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If increased homocysteine or methylmalonic acid levels and a normalization of these metabolites in response to replacement therapy are used as diagnostic criteria for vitamin B 12 deficiency, approximately 50 percent of these patients have serum vitamin B 12 levels above 200 pg per mL

Lab monitoring Before starting supplementation, your provider may recommend checking vitamin B12 levels using tests such as serum B12, methylmalonic acid (MMA), or homocysteine

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