The logic chain is sound, but the clinical endpoint data
This typically involves: Intrinsic factor antibodies (highly specific for pernicious anaemia, though sensitivity is only 50%) [12] [28] Gastric parietal cell antibodies (more sensitive but less specific) Coeliac serology if malabsorption is suspected Consideration of upper gastrointestinal endoscopy in selected cases, particularly with autoimmune gastritis/pernicious anaemia NICE guidance emphasises that treatment should not be delayed whilst awaiting antibody results if clinical features strongly suggest deficiency, as irreversible neurological damage can occur
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[11] Additionally, Rich suggested avoiding choline or TMG supplementation, as it could push the BHMT pathway at the expense of the methionine pathway, and to avoid over-supplementing with different forms of folate that would compete for absorption
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