B12, B6, and Folate: Lab Markers Every Clinician Should Monitor

johnhayesjr1
Oct 13
2 min read

Peripheral neuropathy doesn’t always begin with diabetes or chemotherapy. Sometimes, the answer is as simple and as critical as a vitamin imbalance. The most overlooked (and correctable) contributors to nerve damage are B12, B6, and folate. Yet too often, these markers are either not tested at all—or are misinterpreted by labs using outdated “normal” ranges.

In your private or direct-pay practice, you can go deeper than the surface and deliver answers that make an immediate difference.

Why These Three Matter Most

Vitamin B12 (Cobalamin)

Essential for myelin sheath integrity and DNA synthesis
Deficiency causes numbness, burning, memory loss, fatigue
Common in vegetarians, patients on PPIs, metformin, or with MTHFR variants
Normal serum B12 isn’t always enough check methylmalonic acid (MMA) and homocysteine

Vitamin B6 (Pyridoxine)

Crucial for neurotransmitter production—but easily toxic in excess
Often elevated due to energy drinks, B-complex, pre-workouts, and immune boosters
Symptoms of toxicity mimic deficiency: tingling, burning, glove-distribution numbness
Serum pyridoxal phosphate (active B6) is the preferred test

Folate (Vitamin B9)

Needed for methylation and nerve repair
Deficiency often coexists with low B12 or high homocysteine
Patients with genetic methylation variants (MTHFR) may need methylated folate (5-MTHF)

What You Can Offer as an Independent Physician

In insurance-based settings, these deficiencies are rarely explored in depth. But in your model, you can:

Order functional labs and interpret them in context
Ask detailed questions about diet, supplements, and GI health
Educate patients on what the numbers really mean
Tailor a repair plan based on nutrient needs—not just “normal ranges”

This kind of personalized medicine builds trust and gets results that standardized protocols miss.

Want to Be the Physician Who Finds What Others Overlook?

Book a Strategy Session with John Hayes Jr., MD to learn how physicians are using B12, B6, and folate optimization to reverse neuropathy symptoms—without drugs, frustration, or delay.