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Intrinsic factor is only made in the stomach and after a gastrectomy there is little to no more of it or gastric acid, and the active mechanism in the body where B12 is absorbed is either less available or not available at all depending on if the surgery was a total or a part of a gastrectomy

Other metabolic implications of vitamin B 12 deficiency include the accumulation of homocysteine and methylmalonic acid, which might contribute to the neuropathologic features of dementia (63)

I use Scrivner

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Or bought in a bundle of 6 injections at 180, then works out to be 30 each

Inject subcutaneously or intramuscularly