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Conclusion To answer the original question directly: high B12 levels themselves don't typically cause symptoms

The reality is that that what the FDA means by safety is a matter of regulatory compliance (large scale clinical trials, manufacturing standards, etc.) not toxicity

If oral and intramuscular injections have been proposed historically, alternative treatment routes have been recently proposed with sublingual, intranasal and subcutaneous administrations, which are more patient-friendly than painful intramuscular injections

Malabsorption Malabsorption of B12 is prevalent in people with gastrointestinal (GI) disorders and GI surgeries