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doi:10.1016/j.amsu.2020.11.010

Common symptoms can include : Tingling / numbness in hands/feet Tiredness, exhaustion, significant fatigue Brain fog, impaired thinking and memory Flaking nails, dry skin Shortness of breath Dizziness, difficulty with co-ordination, vertigo Fluctuating weight, gastrointestinal symptoms/poor digestion Irritability, problematic sleep, depression, low libido, mood swings Diagnosing Pernicious Anaemia Due to often slow-growing, generalised symptoms, PA is often overlooked and many can be without treatment for years

Perhaps most importantly, individuals with malabsorption issues may take oral supplements faithfully yet remain deficient, wasting money and time while symptoms persist

In clinical use, significant side effects are uncommon, and the vast majority of patients tolerate the therapy without problems