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Patients who have undergone gastric banding should be aware of the following signs that may indicate falling B12 levels and warrant prompt blood testing: Neurological symptoms: Tingling, numbness, or 'pins and needles' in the hands or feet Difficulty with balance or coordination Memory problems, difficulty concentrating, or 'brain fog' Mood changes, including low mood or irritability Haematological symptoms: Persistent fatigue or weakness disproportionate to activity levels Breathlessness on mild exertion Pallor or a slightly yellowish tinge to the skin Other indicators: A sore, smooth, or inflamed tongue (glossitis) Mouth ulcers occurring frequently It is important to recognise that some of these symptoms particularly fatigue and low mood are non-specific and may overlap with other post-operative nutritional deficiencies, such as iron or vitamin D deficiency

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[33, 34] The most well-known is vitamin D deficiency, which can cause bone and joint pain, as well as a host of other symptoms

(2001) Liver-specific Igf-1 gene deletion leads to muscle insulin insensitivity

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Sequential therapy represents another consideration