Can Low B12 Make It Hard to Walk? The Neurological Connection Explained

October 14, 2025 •

5 min read

According to the NHS, a lack of vitamin B12 can cause neurological problems that affect your nervous system, resulting in loss of physical coordination or ataxia, which directly impacts a person's ability to walk. This is a severe, but often overlooked, consequence of prolonged vitamin B12 deficiency, and yes, low B12 can make it hard to walk.

Quick Summary

A severe or chronic vitamin B12 deficiency can damage the nervous system, affecting motor skills, balance, and coordination, which can result in significant difficulty walking. Timely diagnosis and treatment are crucial to prevent irreversible neurological damage.

Key Points

Low B12 Directly Harms Nerves: A deficiency in vitamin B12 causes nerve damage by degrading the protective myelin sheath, disrupting signal transmission.
Neuropathy and Ataxia Affect Gait: B12 deficiency can lead to peripheral neuropathy (numbness and weakness) and ataxia (poor balance and coordination), both of which impair walking.
Serious Spinal Cord Damage is Possible: In severe cases, low B12 can cause subacute combined degeneration of the spinal cord, leading to progressive motor problems.
Early Intervention is Crucial: Untreated neurological damage from B12 deficiency can become irreversible, emphasizing the need for timely diagnosis and treatment.
Treatment Often Involves Injections: For those with significant neurological symptoms or absorption issues, B12 injections are the standard treatment, followed by ongoing supplementation.
Physical Therapy Aids Recovery: In addition to supplementation, physical therapy and rehabilitation can help individuals regain balance and mobility.

The Essential Role of Vitamin B12 in Nerve Health

Vitamin B12, or cobalamin, is a water-soluble vitamin essential for a wide range of bodily functions. Beyond its well-known role in red blood cell production, B12 is critical for maintaining a healthy nervous system. It plays a crucial part in the production and maintenance of the myelin sheath, a protective layer that insulates nerve fibers throughout the body. This myelin sheath ensures that nerve impulses travel swiftly and efficiently. When B12 levels are critically low, this protective covering can begin to degenerate, leading to a cascade of neurological issues.

Without an intact myelin sheath, nerve signals can become distorted, slowed, or fail to transmit altogether. This affects the communication between the brain and the rest of the body, particularly the limbs, leading to a host of problems that can severely impact mobility. The longer the deficiency persists, the more extensive the potential nerve damage becomes, increasing the risk of permanent neurological damage.

How a Deficiency Can Directly Impair Walking

The deterioration of nerve health due to low B12 can manifest in several ways that directly contribute to difficulty walking:

Peripheral Neuropathy

One of the most common neurological consequences is peripheral neuropathy, which specifically affects the nerves in the extremities, especially the legs and feet. This condition can cause a range of debilitating sensations and physical impairments, including:

Numbness and tingling: Often described as "pins and needles," this sensation is caused by nerve damage interfering with normal sensory signals. This lack of feeling can make it difficult to perceive the ground beneath your feet, leading to an unsteady gait.
Muscle weakness: Nerve damage can weaken the muscles in the legs and feet, making it difficult to lift the feet properly or maintain a stable stance.
Altered sensations: Some individuals experience burning sensations in their feet, which can cause discomfort and further disrupt normal walking patterns.

Ataxia and Balance Issues

Loss of physical coordination, known as ataxia, is another direct result of B12 deficiency affecting the central nervous system. Ataxia can cause a staggering or clumsy gait and general problems with balance. The brain's ability to process proprioception—the body's sense of its own position in space—is compromised. Without this vital feedback, the body struggles to maintain balance, making simple acts like walking or standing challenging and unsafe.

Subacute Combined Degeneration of the Spinal Cord

In severe and untreated cases, B12 deficiency can lead to a condition called subacute combined degeneration (SCD) of the spinal cord. This is a particularly dangerous form of myelopathy, which involves the progressive degeneration of the spinal cord's posterior and lateral columns. SCD directly impacts motor functions, leading to significant weakness, stiffness, and gait disturbances. If left untreated, the damage can become irreversible.

A Broader Spectrum of Symptoms

While difficulty walking is a key symptom, it often appears alongside other signs of a vitamin B12 deficiency, highlighting the importance of a comprehensive diagnosis. Symptoms may include:

Extreme fatigue or lack of energy.
Numbness or tingling in the hands, legs, or feet.
Memory loss or cognitive difficulties.
A sore, red tongue (glossitis) or mouth ulcers.
Disturbed vision.
Psychological problems, including depression and confusion.
Weakness.

