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Common signs and symptoms include the following: Cognitive issues, especially those that deal with memory Extreme fatigue Depression Frequent headaches Problems with maintaining balance Changes in vision Megaloblastic anemia Heart palpitations Pale skin Weight loss Infertility Numbness and tingling in the hands and feet A sore tongue Low appetite Constipation Vitamin B12 Deficiency Risk Factors You have a higher risk of developing vitamin B12 deficiency if you have specific health problems

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Activation (weeks 12): begin at the documented once-daily 330 mcg dose to establish tolerance and observe fluid-balance and injection-site response before committing to a full cycle

A recent randomized, double-blind, placebo-controlled pilot study compared intravenous NR (500 mg), NAD+ (500 mg), oral NR (500 mg), and saline placebo [5]