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Key Points Vitamin B12 Deficiency and Nerve Damage There are two ways in which B12 deficiency can lead to nerve damage: Myelinopathy : damage to the myelin sheaths (protective layer covering the nerves) Axonal degeneration : destruction and dying off of the nerve fibres and axons The central nerves of the spinal cord can also be affected, as well as the smallest nerve fibres in the peripheral nervous system – especially in the hands and feet