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For patients whose levels fall in the borderline or gray zone, a methylmalonic acid (MMA) test provides greater specificity MMA levels rise when B12 is functionally inadequate at the cellular level, even if serum B12 appears borderline normal

Inflamed gastrointestinal lining will impair nutrient and thyroid absorption, thus leading to nutrient deficiencies and possibly even thyroid hormone deficiency due to impaired absorption

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