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The signs of B12 deficiency extend well beyond hair changes and may include: Persistent fatigue and low energy Pale or slightly jaundiced skin Pins and needles or numbness in the hands and feet A sore, red, or swollen tongue (glossitis) Mouth ulcers Cognitive difficulties, including memory problems or difficulty concentrating Low mood or depression Disturbed vision In more severe or prolonged cases, neurological symptoms such as difficulty walking, balance problems, and peripheral neuropathy may develop