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As a matter of fact, no doctor will -at first impression- consider that my patient Charles, mentioned earlier, who needs three strong types of medication to suppress his severe neuropathy symptoms, needs so many medications because he is suffering from the placebo effect

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[10] Initial assessment involves: Detailed medical history, including dietary habits and gastrointestinal symptoms Medication review (certain drugs like metformin and proton pump inhibitors can affect B12 absorption) [20] [21] Family history of pernicious anaemia or autoimmune conditions Physical examination for signs of anaemia or neurological abnormalities Laboratory investigations typically include: Serum vitamin B12 level: The primary test, though interpretation can be complex

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