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Approximately 90% of people who follow a vegan or vegetarian diet are deficient in vitamin B12 (The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature)

This effect is thought to be mediated through GLP-1 receptors in the cardiovascular system and is generally not clinically significant, though patients with certain arrhythmias or those sensitive to heart rate changes should be monitored

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Pernicious Anemia: This is an autoimmune disorder where the body mistakenly attacks a protein in the stomach called "intrinsic factor." Without this protein, you simply cannot absorb B12 from food, making injections a lifelong necessity