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Studies such as this one published in PMC highlight the role of malabsorption from mucocutaneous disorders like epidermolysis bullosa can lead to deficiencies that cannot be addressed adequately with oral supplements

Full-text article Dimet-Wiley AL, Latham CM, Brightwell CR, et al

Certain health conditions such as intestinal or stomach problems, poor nutrition, cancer, HIV, pregnancy, old age, veganism and alcoholism can cause vitamin B12 deficiency

PMID: 34304009

Signs You May Have a Vitamin B12 Deficiency Even a slight Vitamin B12 deficiency can manifest symptoms substantial enough to compromise your everyday quality of life

Cecal mass did not significantly differ between groups (Supplementary Table S2)