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When total B12 levels are difficult to interpret, measurement of holotranscobalamin (active B12), methylmalonic acid (MMA) , or homocysteine can provide a clearer picture of functional B12 status, though availability and interpretation vary (for example, MMA rises in renal impairment)

The list includes (but is not limited to) the following symptoms: Anemia Constipation Fatigue Headaches Mouth lesions Irritability Neurological issues What are the ASMBS Guidelines for Supplementing?* The ASMBS recommends that metabolic and bariatric surgery patients get 350 mcg - 1000 mcg of vitamin B12 daily from food and supplements

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And without strong data, most hospitals will switch to pantoprazole rather than experiment. The concern, he added, is not just the switch but what it signals