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On the other hand, if a vitamin B12 deficiency does occur, it is associated with several undesirable health risks, some of which are as follows: shortness of breath heart palpitations tingling or numbness in the extremities poor balance mood changes incontinence insomnia loss of concentration poor memory chronic fatigue Those who smoke cigarettes, consume excessive amounts of alcohol, or adhere to a vegetarian or vegan diet are at a greater risk of acquiring a nutritional deficiency than younger adults

Doses greater than 0.4 mg/day should be avoided until the diagnosis of pernicious anemia is ruled out

Supplementary information Supplementary Tables 1 and 2 (download XLSX Supplementary Table 1

This reduces the risk of toxicity associated with high-dose supplementation