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Challenges in the diagnosis of vitamin B 12 deficiency Subclinical B 12 deficiency is asymptomatic The diagnosis and management of subclinical vitamin B 12 deficiency, which is defined as a total serum B 12 concentration of 150–249 pmol/L(Carmel, 12 is unknown (Carmel, 12 deficiency rarely evolves into clinical deficiency and the need for treatment with B 12 has not been fully established in spite of its much higher frequency compared to clinical B 12 deficiency (Carmel, 12 -deficient elderly Chileans showed that patients displayed improved function of myelinated peripheral nerves after vitamin B 12 treatment and a positive association with folate status (Brito et al., Functional B 12 deficiency: serum markers vs