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Signs and Symptoms of Vitamin B12 Deficiency Early symptoms: Weakness and fatigue Pale skin Headaches Mild mood changes Intermediate symptoms: Tingling or numbness in hands and feet Breathlessness Heart palpitations Mouth ulcers or a red, swollen tongue (early to intermediate signs) Advanced symptoms: Memory problems Depression, anxiety, mood swings Poor balance or coordination Weight loss, poor appetite Constipation or loose motions Visual disturbances In some cases, long-term deficiency can cause permanent nerve damage , so early detection is key