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If you dont get enough B12 in your diet or through supplementation, you may develop one or more of the following symptoms [4]: - Mild fatigue during exercise or daily activities - Heart palpitations - Skin paleness or hyperpigmentation - Glossitis (tongue inflammation) - Neurological symptoms such as loss of reflexes, loss of proprioception (knowing where your limbs are without looking at them), forgetfulness Signs that healthcare providers use to detect a B12 deficiency include [4]: - Megaloblastic anemia (abnormally large and nucleated red blood cells) - Abnormal blood work, including decreased levels of haptoglobin