Common overlapping symptoms include: Changes in sleep patterns, ranging from insomnia to excessive sleeping Mood swings and emotional instability, which may fluctuate throughout the day Difficulty maintaining relationships, both personal and professional Problems at work or school, including decreased performance and attendance Loss of interest in previously enjoyed activities, often accompanied by social withdrawal Physical health deterioration, including changes in appetite and energy levels Social isolation and withdrawal, which can worsen both conditions These overlapping symptoms often mask underlying conditions
This exact pattern has generated hundreds of poison control calls and FDA adverse event reports
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In the primary healthcare setting, the most commonly seen causes of vitamin B12 deficiency are related to abnormalities of digestion (atrophic gastritis, achlorhydria or the consequences of gastrectomy) or absorption (autoimmune pernicious anaemia, chronic pancreatitis, Crohns disease, the effect of medications that alter the mucosa of the ileum, or the consequences of surgical resection), and, to a lesser extent, a lack of exogenous supply
