As you can read in Part 1 of this article, the standard medical evaluation for B12 levels is by way of a blood test to determine the serum B12 levels. Normal blood levels are considered to be 200 – 900 pg/mL (pictograms per milliliter). Deficiency is normally diagnosed with serum levels below 200.
What Are B12 Deficiency Levels?
Sally Pacholok, co-author of Could It Be B12? An Epidemic of Misdiagnoses indicates that deficiencies begin to appear in cerebral spinal fluid with B12 levels below 550 pg/mL and suggests that normal serum B12 levels should be greater than 550 pg/mL. She further suggests that in older adults for prevention of disease and to maintain brain and nervous system health, serum B12 levels should be maintained near or above 1,000 pg/ml.
Back in 2000, when I completed my research on the B12 status of the select group on The Hallelujah Diet, I suggested the blood test for B12 was not adequate and recommended the MMA (methylmalonic acid) test of the urine. According to Dr. Eric Norman of Norma Clinical Lab, MMA is 40 times more concentrated in the urine than the blood and is the preferred test for ruling out a B12 deficiency when serum levels are questionable. As blood levels of B12 decrease, MMA levels of the urine increase. Urinary MMA levels should be less than 3.8 mcg/mg creatinine. Elevated levels of homocysteine (Hcy) in the plasma may indicate a vitamin B12, vitamin B6 or folate deficiency.
While the Hcy test is not necessary in evaluating a B12 deficiency, it can be a valuable adjunct when deficiency is suspected. Many B12 deficient patients will have elevated levels of homocysteine and be at greater risk of heart disease.
Overcoming B12 Deficiency
If a person is dealing with unresolved issues, experiencing symptoms that could be related to a B12 deficiency, it is wise to have B12 levels evaluated prior to supplementing with B12. Otherwise, if supplementation is started, there will be no way to accurately evaluate levels and know if the issues were B12 related or not. If a person is using a B12 supplement and experiencing what may be symptoms related to deficiency, a comprehensive B12 test may help determine if the current B12 supplementation is inadequate.
For significant or long-standing B12 deficiencies, intramuscular injections are the most efficient way of overcoming the deficiency. The injections need to be individualized as some people may be OK with monthly injections while others may require bi-monthly or even weekly injections. When more frequent injections are necessary, an individual may get a prescription from the doctor and administer their own injections.
The preferred form of B12 is the active form methylcobalamin (available without preservatives at compounding pharmacies). It is not widely used in the U.S. If methylcobalamin is not readily available, hydroxocobalamin would be an option that is still superior to the typical form, cyanocobalamin. Oral supplementation with methylcobalamin sublingually may be sufficient for many folks in overcoming a deficiency. The Hallelujah Diet B12, B6 & Folate supplement is a great option in maintaining B12 status once a deficiency is overcome. It should be noted that oral supplementation with an oral, sublingual B12/B6/Folate can help support a more optimal (lower) homocysteine level - elevated homocysteine is associated with cardiovascular disease.
I strongly encourage reading the book Could It Be B12? to grasp a much greater understanding of the potential for B12 deficiency, especially in people over the age of 40 regardless of diet. There are many factors apart from diet that can impact this devastating, silent crippler that is so easily preventable. Two Ways To Get Your B12! Both Hallelujah Diet's B12, B6 & Folate - B Vitamin Supplements and B-Flax-D Fiber supplements contain over 16,000% daily value of B12 (methylcobalamin) per serving!