[56] [57] Low levels of serum vitamin B 12 may be caused by other factors than B 12 deficiency, such as folate deficiency, pregnancy, oral contraceptive use, haptocorrin deficiency, and myeloma
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For instance, topical applications often require higher concentrations at the site of action compared to injected methods, which bypass first-pass metabolism
Other indications include malabsorption disorders (such as Crohn's disease or coeliac disease), following gastric surgery, strict vegan diets without supplementation, and certain medications that interfere with B12 absorption
Future research should focus on refining these treatment modalities and expanding comparative studies to optimize B12 deficiency management strategies effectively