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Higher doses may be considered under clinical supervision for those who decline injections despite malabsorption, though this is an off-label approach

Am J Phys Heart Circ Phys 298:H2174H2191 Wieczor R, Gadomska G, Ruszkowska-Ciastek B, Stankowska K, Budzynski J, Fabisiak J, Suppan K, Pulkowski G, Rosc D (2015) Impact of type 2 diabetes on the plasma levels of vascular endothelial growth factor and its soluble receptors type 1 and type 2 in patients with peripheral arterial disease

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Vitamin B12 is attached to protein molecules in food and can only be absorbed by the body after being split from the protein by hydrochloric acid in the stomach