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Disruptions in the intrinsic factor (IF) pathway, including impaired IF production due to autoimmune conditions (pernicious anemia), damage to the ileum from diseases like Crohns or celiac disease, or surgical resection of the ileum, can severely impair B12 absorption

Lifestyle Tips to Manage Pernicious Anemia Balanced Diet: Include B12-rich foods such as lean meat, fortified cereals, and dairy products

Gentle mixing by rolling the vial between the hands may be appropriate if settling has occurred, but aggressive agitation should be avoided

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If youre feeling well and your provider confirms theres no underlying health concerns, high B12 levels from supplementation are usually harmless