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Before starting, a provider should review your health history, medications, allergies, wellness goals, and whether lab work may be useful

EXPLORE Primary Care Ongoing care for chronic conditions, prevention, and your annual physical

[20] Pernicious anemia may be present without a person experiencing symptoms at first, over time, feeling tired and weak, lightheadedness, dizziness, headaches, rapid or irregular heartbeat, breathlessness, glossitis (a sore red tongue), poor ability to exercise, low blood pressure, cold hands and feet, pale or yellow skin, easy bruising and bleeding, low-grade fevers, tremor, cold sensitivity, chest pain, upset stomach, nausea, loss of appetite, heartburn, weight loss, diarrhea, constipation, severe joint pain, feeling abnormal sensations including tingling or numbness to the fingers and toes ( pins and needles ), and tinnitus, may occur

Obese individuals under medication to control gastroesophageal reflux also may report vitamin B12 deficiency