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A comprehensive approach may include both strategies: dietary optimization with low-glycemic sweeteners alongside pharmacological support when indicated

Gastrointestinal conditions Some gastrointestinal conditions may affect how vitamin B12 is digested or absorbed, such as: history of gastrointestinal surgery celiac disease Crohns disease pernicious anemia infections, such as from Helicobacter pylori bacteria or parasites pancreatic insufficiency or cancer bowel cancer folic acid deficiency small intestinal bacterial overgrowth Vitamin B12 injections may be more helpful for people with gastrointestinal conditions than oral products

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This is one reason bedtime dosing is common it lines up with a natural dip in somatostatin activity

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