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The aim is not simply to offer an injection, but to identify the treatment most likely to improve your function

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Methylmalonic acid and homocysteine levels provide accurate diagnosis when serum B12 falls between 200-400 picograms per milliliter (the gray zone where symptoms appear but standard tests show normal results)

Nitrous oxide, a commonly used anesthetic, oxidizes and inactivates vitamin B 12 , thus inhibiting both of the vitamin B 12 -dependent enzymes, and can produce many of the clinical features of vitamin B 12 deficiency, such as megaloblastic anemia and neuropathy