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Since a large population of motor neurons and axons remain intact at symptom onset, the role of the immune system might be to protect these remaining neurons from degeneration

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High doses, often used to treat deficiencies, may lead to: Headaches, nausea, vomiting, and diarrhea Fatigue or muscle weakness Skin reactions such as rashes or itching Tingling or numbness in extremities Dizziness and, in severe cases, pulmonary edema and congestive heart failure Rare conditions like polycythemia vera, a slow-growing blood cancer In extremely rare cases, vitamin B12 can cause serious allergic reactions (anaphylaxis), characterized by facial swelling, difficulty breathing, and swallowing issues

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