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We look at the patients goals, medical background, and realistic next steps before making recommendations. Karla K

A study conducted in 2016 thus came to the following conclusion: If we had restricted the treatment of symptomatic patients to patients with both low serum levels and elevated metabolite levels, 63% of patients who responded well to the therapy would not have received treatment [] Only 16% of patients with good clinical improvement from vitamin B12 therapy had low serum levels and 54% of patients with good clinical improvement from vitamin B12 therapy had serum levels higher than 300 pg/mL. Some experts thus advise high-dose B12 treatment to treat all known nervous symptoms associated with B12 deficiency

the R-form of methionine sulfoxide is reduced by MsrB1, 2, or 3

Starting with lower doses and gradually increasing can help minimize any gastrointestinal adjustment

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