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The efficacy of oral supplementation of vitamin B12 is limited by factors such as the absence of IF, gastric surgery, concomitant metformin, or antacid treatment

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Vitamin B12 deficiency symptoms include numbness or tingling in the hands, legs, or feet, difficulty walking, anemia, swollen tongue, weakness, fatigue, and cognitive difficulties, including memory loss

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The metabolic alterations are associated with increased expression of the ectoenzyme CD38 on CMV-specific CD8 + T cells