The client has serum B12 greater than 2,000, high active B12, holotranscobalamin greater than 256, lab ranges from 25.1 to 165, serum MMA normal at 150, significant deficiency symptoms including peripheral neuropathy, loss of balance, and high homocysteine. What could this mean?

One of the questions about peripheral neuropathy and loss of balance and even high homocysteine, I mean, those aren’t necessarily going to be due to B12 deficiency and the serum methylmalonic acid is within normal limits, so it’s hard to say that B12 isn’t getting into the cells, I think, because of peripheral neuropathy and loss of balance, so peripheral neuropathy can be due to a heavy metal toxicity. [As for] loss of balance, if the person is still eating gluten, could this be gluten ataxia? Could this be due to other causes of inflammation, certainly the loss of balance. I mean, I would look into that a little bit more before just saying that it’s due to B12. Again, for high homocysteine, I sometimes find that supporting patients by increasing choline in the diet [helps]. Sometimes, I’ll increase collagen peptides in the diet, finding that improving the glycine-to-methionine ratio could actually improve the homocysteine level. I might actually start thinking about other potential causes of the neuropathy, ataxia, or whatever the loss of balance. I don’t know if it’s just ataxia or there’s something different, more specific, that you’re seeing, and then again, the high homocysteine. Remember that you might need to bring in something like choline. You do need other B vitamins for that homocysteine kind of recycling. Think about if they are getting the full complement of B vitamins. Is there choline in the diet? Do you need to change the glycine and methionine? Think about some other contributing factors. I wouldn’t quite be ready to settle on just saying that B12 is not getting into the cell.