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Consider intramuscular vitamin B 12 injections instead of oral replacement for suspected or confirmed vitamin B 12 deficiency caused by diet if: The person has another condition that may deteriorate rapidly and have a major effect on their quality of life (for example, a neurological or hematological condition such as ataxia or anemia)

[Google Scholar] Higgins J

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Several autoimmune diseases can make it harder for your body to absorb B12, including pernicious anemia

The British Obesity and Metabolic society recommend intramuscular injection of vitamin B 12 should be taken every three weeks in RYGB and BPD/DS patients, since the deficiency of B 12 still exists in the presence of higher doses of the oral supplement [120]