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Brain function: Brain fog, memory problems, cognitive impairment, insomnia, headaches (especially migraine), behavioural changes, learning problems, nominal aphasia Mood: Mood swings, irritability, depression, anxiety, hallucinations, delusions, psychosis Sensory: Peripheral paraesthesia (pins and needles), numbness, neuropathic pains, poor balance, reduced vibration sense or proprioception (joint position sense), tinnitus, ataxia, taste impairment, sometimes myelopathy Constitutional: Fatigue, anaemia (either macrocytic, or normocytic when also iron deficient or associated with thalassaemia minor), other cytopenia, abdominal complaints, malabsorption, failure to thrive, weight loss, diarrhoea, hyperpigmentation, glossitis, (aphthous) stomatitis, infertility, urinary tract infections Motor: Muscle weakness, altered reflexes (increased in degeneration of the spinal cord, reduced when peripheral neuropathy dominates), spasticity, seizures, cardiomyopathy Autonomic: Urinary and/or faecal incontinence, postural hypotension or dizziness, erectile dysfunction Diagnosing B 12 deficiency can be challenging because no single specific measurement exists to reliably diagnose or refute the presence of B 12 deficiency 11 12 26 27 (box 2)

if you develop symptoms like hives, difficulty breathing, chest tightness, or severe dizziness after an injection, seek medical attention, as those could indicate an allergic reaction (which is extremely uncommon)

Summary On Thursday an FDA advisory committee voted to loosen the 2023 ban on four of the seven peptides under reviewBPC-157, TB-500, KPV and MOTS-copening a path for compounding pharmacies (the specialty shops that mix drugs to order) to make and sell them

When energy drops, consistency often suffers

Neurologic symptoms The neurologic symptoms of vitamin B 12 deficiency are myriad and include numbness and tingling of the hands and, more commonly, the feet (peripheral neuropathy)

NICE guidance recommends 1 mg hydroxocobalamin three times weekly for 2 weeks for patients without neurological symptoms, with lifelong maintenance therapy for irreversible causes