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Symptoms may include: Constantly feeling tired or chronic fatigue Muscle aches and weakness Joint pain Difficulty breathing or shortness of breath Feeling dizzy Poor memory Inability to concentrate well Mood changes, like increased depression and anxiety Having abnormal heart problems, such as palpitations Poor dental health, including bleeding gums and mouth sores Digestive problems like nausea, diarrhea or cramping A poor appetite A more serious deficiency can also cause a form of anemia called pernicious anemia, a serious condition that can cause memory loss, confusion and even long-term dementia

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Proton-pump inhibitors (e.g., omeprazole, esomeprazole, and lansoprazole), used to treat Zollinger-Ellison syndrome and gastroesophageal reflux disease (GERD), markedly decrease stomach acid secretion required for the release of vitamin B 12 from food but not from supplements

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