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Clinical signs of B12 deficiency include nausea, vomiting, loss of appetite, poor absorption of food (malabsorption syndrome), constipation, gas, weight loss, fatigue, lethargy, abdominal pain, and diarrhea

Pregnant or breastfeeding individuals should consult first, but most enjoy benefits without complications

In 2014, the European Medicines Agency (EMA) approved afamelanotide (Scenesse) for the treatment of EPP, making it the first melanocortin receptor agonist to receive regulatory approval for a medical condition

593 Current research on DN and its associated complications remains limited in terms of comprehensive management and multidisciplinary collaboration, and the interactions between different complications remain poorly understood

Certain medications , including acid reducer medication which interferes with B12 absorption and oral contraceptives