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High B12 blood serum levels can often mean: The body is having trouble converting, transporting and absorbing vitamin B12 into the cells where it's needed for intracellular and downstream processes The vitamin B12 in your serum is inactive and not able to be utilized You could also have contributing deficiencies in iodine, selenium, molybdenum, and/or B21 And it can also mean that youre getting a form of B12 in your diet (or vitamins) that is not converting well in your body for absorption (likely cyanocobalamin) Ironically, this is called a paradoxical B12 deficiency