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For this reason, deficiency can lead to widespread signs and symptoms, including: Pale skin Weakness, fatigue and light-headedness Constipation, diarrhoea or gas Loss of appetite Nerve issues like tingling, numbness and muscle weakness Impaired vision Hormonal and mood imbalances Sleep disturbance Reduced immunity Cognitive impairment Problems with balance Absorption of B12 The absorption of B12 in the body is a highly complex process which can be divided into three key phases: the gastric phase, the intestinal phase and the mucosal phase