The Methylmalonic Acid Test, also called an MMA Test is a more accurate test of B12 deficiency. Methylmalonic Acid, also called Methylmalonate, is a waste product that builds up in the blood and is excreted in the urine when Vitamin B12 is not available to transform into the energy metabolite Succinic Acid. Because it begins to build up within ten days after a Vitamin B12 deficiency begins, it is not only the most accurate marker, but it is the earliest detectable marker of Vitamin B12 deficiency. And because Methylmalonic Acid is found in both blood and urine in amounts relative to the degree of deficiency, both urine and blood tests are good tests for Vitamin B12 deficiency.
Taking supplements of certain vitamins mostly in larger than RDA amounts (especially ongoing) may possibly lead to sleep disturbances including excessive B12 or B6 levels.
The body can only use the B12 methylcobalamin and adenosylcobalamin directly, while all other forms of vitamin B12 must first be converted in the body. The conversion steps involved in this are dependent on the vitamins B2 (riboflavin) and B3 (niacin). The second bioactive form of vitamin B12, adenosylcobalamin, requires biotin (also known as vitamin B7 or vitamin H) and magnesium, in order to fulfill its important role in aiding the function of the mitochondria – the “power stations” of our cells. Hydroxocobalamin has also been revealed to inhibit the Nitric Oxide system. Hydroxocobalamin (OH-Cbl), cobinamide, and dicyanocobinamide (CN(2)-Cbi) potently inhibited all isoforms (NOS1, NOS2, and NOS3), whereas cyanocobalamin, methylcobalamin, and adenosylcobalamin had much less effect
https://pubmed.ncbi.nlm.nih.gov/19328848/ So that form may work in certain cases but not a good substitute in others obviously for that reason.
Testing homocysteine is another to see what actually is going on. High homocysteine following folic acid or vitamin B12 or B6 deficiency is shown it down-regulates peroxisome proliferator-activated receptor (PPAR) expression. Homocysteine has recently been found to be a competitive inhibitor of the nuclear transcription factors: Peroxisome proliferator activated receptors (PPARs) alpha (PPAR-a) and gamma (PPAR-y) which are your anti inflammatory pathways.
https://link.springer.com/article/10.1186/1475-2891-3-4 Homocysteine activated NLRP3 inflammasomes in THP-1-differentiated macrophages and promoted subsequent production of IL-1 and IL-18 in macrophages, which were blocked by NLRP3 gene silencing or the caspase-1 inhibitor Z-WEHD-FMK.
https://pubmed.ncbi.nlm.nih.gov/28394319/ This means it can increase inflammation, but inflammation is a balance that the body has a number of ways to compensate so you can then check things like c-reactive protein to see if your actually even high in inflammation in the first place.