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Of these the only two that are biologically active are adenosylcobalamin (a co-factor for the enzyme MMA-CoA mutase) and methylcobalamin (a co-factor for the enzyme methionine synthase)(see structure on the right)

chronic liver disease and hepatitis may present with elevated levels Renal impairment : Reduced clearance can contribute to accumulation, though this is rarely clinically significant Solid tumours : Certain malignancies, particularly hepatocellular carcinoma and metastatic disease, may elevate B12 levels [3] Evidence suggests that unexplained markedly elevated B12 levels without supplementation may sometimes be associated with underlying disease

Anemia happens when your blood doesnt have enough healthy red blood cells or hemoglobin to carry oxygen efficiently throughout the body

I go into detail on the two most common oral B12 supplements, Methylcobalamin and Cyanocobalamin, in my Youtube video here: Ive found that most older patients prefer oral supplements over regular vitamin B12 injections, which is understandable