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There are often large gaps between total B12 and active-B12 levels in the blood

Department of Health and Human Services, ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/

Healthcare providers assess B12 status, medical history, and specific symptoms to determine treatment appropriateness

For example: Fatigue, unexplained weight loss, or abdominal pain may indicate liver disease or cancer Easy bruising, night sweats, or feeling full quickly (early satiety) may suggest a myeloproliferative disorder Swelling in the legs, reduced urine output, or persistent nausea may point to kidney disease In cases of very high B12 from injections (not oral supplements), some people have reported headache, nausea, diarrhea, facial flushing, or skin rash

All examinations were conducted by the same certified radiologist who was blinded to the study groups