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Musculoskeletal toxicities usually include myalgias, arthralgias with elevated muscle enzymes signifying significant muscle destruction [26, 27]

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Conditions known to be associated with Paradoxical B12 deficiency include: Chronic Fatigue Syndrome Fibromyalgia Myalgic Encephalitis Autism Down Syndrome Cerebral Palsy (Bottinger etal, 2020) Insufficient intake of vitamin B2, Iodine, Selenium and/or Molybdenum Hypothyroidism Rheumatoid arthritis Cystic fibrosis Conditions which are associated with functional B2 deficiency, or where Paradoxical B12 deficiency should be suspected Gestational diabetes Obesity Diabetes Conditions of elevated serum vitamin B12 levels above the norm