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this occurs because there is not enough vitamin B12 in the diet, or poor absorption Pernicious anemiaa type of megaloblastic anemia caused by a lack of intrinsic factor, so that vitamin B12 is not absorbed Fatigue, weakness Nerve damage with numbness, tingling in the hands and legs Memory loss, confusion Dementia Depression Seizures Up to 15% of the general population has a B12 deficiency

Martins F, Sofiya L, and Sykiotis GP, et al (2019) Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance Nat Rev Clin Oncol 16 (9) 563580 PMID: 31092901 22

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This integrated approach may allow lower doses or shorter cycles of BPC-157 while still achieving desired healing outcomes