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Some of the serious symptoms of a B12 deficiency include tinnitus, severe joint pain, memory problems, depression, anxiety, impaired muscle function, ataxia, changes in reflexes, and even infertility
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It can be further oxidized to N-methyl-2-pyridone-5-carboxamide (2PY) and N-methyl-4-pyridone-3-carboxamide (4PY) in vivo and is easily excreted in urine in the forms of MNA, 2PY, and 4PY (in humans, the major metabolite of MNA is 2PY, and in rodents, the major metabolite of MNA is 4PY) [65–67]