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Symptoms of severe vitamin B12 deficiency can include visual disturbances, severe joint pain, paresthesia (tingling in the hands and feet), memory problems, depression, anxiety, poor muscle function, ataxia (impaired balance and coordination), changes in reflexes and even infertility

Front Immunol 13:772446 Huang J, Yi H, Zhao C, Zhang Y, Zhu L, Liu B et al (2018) Glucagon-like peptide-1 receptor (GLP-1R) signaling ameliorates dysfunctional immunity in COPD patients

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People with poor B12 absorption may also benefit from injections more than oral supplements