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A serum B12 level test and ideally a methylmalonic acid test should be performed before starting B12 injections

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And this is not to be mistaken for a comprehensive list

SAM does the following: Breaks down estrogens Carnitine synthesis (the fat carrier molecule of the body) Choline synthesis Creatine synthesis Epinephrine synthesis Melatonin synthesis (aids in sleep, a powerful antioxidant) Nucleic acid synthesis- a component of DNA Breakdown of histamine Glutathione synthesis (the major detox antioxidant of the body) Maintains cartilage health Inositol: A B vitamin and a primary component of cell membranes

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Adding micronutrient supplementation to address any co-factors needed for B12 activation