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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and later versions.Written informed consent was approved by the IRB and signed by all participants before enrolment

Other signs may include shortness of breath, pale skin, stomach problems, such as constipation, diarrhea or gas, or nerve problems, like muscle weakness or tingling in fingers or toes. Over time, a deficiency of B12 can cause problems with balance, confusion, depression, poor memory and possibly dementia, and it can even cause permanent damage to the nervous system, Somers says