This is Dr. David
have you been tested for gout?
you could have gout or arthritis in your big toe and fingers and elbow causing pain.
you should get xrays of your joints to check for arthritis
and blood testing to check for gout
which is a condition where too much uric acid is in your blood stream
and you get uric acid crystals in your joints
you would be order to speak with him and follow up for another appointment.
and get more testing.
do you have other questions?
you want to try to get your cholesterol below 5.2
have you ever had testing to check for H Pylori bacteria infection in your stomach?
this bacterial infection in your stomach can cause worse stomach acid and stomach ulcers.
fatty liver is more common if you are overweight.
you might need follow up testing to see if the H Pylori is still there or not.
this could still be causing your stomach acid.
for some people, Manuka Honey can help excessive stomach gastritis issues along with acid blockers.
do you have other questions ?
normal B12 values are 200 - 900 pg/mL (picograms per milliliter)
so yours is in normal range
I don't think the B12 is causing your toe numbness issues.
no, fasting would not affect B12 level.
different labs have different ranges.
in the US, we consider 200-900 as normal.
I would not stress about the 200 level on the first test.