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Seek medical advice if you experience: New-onset insomnia or significant sleep disruption that persists after starting B12 supplementation Paradoxical fatigue : Worsening tiredness despite taking B12, which may indicate an underlying condition requiring investigation Neurological symptoms : Tingling, numbness, balance problems, or cognitive changes, which could suggest B12 deficiency or other neurological conditions Mood changes : Anxiety, agitation, or depression that develops or worsens after starting supplementation Palpitations or rapid heartbeat : Though rare, some individuals report cardiovascular symptoms that should be evaluated It's important to note that sleep disturbances may be unrelated to B12 supplementation