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[51] Diagnosis [edit] According to one review: "At present, no 'gold standard' test exists for the diagnosis of vitamin B 12 deficiency and as a consequence the diagnosis requires consideration of both the clinical state of the patient and the results of investigations." [52] The vitamin deficiency is typically suspected when a routine complete blood count shows anemia with an elevated mean corpuscular volume (MCV)

Further damage from inflammation comes directly from the triggering of death receptors leading to apoptotic death, and direct cell death by nitrogen oxide

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And why exceeding 50 mcg daily increases side effect risk without proportional benefit

Is this a known problem