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For this reason, our 2001 B12 recommendations in What Every Vegan Should Know about Vitamin B12 were focused as much on keeping homocysteine levels low as on preventing the traditional B12 deficiency symptoms of blood and nerve abnormalities

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These include new or worsening acne and excessive hair growth, unexplained weight changes, persistent fatigue, nipple discharge when not breastfeeding, severe pelvic pain, headaches or vision changes, hot flashes outside of the typical perimenopausal age, and difficulty conceiving

That means diagnostic rigor and safety-first protocols not a PA reading from a flowchart