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On examination, well-demarcated areas of pigmentation localized to knuckles of both hands were noticed (Figure 1)

Many people notice a difference in their energy levels within a day or two

Consult a doctor if you experience: Persistent fatigue that doesnt improve with rest Breathlessness during routine activities Frequent dizziness or fainting Heavy menstrual bleeding (more than 7 days or soaking pads rapidly) Blood test results showing hemoglobin below 10 g/dL Symptoms that are not improving despite two to three months of dietary changes Chest pain, severe weakness, or sudden fainting require emergency medical attention immediately

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This is because ATP is consumed at a high rate during exercise, which can lead to slight reductions in performance as ATP stores are depleted

While B12 plays a role in energy metabolism and red blood cell production, it's important to note that supplementation will only improve energy levels in people with an existing deficiency