How do we evaluate a marginally low B12 level?
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The best way to evaluate a low-normal B12 level is to check serum methylmalonic acid and homocysteine levels1 (strength of recommendation [SOR]: B, based on consistent level 2 or 3 studies). Give 1 or 2 mg of oral vitamin B12 a day if levels are marginally low and either methylmalonic acid or both methylmalonic acid and homocysteine are elevated (SOR: A).
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