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Common symptoms include: Fatigue and weakness — One of the earliest and most common complaints Pale or yellowish skin — Due to reduced red blood cell production Shortness of breath — From anemia reducing oxygen-carrying capacity Numbness or tingling in hands and feet — A sign of nerve damage Balance problems and difficulty walking — Neurological manifestation of deficiency Memory problems or brain fog — Cognitive effects of low B12 Mood changes, depression, or irritability Sore, red, or swollen tongue (glossitis) Mouth ulcers Constipation or diarrhea Neurological symptoms — numbness, balance issues, cognitive changes — can become permanent if deficiency is not treated promptly

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Biochemistry 64 , 2699–2711 (2025)