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2011 Mar;110(3):774-80

Patients with evidence of vitamin B 12 deficiency and chronic gastrointestinal symptoms such as dyspepsia, recurrent peptic ulcer disease, or diarrhea may warrant evaluation for such entities as Whipple's disease (a rare bacterial infection that impairs absorption), Zollinger-Ellison syndrome (gastrinoma causing peptic ulcer and diarrhea), or Crohn's disease

Where serum B12 results are borderline or do not fit the clinical picture, further tests such as active B12 (holotranscobalamin), methylmalonic acid, or homocysteine may be helpful

Shaking can cause the delicate peptide chains to break apart or denature, which may render the compound ineffective

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They also help form red blood cells