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A blood test is an indication for how much the brain might have access to B12, but if for instance the blood-brain barrier does not absorb enough B12, the brain will have too little B12, while the blood test is normal

The amount of drug reaches the circulation, the effects are stronger

Boch J, Scholze H, Schornack S, Landgraf A, Hahn S, Kay S, Lahaye T, Nickstadt A, Bonas U

This mechanism becomes clinically important when using high-dose oral supplements (typically 1000 micrograms or more), as it can provide adequate absorption even when the intrinsic factor pathway is impaired

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According to medical studies, the majority of people are diagnosed between the ages of 20 and 50