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The realistic caveat is that long-term maintenance without pharmacologic or procedural support is difficult for most people which is the entire reason the rest of this list exists

When stratified by administration route, the mean percentage changes were: Intramuscular (IM): 307% Oral: 285% Sublingual: 199% IM administration showed the highest average B12 increase, although oral and sublingual routes also yielded substantial improvements, supporting their use as effective and less invasive alternatives

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Some studies have shown that, if people with Down syndrome take the inactive oral forms of vitamin B12 and folate, their bodies may have difficulty converting from the inactive to the active form and the inactive form may not be as effective