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[13] Additionally, the benefits demonstrated the reduction in visceral abdominal fat that remained for upwards of 52 weeks according to a double-blind placebo clinical trial

The American Academy of Family Physicians and NIH identify the following clinical manifestations: Fatigue and generalized weakness Megaloblastic anemia (abnormally large, immature red blood cells) Tingling or numbness in the hands and feet (peripheral neuropathy) Difficulty walking and balance problems Cognitive disturbances including memory difficulty and confusion Mood changes, including depression and irritability Glossitis (swollen, inflamed tongue) Early symptoms such as fatigue and mild tingling are often attributed to stress, aging, or other conditions

Pregnant women who are strict vegans or vegetarians are at an increased risk for deficiencies