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NICE and the BNF provide clear guidance on appropriate use, emphasising that injections should be reserved for cases where oral supplementation is inadequate or inappropriate

Vitamin B12 injections are most clinically appropriate in cases of confirmed vitamin B12 deficiency, malabsorption syndromes including pernicious anaemia or post-gastric surgery, significant symptoms where rapid restoration of vitamin B12 levels is required, or failure of oral supplementation due to poor absorption

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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

But the body can convert synthetic forms into natural ones

In fact, side effects are a great indication that our immune systems are working to produce antibodies and are activating other immune cells to fight off what they think is an infection