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In acquired B12 deficiency, both oral and IM routes have been featured in guidelines to replenish this compound in deficient states

Response of elevated methylmalonic acid to three dose levels of oral cobalamin in older adults

In this study, the cB 12 quotient helped to establish that MMA is the most sensitive marker of vitamin B 12 in cancer patients, and that total serum B 12 has very little diagnostic value (Vashi et al., 2016)

It is most relevant during GLP-1 use or caloric deficit, when fatigue is part of the picture, with age-related NAD+ decline, or when progress stalls after a clean first month