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Polymorphisms in various genes involved in vitamin B 12 metabolism, including the genes encoding the intrinsic factor-cobalamin receptor (60) and the holo-transcobalamin receptor (61), have been associated with increased NTD risk in some studies
The biggest issue I've seen is these are, these are people that have some gene mutations that cannot produce, they cannot conjugate and make enough glutathione
"Paradoxical Vitamin B12 Deficiency: Normal to Elevated Serum B12, With Metabolic Vitamin B12 Deficiency"
B12 shots from IV Lounge made all the difference
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