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Signs and symptoms of vitamin B12 deficiency can include fatigue, pale skin, headaches, shortness of breath, fast heartbeat, gastrointestinal issues, mouth inflammation, paresthesias (abnormal sensations), decreased cognitive ability, depression, muscle weakness, imbalance and incoordination, vision problems, and erectile dysfunction

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The most common issues, if any, are mild, such as nausea or irritation from the nasal spray

Bistrian, Chief of Clinical Nutrition, Beth Israel Deaconess Medical Center What Happens If Vitamin B12 Is Low