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Persistent lumps that are hard, painful, and dont improve within the expected timeframe should also be checked

Seek urgent same-day assessment or call 999 for emergency care if experiencing: Severe chest pain Severe shortness of breath Fainting or collapse Acute or rapidly worsening neurological deficits (such as new limb weakness, sudden gait disturbance, or bladder/bowel dysfunction) Persistent or worsening anaemia symptoms despite treatmentincluding breathlessness, chest discomfort, palpitations, or extreme fatigueshould trigger medical review

Its often used to address deficiencies in B12, which can lead to fatigue, anemia, and neurological symptoms

Was there a placebo-controlled human trial

Certainly