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Signs and symptoms of vitamin B12 deficiency can include fatigue, pale skin, headaches, shortness of breath, fast heartbeat, gastrointestinal issues, mouth inflammation, paresthesias (abnormal sensations), decreased cognitive ability, depression, muscle weakness, imbalance and incoordination, vision problems, and erectile dysfunction
When taken orally, metformin is concentrated in the intestine at levels up to 300 times greater than in the blood, significantly influencing the composition and metabolism of the gut microbiota [16]
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