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Thus, in my clinical practice, given the uncertainty about B12 blood levels, if a patient has symptoms suggestive of B12 levels affecting cellular function, unless he/she wishes to undertake further testing with homocysteine and MMA, a trial of sublingual B12 in the active form at 1-2000 mcg daily (to avoid malabsorption issues) is a reasonable course of action
Occasionally, some people notice mild, body-wide effects in the first day or so: Mild diarrhea or an upset stomach
