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In cases of unexplained macrocytic anemia associated with high homocysteine levels and normal B 12 testing results, folate testing may be arranged if supported by laboratory specialist consultation

So if you took B12 and felt worse, and your blood B12 is elevated, and you have a constellation of symptoms across multiple systems that's three signals pointing toward MCAS as worth ruling out

Evidence is limited

You likely do need modifications to your protein, water and other factors

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