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As mentioned above, some researchers suspect that the biotin deficiency that occurs during B12 therapy might be the cause of B12 acne: some people who take B12 experience severe acne, the cause of which has remained a mystery for years
The correlations between S-5-HT and fatigue were also similar
Further, long-term use of acid-reducing drugs and the anti-diabetes drug metformin and repeated exposure to nitrous oxide have been implicated in vitamin B 12 deficiency (see Drug interactions)
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Vitamin B12 and vitamin d deficiencies: an unusual cause of fever, severe hemolytic anemia and thrombocytopenia
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