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Intramuscular hydroxocobalamin is the preferred treatment for most patients with confirmed deficiency, particularly when malabsorption is present or neurological symptoms exist

However, structured cycling with breaks is recommended to maintain receptor sensitivity

and carnitine palmitoyltransferase 2 regenerates fatty acyl-CoA in the matrix

This often appears alongside iron deficiency in Indian women, as both tend to be low at the same time

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If you do not have severe neurological symptoms, however, research suggests that very high-dose oral supplementation (typically 1,000 mcg daily) can effectively treat B-12 deficiency even in people who have compromised absorption due to lack intrinsic factor (a cause of "pernicious anemia") or from gastrointestinal disease or bowel resection (Lacombe, Am J Clin Nutr 2024