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If the kidneys are already under strain (which is common with age, diabetes, or high blood pressure), this direct load can be too much to handle

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This includes people with: Pernicious anaemia (autoimmune destruction of intrinsic factor-producing cells), typically requiring lifelong IM injections Crohn's disease or surgical resection affecting the terminal ileum Coeliac disease causing malabsorption (may improve with gluten-free diet) Chronic pancreatitis reducing enzyme availability needed for B12 release Vegans and strict vegetarians need reliable B12 sources through fortified foods or supplements, as plant-based diets contain negligible amounts of active B12