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For CFS patients, form and delivery method can significantly affect outcomes: Why Standard B12 Tests May Miss CFS Deficiency Standard serum B12 tests measure total cobalamin, which can appear normal even when cellular B12 is insufficient Functional markers like methylmalonic acid (MMA) and homocysteine better reflect intracellular B12 status CFS researchers advocate for these functional tests in place of standard serum B12 alone High-dose B12 protocols (injections or sublingual) are used when functional deficiency is suspected even with normal serum levels Methylcobalamin — the active form your body can use immediately, without conversion