Diagnosis and Management

Diagnosing a B12 deficiency typically involves a series of blood tests. A doctor will likely start with a complete blood count (CBC) to check for macrocytic anemia, a hallmark of B12 deficiency characterized by larger-than-normal red blood cells. Serum B12 and folate levels will also be measured. In borderline cases, or to confirm the diagnosis, additional tests such as methylmalonic acid (MMA) and homocysteine levels may be ordered.

Key Considerations for Treatment

Treatment and prognosis depend on the underlying cause and severity of the deficiency. For those with significant neurological symptoms, including difficulty walking, treatment usually begins with a series of B12 injections. This is particularly crucial for individuals with malabsorption issues, such as those with pernicious anemia, as oral supplements are not effectively absorbed. High-dose oral B12 may be used for less severe cases or for maintenance after initial injections.

Comparing Treatment and Management Approaches


Feature	B12 Supplementation	Physical Therapy and Rehabilitation
Primary Goal	To correct the underlying vitamin deficiency and stop further nerve damage.	To address and improve existing gait and balance issues.
Method	Injections (e.g., hydroxycobalamin) or high-dose oral supplements.	Targeted exercises to improve balance, coordination, muscle strength, and proprioception.
Symptom Impact	Can reverse or significantly improve neurological symptoms, especially if detected early.	Directly works on improving functional mobility, even if some nerve damage is permanent.
Effectiveness	Highly effective for stopping disease progression and often reversing symptoms over time.	Can be crucial for long-term management and adapting to any persistent deficits, maximizing independence.
Timing	Administered immediately upon diagnosis and continued as long as needed.	Can be started alongside medical treatment to aid in recovery and regain function.

Conclusion

In conclusion, the answer to the question "Can low B12 make it hard to walk?" is a definitive yes. A severe or long-term vitamin B12 deficiency can lead to irreversible damage to the nervous system, resulting in peripheral neuropathy, ataxia, and potentially myelopathy, all of which directly impair a person's ability to walk and maintain balance. Early detection is paramount. If you or someone you know is experiencing unexplained mobility issues, fatigue, or other neurological symptoms, it is vital to consult a healthcare professional to get tested for B12 deficiency. Prompt treatment with supplementation can often halt the progression of nerve damage and, in many cases, lead to a significant improvement in symptoms and overall quality of life.

For a more comprehensive look at B12 deficiency and its management, consult authoritative sources such as the American Academy of Family Physicians (AAFP) guide on the topic.

Causes and Risk Factors

Pernicious Anemia: An autoimmune condition where the immune system attacks stomach cells, preventing the absorption of B12.
Dietary Factors: A strict vegan or vegetarian diet that excludes meat, dairy, and eggs can lead to a deficiency over time if not supplemented.
Malabsorption Issues: Conditions like Crohn's disease, celiac disease, and gastric surgery can interfere with the gut's ability to absorb B12.
Older Age: As people age, their ability to absorb B12 from food often decreases.
Medications: Certain medications, including proton-pump inhibitors and metformin, can reduce B12 absorption.
Excessive Alcohol Consumption: Chronic alcohol use can interfere with B12 absorption and storage.
Nitrous Oxide Exposure: Prolonged or repeated exposure to nitrous oxide can inactivate B12.

Frequently Asked Questions

B12 deficiency can cause nerve damage by interfering with the maintenance of the myelin sheath, a fatty layer that insulates and protects nerve fibers. When this sheath breaks down, nerve signals become inefficient, leading to neurological problems.

The progression can vary, but neurological symptoms often develop gradually over time as the deficiency persists. The longer the deficiency goes untreated, the more severe the symptoms, including difficulty walking, are likely to become.

For those with neurological symptoms or malabsorption issues, injections are often more effective initially because they bypass the digestive system and deliver the vitamin directly into the bloodstream. High-dose oral supplements may be suitable for long-term maintenance or less severe cases.

Walking difficulties can often improve with timely treatment. However, if the deficiency has caused long-term or severe nerve damage, some neurological effects may be irreversible.

You should start by consulting your primary care provider, who can order blood tests. They may then refer you to a neurologist for further evaluation and a physical therapist for gait training.

No, not always. While it is a potential symptom, not everyone with a B12 deficiency will experience difficulty walking. However, the risk increases with the severity and duration of the deficiency.

Peripheral neuropathy involves damage to the nerves in the extremities, causing symptoms like numbness and weakness. Ataxia is a lack of physical coordination and balance, stemming from central nervous system damage.