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Other causes of vitamin B12 deficiency are rare, but include: Malabsorption due to gastrectomy, gastric resection, crohns disease, chronic alcoholism, coeliac disease, pancreatic failure and/or chronic alcoholism

Over time, this chronic neurotoxicity and demyelination lead directly to autonomic neuropathy

However, B12 shots are less likely to increase energy or performance when B12 levels are already normal

Sikiric, P., Seiwerth, S., Rucman, R., Turkovic, B., Rokotov, D

[30] This property allows the convenient preparation of cobalamin analogs with different substituents, via nucleophilic attack on alkyl halides and vinyl halides

The test does not actually detect the drug itself in most cases