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In pernicious anemia, antibodies form and begin to attack certain parts of your stomach, rendering it ineffective in absorbing vitamin B12

This makes essential nutrient delivery harder

Both sublingual vitamin B12 supplements and B12 injections can be appropriate depending on your specific circumstances

For Hereditary B12 Malabsorption If you suffer from Imerslund-Grasbeck disease, your vitamin B12 malabsorption will be treated with hydroxocobalamin injected into the muscle at a dose of 10 mg per day for 10 days followed by monthly injections for life

This size is recommended so that the needle reaches the muscle tissue where the B12 can be absorbed effectively

Hormonal shifts: Declines in growth hormone, estrogen, or testosterone affecting metabolism