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Vitamin B12 is the one nutrient a vegetarian diet cannot reliably provide from plants. It is made by microbes, and the foods that carry it are animal foods. Surveys of Indian adults have found low B12 levels to be very common, especially among strict vegetarians.

How much B12 do you need?

ICMR-NIN's 2020 allowance for adults is about 2.2 micrograms (µg) a day, a very small amount. The body stores B12 in the liver, so deficiency usually develops slowly, over years, which is why it is easy to miss.

Where B12 comes from

• Milk, curd, paneer and other dairy. The most important source for lacto-vegetarians. One to two glasses of milk and a katori of curd a day add up to a meaningful part of the requirement.
• Eggs, for ovo-vegetarians.
• Fish, meat and poultry, which are the richest sources.
• Fortified foods, such as some breakfast cereals, plant milks and nutritional yeast. Check the label for the amount of B12 per serving.

Plant foods such as spinach, mushrooms, tempeh or seaweed are often claimed to contain B12, but the forms they carry are generally unreliable for humans. Do not rely on them.

Who is most at risk

• Strict vegetarians who eat little dairy, and vegans.
• Adults over 50, because stomach acid and absorption decline with age.
• People on long-term metformin (a common diabetes medicine) or on acid-reducing drugs such as pantoprazole or omeprazole.
• People with gut conditions or those who have had stomach or intestinal surgery.
• Pregnant and breastfeeding women who are vegetarian, because the baby depends on the mother's stores.

Warning signs

• Tiredness and weakness, pale or slightly yellow skin.
• Tingling, numbness or "pins and needles" in hands and feet.
• Difficulty with balance, memory trouble, low mood.
• A sore, red tongue and mouth ulcers.

These are not specific to B12, and the same symptoms can come from anaemia, thyroid problems or diabetes. That is why the next step is a test, not a guess. Nerve symptoms deserve attention early, because delay can make the damage permanent.

Getting tested and treated

A blood test measuring serum B12 shows your level. Where the result is borderline, doctors sometimes also check homocysteine or methylmalonic acid. If you are low, your doctor will decide between oral tablets, a course of injections, or a combination, and how long to continue. Dose and duration depend on how low you are and whether the cause is diet or poor absorption, so this is a doctor's decision, not something to buy off the shelf and guess.

How to protect yourself through diet

• Include dairy daily: milk, curd, buttermilk or paneer. The more regularly, the better.
• Ovo-vegetarians can add eggs.
• If you eat little or no animal food, ask your doctor about a regular supplement and a yearly check.
• When buying fortified foods, check the label for the actual B12 content per serving. See how to read an Indian food label.

Frequently asked questions

Can vegetarians get B12 from food?

Yes, if they eat dairy or eggs regularly. Strict vegetarians who eat little dairy, and vegans, usually need a fortified food or a supplement.

Do spinach or mushrooms give vitamin B12?

Not in a form you can rely on. Do not count on plant foods for B12.

How do I know if I am low in B12?

Only a blood test confirms it. Symptoms such as tiredness and tingling in the hands and feet can have other causes.

Is it safe to take B12 tablets without a test?

B12 is generally low-risk, but a test first tells you whether you need it and which type of treatment suits you. Nerve symptoms should always be checked by a doctor.

Read next

• Iron-rich Indian foods for vegetarians
• Calcium-rich foods for vegetarians in India
• High-protein Indian foods: the vegetarian list with real numbers
• Dal for diabetes: which dal to eat and how much

Sources

• ICMR-National Institute of Nutrition. Recommended Dietary Allowances and Estimated Average Requirements for Indians, 2020.
• ICMR-National Institute of Nutrition. Dietary Guidelines for Indians, 2024.
• Indian Council of Medical Research and published Indian studies on vitamin B12 status in adults — surveys report that low B12 levels are common among Indian vegetarians; reported prevalence varies by study and population.

Figures marked with a tilde (~) are rounded estimates drawn from the sources above using standard home portions; real foods and recipes vary. This article is educational information, not medical or nutrition advice, and does not replace your doctor or dietitian.

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