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Health and social care professionals need to acknowledge that their patients are living with ME/CFS, and how they have symptoms that severely affect them (11)

Common symptoms of vitamin B12 deficiency: Fatigue and a subjective feeling of low energy levels Hair loss and changes in skin color (usually manifests as pale skin) Brain and cognitive issues like decreased memory, depressive-like symptoms, mood changes, and brain fog Shortness of breath or difficulty with sustained exercise Megaloblastic anemia Depression and even a dementia-like syndrome can be confused with Alzheimers Nerve conditions like nerve pain and peripheral neuropathy Why are the symptoms so diverse

A study published in 2020 found that women with sufficient vitamin B12 levels had better reproductive outcomes
E.DorseyD.KleinR

In the present study, 18 subjects were assigned to each of the considered two groups to detect a change of 4.7 mol/l in serum levels of homocysteine with 90% power and 5% significance

Therefore, it should be kept in mind that these symptoms, as well as those described below, may be just as common or even more common in the BH 4 Ds other than SRD, but underestimated in published reports where patients clinical phenotypes were less precisely characterized
