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Fakhry C, Zhang Q, Gillison ML, Nguyen PD, Rosenthal DI , Weber RS, Lambert L, Trotti A, Barrett W, Thorstad W, Yom SS, Wong S, Ridge JA, Rao SS, Bonner JA, Vigneault E, Raben D, Harris J, Le QT

Causes of vitamin B 12 deficiency Absorption of vitamin B 12 from food requires normal function of the stomach, pancreas, and small intestine

If you've been taking oral B12 supplements without feeling a difference, a shot is the most reliable way to find out whether the issue is your B12 levels or something else

Clinical signs of B12 deficiency include nausea, vomiting, loss of appetite, poor absorption of food (malabsorption syndrome), constipation, gas, weight loss, fatigue, lethargy, abdominal pain, and diarrhea