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Key Takeaways Vitamin B12 is essential for nerve function, red blood cell formation, and DNA synthesis — deficiency can cause irreversible neurological damage if left untreated for extended periods B12 deficiency affects an estimated 6% of adults under 60 and nearly 20% of adults over 60 globally, with higher rates in vegetarians, vegans, and individuals from South Asia due to predominantly plant-based dietary patterns The 8 most common deficiency symptoms are: persistent fatigue, tingling or numbness in hands and feet, brain fog, mood changes, pale or yellowish skin, swollen or sore tongue (glossitis), balance problems, and shortness of breath A normal serum B12 level is 200–900 pg/mL — levels below 200 pg/mL indicate deficiency