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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