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While ruminants can synthesize B 12 via gut bacteria if soil cobalt levels are adequate, monogastric animals like swine and poultry require direct supplementation through fortified feed to maintain health and growth rates in intensive farming environments

This makes it the preferred route when a patient cannot absorb B12 through the gastrointestinal tract

Individuals with Gastrointestinal Disorders: Such as Crohns disease, celiac disease, atrophic gastritis, or those who have had gastric bypass surgery or other stomach/intestinal resections, which can interfere with B12 absorption

There are differences in practice between countries, with Canada and Sweden favoring use of oral vitamin B 12

If you havent had any luck with diet and exercise, no matter how many variations youve tried, you may want to start looking into semaglutide