Can Lack of B12 Cause Acid Reflux? The Surprising Link

Absolutely. Vitamin B12 is essential for nerve function and digestion. A deficiency can weaken the esophageal muscles, slow digestion, and contribute to acid reflux.

Certain B vitamins play a key role in digestion, supporting stomach acid production, gut motility, and nerve function—all of which impact reflux. This article will help you understand which B vitamins support digestion and the best ways to optimize your intake for better reflux symptom management and overall health.

Low stomach acid impairs B12 absorption by preventing the release of B12 from food proteins, a common issue in aging, acid-suppressing medications, H. pylori infections, gastric bypass surgery, and persistent stress.

Dietary deficiency of B12 is common in vegans, vegetarians, and those on restrictive diets, as B12 is naturally found only in animal products unless fortified foods or supplements are consumed.

Common symptoms include fatigue, brain fog, difficulty focusing, headaches, tingling in the mouth, tongue, fingers, and toes, vision problems, and weakness.

However, B12 deficiency can cause a wide range of issues affecting the nervous system, blood production, digestion, and mood. For a more comprehensive list, see the references in my Acid Reflux Vitamins post.

However, some symptoms do not appear until the later stages of B12 deficiency:

The four stages of B12 deficiency were outlined by Vincent Herbert in 1994:

Stage 1: The body starts using stored B12, but blood tests often appear normal, and there are usually no symptoms.

Stage 2: Some may begin to experience fatigue, weakness, brain fog, or headaches, though symptoms aren’t always noticeable.

Stage 3: Red blood cell production is affected, leading to tingling or numbness in the fingers, toes, lips, or mouth. Memory issues, difficulty concentrating, and more pronounced fatigue, dizziness, depression, anxiety, irritability, nausea, bloating, or constipation may also appear.

Stage 4: Symptoms from Stage 3 worsen, with possible nerve damage, burning pain in the hands and feet, balance and coordination problems, severe memory loss, hallucinations, heart palpitations, and shortness of breath.

Left untreated, vitamin B12 deficiency can continue to progress into later stages of development as described in the above Q&A on the four stages of B12.

Looking back, I was firmly in stage 3 but I had no idea these issues were connected to my reflux. Early detection is key—Thankfully, B12 deficiency can be reversed if caught in time, but prolonged deficiency can progress into permanent nerve damage.

Unfortunately, B12 deficiency does not always show up in standard blood tests because, while your body may be using up stores of B12, there can still be levels of B12 in your blood that are detectable but inactive and unusable in the body.

Oftentimes the first indication are the stage 3 vitamin B12 deficiency symptoms such as tingling in the extremities, fatigue, headaches, brain fog, difficulty concentrating, etc. If you’re experiencing any of these or would like to view a more comprehensive list, see the references in the B12 deficiency section of my Acid Reflux Vitamins post.

A pale or yellowish complexion can be a tell tale sign of B12 deficiency due to the impaired development of red blood cells. Individuals with B12 deficiency can often complain of tingling, numbness, a crawling sensation, or burning sensations in the mouth and tongue.

For me, the worst symptoms were the brain fog, memory loss, and difficulty concentrating. For the longest time I didn’t realize my increasing struggles in these areas were at all related to my reflux. I struggled daily with severe social anxiety as a result.

If you’re struggling with some of the symptoms discussed in this article, my comparison on the various types of B12 can help you find a high quality option. To read it, click here.