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blood tests (B12, HbA1c, thyroid) for metabolic causes

Alcohol affects B12 absorption in the body in many ways

Increased Susceptibility to Oxidant Injury in Hepatocytes From Rats With Intra-Abdominal Hypertension

arguments against the use of oral cobalamin Oral treatment may be considered in certain situationsfor example, in mild or subclinical deficiency with no clinical features and when absorption and compliance are definitely not a problem

Details and Options: The usual B12 injection is cyanocobalamin 1 mg (1,000 mcg) administered intramuscularly (IM)

Cycle Most community protocols run 612 weeks total, often loading + maintenance