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Regular consumption of these foods or supplements is essential, especially for vegetarians and vegans, to maintain adequate B12 levels and support energy, red blood cell production, and nerve function

Although there are some secondary biomarkers such as the measurement of certain enzyme activities in the leukocytes or the excretion of 3-hydroxy-3-methylbutyric acid in the urine, these are ambiguous indications and only a few doctors are familiar with the corresponding tests (8, 9)

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A lack of intracellular cobalamin leads to reduced enzyme activity and an intracellular and subsequent systemic accumulation of methylmalonic acid (MMA), resulting in methylmalonic acidemia [29]

Vitamin B-12 is an essential nutrient that plays a vital role in the functioning of the human body