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Access typically requires specialist referral to endocrinology or reproductive medicine services, with NHS funding varying by integrated care board

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3 In B12 deficiency, methylmalonic acid (MMA) can accumulate, and it is thought that elevated MMA, alongside elevated homocysteine, contributes to damage of the myelin sheath (which protects nerve cells and speeds up nerve transmission), which can cause irreversible neurological problems

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The side effects due to this condition are not severe but can reduce the efficacy of the medication