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Heres my game plan: Test for intrinsic factor antibodies if my doctor offers this Try high-dose sublingual B12 (5000mcg daily) for 8 weeks as a test If my B12 stays below 400 pg/mL, go straight to injections Calculate the cost difference to justify the investment The 10% Rule If youre absorbing less than 10% of your oral B12 (you can estimate this by comparing your supplement dose to your blood response), weekly shots often cost less than daily high-dose pills

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Common adverse effects include irritant contact dermatitis, scaling, and itching, often attributed to the propylene glycol component, which can lead to poor patient compliance

Some people never get comfortable with needles