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So, you measure a higher B12, but part of that B12 is inactive, so useless Oral B12 supplementation, even in the form of a multivitamin preparation, may result in serum B12 concentrations just within the normal range without abolishing symptoms

This type of study can show an association between a factor and an outcome but cannot prove cause and effect

Whether this tradeoff makes sense depends on individual priorities, including needle aversion, convenience requirements, and budget considerations

and c) irregular dietary patterns), reduced bioavailability (impairment of the intrinsic factor-mediated absorption pathway, often due to the widespread and prolonged use of proton pump inhibitors), and malabsorption syndromes

Shaking can destroy the peptide bonds