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GENERAL INFORMATION

extreme tiredness (fatigue) shortness of breath chest pain or tightness problems with memory and concentration (brain fog) difficulty sleeping (insomnia) heart palpitations dizziness pins and needles joint pain depression and anxiety tinnitus, earaches feeling sick, diarrhoea, stomach aches, loss of appetite a high temperature, cough, headaches, sore throat, changes to sense of smell or taste rashes Ah

Brain function: Brain fog, memory problems, cognitive impairment, insomnia, headaches (especially migraine), behavioural changes, learning problems, nominal aphasia Mood: Mood swings, irritability, depression, anxiety, hallucinations, delusions, psychosis Sensory: Peripheral paraesthesia (pins and needles), numbness, neuropathic pains, poor balance, reduced vibration sense or proprioception (joint position sense), tinnitus, ataxia, taste impairment, sometimes myelopathy Constitutional: Fatigue, anaemia (either macrocytic, or normocytic when also iron deficient or associated with thalassaemia minor), other cytopenia, abdominal complaints, malabsorption, failure to thrive, weight loss, diarrhoea, hyperpigmentation, glossitis, (aphthous) stomatitis, infertility, urinary tract infections Motor: Muscle weakness, altered reflexes (increased in degeneration of the spinal cord, reduced when peripheral neuropathy dominates), spasticity, seizures, cardiomyopathy Autonomic: Urinary and/or faecal incontinence, postural hypotension or dizziness, erectile dysfunction Diagnosing B 12 deficiency can be challenging because no single specific measurement exists to reliably diagnose or refute the presence of B 12 deficiency 11 12 26 27 (box 2)

Forms Available Oral B12 comes in several forms, including: Tablets Capsules Lozenges Sublingual drops (placed under the tongue) Pros of Oral Supplements Widely Available: You don't need a prescription to purchase them

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