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However, its still possible to be deficient, especially if you: have certain medical conditions, such as pernicious anemia and Crohns disease take certain medications, such as proton pump inhibitors follow a strict vegan or vegetarian diet The following symptoms may signal youre not getting enough B vitamins: fatigue weakness dyspnea (shortness of breath) heart palpitations loss of appetite headaches mouth ulcers swollen tongue irritability depression indigestion diarrhea cognitive changes, such as confusion and memory problems Speak with a healthcare professional if you experience any of these symptoms

However, most data pertains to oral administration, with limited information on injection use.

The doctor may order blood tests to see if a slightly lower daily dose can still effectively manage the SPCD while reducing the amount of excess carnitine that fuels TMA production [6]

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