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Other common symptoms of B12 deficiency include: Lethargy or a total lack of energy Extreme fatigue Palpitations Pale skin Feeling faint Breathlessness Weight loss and loss of appetite Your doctor may prescribe B12 injections in extreme cases that take effect right away

High-dose supplementationparticularly intramuscular injections that can deliver 1,000 micrograms or morecreates substantially elevated serum B12 levels compared to dietary intake, which may more readily trigger these bacterial changes, though comparative studies between different forms are limited