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Patients with these risk factors should discuss screening and supplementation strategies with their GP, particularly if experiencing symptoms such as fatigue, paraesthesia, glossitis, or cognitive changes suggestive of deficiency

Most people will see an improvement. Ruscio recommends a three-tier approach: a Lactobacillus and Bifidobacterium blend, the probiotic yeast Saccharomyces boulardii (for more information, see Protective Yeasts at below), and a soil-based probiotic

Diagnosis typically involves blood tests including full blood count (showing macrocytosis), anti-intrinsic factor antibodies (which are specific for pernicious anaemia), and sometimes anti-parietal cell antibodies

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