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Publication Bias The funnel plot of active smoking seems to be slightly skewed to the left, which indicates a potential lack of studies that favor a positive association of the disease with smoking (Figure 4)

This should give you a clear indication of where your parcel is

Tobacco chews were also a bit popular in those days

An elevated methylmalonic acid (MMA) level has been thought to be the most direct, metabolic indicator of B12 deficiency because B12 is the only cofactor required by the enzyme that degrades MMA

It's likewise important to monitor for signs of irritation or unusual changes in your mouth and seek medical advice if anything seems off