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Ruff, D., et al

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Considering the latter possibility, treatments that were considered failures in previous clinical trials could be reanalyzed for potential efficacy in ALS, taking into account the duration of the disease at the start of therapy. Therefore, using diagnostic criteria that enables earlier identification of the disease and a change in the physicians attitude towards offering an early diagnosis and treatment could result in better ALS patient outcomes.

Of course, these symptoms can also be associated with a busy or stressful life where you may be grabbing food on the go and not looking after your diet, which can also lead to transient low Vitamin B12 levels

There isnt an easy remedy for this problem, but when labs are particularly bad, there tend to be a lot of discussion threads on various social platforms