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This assessment was repeated after 26 weeks of following experimental procedure

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When B12 runs low, symptoms tend to creep in slowly enough to get blamed on something else: persistent fatigue, brain fog, low mood, weight gain or difficulty losing weight, weakness, tingling in the hands or feet, shortness of breath, and a weakened immune system

Early diagnosis improves outcomes, so persistent or progressive symptoms should lead to a timely clinical assessment, often involving imaging and specialist referral

Acknowledgments The authors acknowledge the funding of the National Natural Science Foundation of China [No.82173989] and the support from the National Administration of Traditional Chinese Medicine [No.zyyzdxk-2023272]