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doi:10.3109/00016488309123000 D'Avila C, Lavinsky L

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1 As a brief aside, the term blood level is used nonspecifically, here

McMullen JR, Shioi T, Huang W-Y et al (2004) The insulin-like growth factor 1 receptor induces physiological heart growth via the phosphoinositide 3-kinase(p110alpha) pathway

The most common form of B12 that youll find everywhere is cyanocobalamin and it is not very active or beneficial to the body because the absorption rate is fairly low, thats because the body has to convert it first into Hydroxy B12, and from there the Hydroxy B12 has to be converted into both adenosylcobalamin and Methylated-B12. But if the body has genetic mutations then these conversions dont happen well at all and the effect is the body does not get the absorption or use of the nutrient