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Signs and symptoms of vitamin B12 deficiency can include fatigue, pale skin, headaches, shortness of breath, fast heartbeat, gastrointestinal issues, mouth inflammation, paresthesias (abnormal sensations), decreased cognitive ability, depression, muscle weakness, imbalance and incoordination, vision problems, and erectile dysfunction
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In addition, the concentration of cyanocobalamin is detectable in plasma only in smokers due to the increased cyanide exposure of cigarette smoke in combination with the dietary supplement (Domke et al., 2004)