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B12 deficiency is extremely common in India as is Vitamin D, folic acid, or iron deficiency, all because malnutrition is extremely common, even among the rich. The reasons for these are too many and are related to diet, lifestyle, and social and cultural issues. Any one of its varied manifestations can occur in isolation and can be coexisting with other comorbidities. In addition, the symptoms are modified also by the underlying disorder causing its deficiency. In spite of being a common disorder, its recognition is delayed or missed because the manifestations are diverse in nature, affecting all the organs and systems, and is often subclinical. To add to the confusion, laboratory estimations are notoriously unreliable even from the best of centers and doctors tend to rely on laboratory estimate of B12 levels. In this scenario, the doctors in India have to sharpen clinical skill to make a clinical judgment and initiate therapy and advocate a diet plan to give benefit to the patient. The ways and means of picking up those with clinical or subclinical B12 deficiency and the reasons and solutions to the problem are discussed in this article.