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National Institutes of Health lists the characteristics of B12 deficiency as: megaloblastic anemia (abnormally large and immature red blood cells) fatigue constipation loss of appetite neurological issues, such as difficulty with balance, depression, and confusion Certain people might also be more likely to need a vitamin B12 supplement: If you’re vegan or vegetarian If you follow a vegetarian or vegan diet, you’re at a higher risk of a vitamin B12 deficiency since meat, eggs, poultry, and other dairy animal products are the main sources of B12