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Patients should be aware that heavy, chronic ethanol use may counteract the therapeutic effects of vitamin B12

Some people use sublingual delivery (powder held under the tongue briefly before swallowing) but there's no strong evidence this meaningfully improves bioavailability for this compound class

Simply put, without sufficient levels of B12, both energy production and red blood cell formation are impaired, leading to symptoms of B12 deficiency, such as low energy and fatigue

H., & da Costa, K.-A

Therefore, vitamin B12 supplements are recommended for dogs with digestive ailments, including long-term diarrhea or chronic colitis, inflammatory bowel disease (IBD), and exocrine pancreatic insufficiency (EPI)