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Recognising early warning signs is crucial because neurological damage can become irreversible if deficiency persists untreated

[7] [8] [2] The deficiency may occur in pernicious anemia, following surgical removal of the stomach, with fish tapeworm, or due to bowel cancer

doi:10.2174/1871525717666181211110332 Lu DY, Huang CC, Huang PH, et al

These patients may experience a blunted or impeded response to the intranasal medication

The impact can be significant, both mentally and physically

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