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However, observational studies suggest that whilst acute toxicity remains exceptionally rare, sustained very high levels of B12particularly from supplements or injectionsmay be associated with certain health concerns, though these are correlations rather than proven causal relationships

This is because issues with regular function of the gastrointestinal tract can prevent the proper release and absorption of the vitamin, which can cause a deficiency if not supplemented properly

doi:10.1016/j.bcp.2019.02.008 (PMID 30753815) Pissios P

When B12 levels are low, fatigue, weakness, poor focus, and low mood can become more noticeable