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To maintain constant blood levels, B complex injections should be given on a regular basis

Celiac disease (gluten intolerance)

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Sources NIH Office of Dietary Supplements, Vitamin B12 Fact Sheet NIH Office of Dietary Supplements, Choline Fact Sheet MedlinePlus, Cyanocobalamin Injection Mayo Clinic, Vitamin B12 Injections and Weight Loss NCBI Bookshelf, Essential Amino Acids PubMed, Inositol Phosphate Signaling Network The American Journal of Clinical Nutrition, Lipotropic Agents and Lipid Transport

Another cause of deficiency may be due to medications such as proton pump inhibitors or metformin reducing B12 levels over time