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But if untreated, it may lead to symptoms such as: Weakness, tiredness, or lightheadedness Heart palpitations and shortness of breath Pale skin A smooth tongue Constipation, diarrhea, loss of appetite, or gas Nerve problems like numbness or tingling, muscle weakness, and problems walking Vision loss Mental problems like depression, memory loss, or behavioral changes Treatment If you have pernicious anemia or have trouble absorbing vitamin B12, you'll need shots of this vitamin at first