A peptide is a chain of amino acids held together by peptide bonds, and those bonds are precisely what digestive enzymes (pepsin, trypsin) are built to cut, with the acidic stomach environment finishing the job so an oral peptide is largely destroyed before it can be absorbed, which is why injection is the default
This includes if symptoms get better and B12 levels in the blood rise
B12/MIC is most effective when used as part of a healthy lifestyle, including a balanced diet & regular exercise
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Cyanocobalamin: This is a synthetic form of B12, which the body has to convert into the next two forms below before it can be used
recent guidelines affirm its use (e.g., AHA updates, StatPearls reviews)