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Vegans who do not pay careful attention to fortified food intake may be at risk for a deficiency

The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for the two primary biochemical outcomesserum vitamin B12 concentration increase and homocysteine reductionacross all included studies, and separately for randomised controlled trials (RCTs) and observational studies

This could be due to its effect on serotonin or even the increased energy levels

In one case study, a 5 month old breastfed infant of a vegan mother (who actually received a prenatal vitamin containing 96% of her daily needs of B12 throughout her pregnancy) presented with many of the above symptoms and required a 19 day hospital stay to stabilize