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The USDA Agricultural Research Service used the 148 pmol/L threshold in their national prevalence studies, and the NIH Office of Dietary Supplements acknowledges that lab reference ranges can vary between institutions

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For patients with clinical deficiency, effective replacement therapy should lead to a normal blood count after two months of treatment, while improvement in neurologic symptoms begins within one week after initiation of therapy and is usually complete within 6 weeks to 3 months.13 For patients with an asymptomatic biochemical deficiency (ie, subclinical disease), measurement of serum B12 or MMA levels should be done 2 to 3 months after initiation of replacement therapy.12 Once metformin is started, this medication is seldom discontinued unless advanced renal impairment develops

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The best option at that time was a hysterectomy, and I got advice to go ahead and take out my ovaries because I always had a lot of headaches and they seemed to be hormone-related