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Conditions like celiac disease, inflammatory bowel disease, gastric surgeries, or chronic use of certain medications can reduce absorption from food and pills. If you have ongoing digestive issues, your provider may recommend a combination of gutsupporting strategiessuch as probiotics, a balanced diet, or targeted therapiesalong with B12, often using injections to bypass the digestive tract altogether

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Megaloblastic anemia Diminished activity of methionine synthase in vitamin B 12 deficiency inhibits the regeneration of tetrahydrofolate (THF) and traps folate in a form that is not usable by the body ( Figure 3 ), resulting in symptoms of folate deficiency even in the presence of adequate folate