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Signs and symptoms of vitamin B12 deficiency can include fatigue, pale skin, headaches, shortness of breath, fast heartbeat, gastrointestinal issues, mouth inflammation, paresthesias (abnormal sensations), decreased cognitive ability, depression, muscle weakness, imbalance and incoordination, vision problems, and erectile dysfunction

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Compounded medications provide for customization of strengths and volumes, as determined necessary by the prescribing physician for the identified patient, that may not be available in commercial products

However, since small intestinal permeability was significantly higher in patients with alcoholic liver diseases than in patients with chronic alcohol abuse in the absence of liver disease, the direct barrier toxicity of alcohol does not fully account for the permeability defect (155)