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Position the vial upright and away from the refrigerator door where temperature fluctuations occur

But the studies included were small and only lasted about 3 to 4 months

The 4 stages of B12 deficiency include (31): Stage 1: decreased levels of vitamin B12 in your blood Stage 2: low levels of vitamin B12 in your cells along with metabolic abnormalities Stage 3: neurological and psychological symptoms like anxiety, confusion, problems with balance, and others Stage 4: macrocytic anemia very large red blood cells (32) B12 deficiency can cause a variety of symptoms, including fatigue, headaches, depression, pale or yellow skin, mental impairment, and pain and inflammation in the mouth and tongue

Some people also give themselves injections under the skin

Treating pernicious anemia by diet alone, though, is likely not going to work due to the damage to the cells that make intrinsic factor