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Altered B12 handling and reduced clearance in kidney disease, and both cellular release and reduced clearance in liver disease, can raise B12, so supportive renal or hepatic findings make those causes plausible
I know that because the consultant told me how difficult it is to get some GPs to comply with this
PMID 18566306

Your body can only absorb so much B12 through your gut at one time, regardless of how much you swallow

Longer-lasting effects sustained levels for several weeks
