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[20] Patients should contact their GP or bariatric team promptly if they experience any of the following: New or worsening tingling, numbness, or weakness in the limbs Difficulty with balance, coordination, or memory Unexplained fatigue, breathlessness, or palpitations A sore or swollen tongue, or persistent mouth ulcers Any concern that they have missed supplementation for a prolonged period Symptoms that suggest anaemia, such as pallor or dizziness New or worsening neurological symptoms such as paraesthesia, gait disturbance, or cognitive change warrant same-day assessment

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post-gastric bypass surgery) Pregnancy Malabsorption diseases (Celiac Disease, Colitis, Crohns disease) Lack of or deficiency of stomach acid

It causes oxidative damage to the cells lining blood vessels (endothelial cells), which promotes a hypercoagulable state