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Diagnosis of elevated vitamin B12 begins with serum B12 measurement, typically performed as part of routine blood tests or when investigating anaemia, neurological symptoms, or other clinical concerns
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The correct approach: Test serum B12, MMA, and homocysteine not just serum B12 Use the functional cutoff of 500 pg/mL for optimal status, not the labs lower limit of 200 pg/mL Identify the cause diet, malabsorption, medication, or autoimmune Match the supplementation protocol to the cause and severity Retest to confirm response, and continue monitoring if the underlying cause persists If youre over 50, vegan, taking metformin or PPIs, or experiencing unexplained fatigue, brain fog, or neuropathy get tested
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