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Poor sleep, inadequate nutrition, excessive sun exposure, and chronic stress all limit results regardless of dosing optimization

The Vegan Society and NHS recommend that vegans take B12 supplements or consume fortified foods regularly

Oral B12 supplementation: High-dose oral cyanocobalamin (10002000 micrograms daily) represents an alternative for patients with dietary deficiency or those without severe deficiency or neurological symptoms, and for those unable or unwilling to receive injections

Additionally, vitamin B 12 deficiency can also occur as a result of other malabsorptive conditions (such as inflammatory bowel disease, or pancreatic insufficiency), after certain procedures (such as bariatric surgery, or ileal resection), restricted diets (such as veganism), or the use of certain medications (such as metformin or proton-pump inhibitors)