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Difficulty walking

These are likely a byproduct of steadier blood sugar rather than a direct cognitive effect

Although vitamin B12 deficiency with these classic hematologic and neurologic signs and symptoms is rare (HughesJones & Wickramasinghe SN, 1996), low or marginal vitamin B12 status (serum B12 200300pg/mL [148221pmol/L]) without these symptoms is more common (i.e., up to 40% in Western populations), especially in individuals with low intakes of vitamin B12rich foods (NIH, 2024)

F., Bottiglieri, T., Jin, S., Stokes, K

In fact, the NAD + glycohydrolase activity of CD38 was essential for tumor progression by downregulating tumor suppressors (such as KEAP1) and upregulating oncogenes (such as NRF2) [46]

For plant-based eaters, fortified cereals, nutritional yeast, and B12 supplements can help fill the gap