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Haematological Isolated red cell macrocytoisis Macrocytic anaemia (especially if MCV more than 110fl) Pancytopenia (especially if MCV more than 120fl) Neurological or Psychiatric Optic neuropathy Peripheral neuropathy (sensory or motor) Symmetrical neuropathy affecting the legs more than the arms

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However, the full benefits, including improved mood, enhanced mental clarity, and better metabolism, typically develop over 2-3 weeks of consistent treatments