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A B12 deficiency which is remarkably common, especially among vegetarians, vegans, and adults over 50 can lead to persistent fatigue, brain fog, mood changes, and even numbness or tingling in the extremities

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Win KT, Lee SW, Huang HY, Lin LC, Lin CY, Hsing CH, Chen LT, Li CF (2013) Nicotinamide N-methyltransferase overexpression is associated with Akt phosphorylation and indicates worse prognosis in patients with nasopharyngeal carcinoma

However, persistent or severe fatigue is not expected