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Clinical improvement often guides management more reliably than biochemical values alone

this is why most people do better with sublingual B12 tablets rather than vitamins

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Signs and symptoms: Many common symptoms can be caused by vitamin B12 deficiency, including weakness, tiredness, lightheadedness, heart palpitations, shortness of breath, pallor (pale skin), diarrhea, decreased appetite, nerve problems like numbness or tingling, visual changes and psycho-emotional problems like depression, memory loss or behavioral changes