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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

Tolerability: Tolerability needs to be monitored especially as the dose is increased

see linked DOIs above