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Deficiency causes megaloblastic anemia — abnormally large, poorly functioning red blood cells — which reduces the blood's oxygen-carrying capacity and contributes to fatigue, pallor, and shortness of breath

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Being a vegetarian or vegan : This group consumes less foods that are naturally high in vitamin B12, such as beef and poultry (and sometimes dairy and fish too), which means their intake of vitamin B12 is lower whether their absorption is adequate or not