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Clinical deficiency with clearly low blood levels affects a smaller percentage, but a much larger group falls into a gray zone where levels are low enough to cause subtle symptoms without triggering an obvious diagnosis

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Other signs may include shortness of breath, pale skin, stomach problems, such as constipation, diarrhea or gas, or nerve problems, like muscle weakness or tingling in fingers or toes. Over time, a deficiency of B12 can cause problems with balance, confusion, depression, poor memory and possibly dementia, and it can even cause permanent damage to the nervous system, Somers says