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It needs to be shouted from the roof tops that PA is JUST ONE OF MANY CAUSES of B12 deficiency

Caveolin-1 knockout mice also fail to properly liberate fatty acids from TAG stores in brown adipose tissue in response to fasting, resulting in impaired thermogenesis (24)

However, If vitamin B12 is lyophilized, such as in some forms of methylcobalamin, the medication should be refrigerated after mixing

Because B12 vitamin is bound to amino acids (found in protein foods) and is only released when certain enzymes and stomach acids are present, its possible to consume enough but still remain somewhat deficient