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In such cases, someone with the MTHFR gene variation may seem to have elevated levels of B12 (as well as elevated levels of homocysteine), but will actually have low levels of B12 in the form that their body can utilize

Meaning a 50mg dose requires 0.2mL injection volume, while 100mg requires 0.4mL

When you bypass the stomach or put a band around the stomach, or any of these various surgical procedures to reduce weight, you diminish the capacity to absorb B12, says Green