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Additional symptoms are included below aside from the ones mentioned above: a sore tongue constipation difficulty thinking and remembering dementia fatigue heart palpitations infertility low appetite mood changes numbness and tingling sensation in the hands and feet pale skin weight loss Other conditions that may affect vitamin B12 release or absorption are related to the gastrointestinal tract, including the following: celiac disease Crohns disease fish tapeworm infestation bowel or pancreatic cancer folic acid deficiency overgrowth of bacteria in the small intestine pernicious anemia (can lead to gastric atrophy or stomach damage) Moreover, those who have undergone gastrointestinal surgery, including weight loss surgery, may have fewer cells necessary to secrete stomach acid and intrinsic factors

Gut Microbiota and Iron: The crucial actors in health and disease

is supported in part by a Banting and Best Diabetes Centre Novo Nordisk Chair in Incretin Biology, and a Sinai Health Novo Nordisk Foundation Fund in Regulatory Peptides

Front Microbiol 12:657467

NNMT is not simply a metabolic toxin The enzyme and its products have physiological roles

While vitamin B 12 deficiency is not a primary test in newborn screening programs, a study showed that markers C3, C3/C2, and C3/C16 exhibit a negative correlation with maternal levels of vitamin B 12 in the first trimester of pregnancy, and thus may bear diagnostic value (Dayaldasani et al., 2014)