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Metabolism: Individual differences in liver enzymes, particularly the cytochrome P450 family, can significantly alter how quickly a compound is broken down and cleared

An infection with Helicobacter pylori bacteria can also lead to lower B12 levels

[1] Because intrinsic-factor-dependent uptake in the distal ileum can be absent in conditions such as autoimmune gastritis, pancreatic insufficiency, or bariatric surgery, the intramuscular or subcutaneous route bypasses gastrointestinal barriers and reliably restores serum concentrations