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Common symptoms include: Hematologic : Macrocytic (megaloblastic) anemia Pallor and shortness of breath on exertion Neurological : Paresthesias (tingling, “pins and needles”) in hands and feet Gait disturbances and balance problems Cognitive changes: memory lapses, “brain fog,” mood swings Gastrointestinal : Glossitis (inflamed tongue) Appetite loss and weight changes Nausea or diarrhea Because the nervous system can be permanently damaged if deficiency persists, early detection and correction are paramount