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malabsorption (insufficient absorption of vitamin B12 in the intestine), insufficient production of intrinsic factor (a protein that is formed in the stomach lining and required to absorb vitamin B12), Diseases in the end section of the ileum (part of the small intestine), e.g

People with GI disorders like Crohns syndrome and celiac disease are often unable to break down and absorb dietary B12 and oral B12 supplements, leaving them deficient

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doi:10.1186/2008-2231-20-42 Hosseini SR, Kaka G, Joghataei MT, et al