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In 1998, the recommended dietary allowance for all women of child bearing age who are capable of becoming pregnant was increased to 400 mcg of folic acid daily

Beyond extreme fatigue, patients commonly experience haematological symptoms including pallor (pale or yellowish skin), breathlessness on exertion, palpitations, and dizziness

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Metformin recipients also had significantly higher levels of homocysteine and methylmalonic acid (markers of B12 deficiency) and significantly worse scores on standardised clinical assessments of the severity of neuropathy