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Excess hydroxocobalamin can bind to other plasma proteins such as albumin, which helps explain the very high B12 levels seen after injections of that form

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While that initial boost is great, the real goal is to maintain your B12 levels over time so you can enjoy sustained energy and focus without the ups and downs

It may be possible to treat the underlying disease by surgical correction of anatomic lesions leading to small bowel bacterial overgrowth, expulsion of fish tapeworm, discontinuation of drugs leading to vitamin malabsorption (see Drug/Laboratory Test Interactions), use of a gluten free diet in nontropical sprue, or administration of antibiotics in tropical sprue