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Research consistently shows an inverse association between serum B12 and serum MMA levels, although researchers havent found specific cutoff points for determining B12 deficiency by way of serum B12 or MMA levels using cross-sectional data (Bailey, 2011, Bailey, 2013)

According to the NIH, you absorb only about 50% of the B12 you take in

Vitamin B deficiency in older people: a practical approach to recognition and management

They advocate for a treatment approach that is: Symptom-led : Recognising that many patients become symptomatic well before their next scheduled dose, meaning they are being under-treated