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Increase in homocysteine as vitamin B12 levels decrease below 250 pmol/L from Elmadfa and Singer 2009 Increase in MMA as serum vitamin B12 decreases below 250 pmol/L - from Shobha etal, 2011 Many people, however, experience symptoms of vitamin B12 deficiency yet their serum levels of vitamin B12 may be normal or much higher than normal