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Freezing damages B12, and a frozen vial should be discarded

No one has tested whether the effects are additive, synergistic, or negligible when combined

If clinically appropriate, treatment options may be discussed and fulfilled through licensed providers and pharmacies where permitted

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Here are some signs you have PA: Early signs of pernicious anemia Fatigue (many people wake up tired despite getting enough sleep) Shortness of breath Feeling dizzy Loss of appetite Diarrhea or constipation Lightheadedness when standing up or moving around Pale or yellow skin (in people of European ancestry) Heartburn Swollen tongue Long-term signs of pernicious anemia Short-term memory loss Trouble with balance (for example, struggling to put on your pants or socks while youre standing) Burning feeling in your legs or feet that may get worse at night Depression Trouble focusing and confusion Cold hands and feet Hallucinations Eyesight problems Pernicious anemia tongue About 25% of people with pernicious anemia have symptoms on their tongues