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[26] A complication of severe chronic PA is subacute combined degeneration of spinal cord, which leads to distal sensory loss (posterior column), absent ankle reflex, increased knee reflex response, and extensor plantar reflex response

Others space it out to every few weeks or monthly

10.3390/brainsci13091289 Brain Sci

Certain B vitamins, including B12 and folate, benefit gut health by supporting the growth of beneficial bacteria

In severe cases, prolonged deficiency can cause nerve damage, difficulty walking, and cognitive decline, making early diagnosis and treatment essential