, but stubborn cases can require several months of rehabilitation.

So when the signs first emerge, the focus should be on reducing swelling and inflammation of the tendons.

The rotator cuff, located in the shoulder, comprises shoulder tendons that work together to stabilise the joint, rotate the shoulder, and lift the arm above the head.

Tendonitis usually starts off with low-grade inflammation of one tendon and could spread to all three others if the condition advances.

Who’s at risk?

Vitamin B12 can be sourced from meat, dairy and eggs, so those who cut out these foods from their diet may be at risk.

Fortunately, once ingested, the nutrient is stored in the liver where it can sustain the body’s needs for years.

“Patients who have followed a strict vegan diet for approximately three years may develop a B12 deficiency from a lack of dietary intake,” according to the National Library of Medicine.

During digestion, vitamin B12 combines with a protein called intrinsic factor, which enables its absorption further down in the intestine.

The natural substance is usually produced in the lining of the stomach, so anyone who undergoes gastric surgery could suffer low levels of intrinsic factor as a result.

Compared with the younger population, absorption of vitamin B12 is decreased in the elderly, owing to inflammation of the stomach.

People who fall under this category may be prescripted vitamin B12 injections or supplementation to help correct their B12 levels.

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