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It takes several years to completely deplete your livers stores of B12, so people who have recently started a vegan or vegetarian diet may still have moderate vitamin B12 levels.[ref] Dietary sources: Foods that are highest in B12 include:[ref] beef liver mussels lamb caviar chicken livers High Homocysteine and B12: Homocysteine levels: If your homocysteine levels are high and you carry the MTHFR or MTRR reduced function variant above, supplementing with vitamin B12, methylfolate, riboflavin, and B6 may help to lower your levels.[ref][ref][ref] Interaction with alcohol: Alcohol is metabolized into acetaldehyde, which is toxic and inhibits methionine synthase (MTR)

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For these individuals a B12 energy shot is extremely beneficial and could likely be their only significant source of B12

Vitamin B12 injections are significantly more expensive than oral supplements when accounting for the full cost of treatment including office visits, injection fees, and ongoing maintenance appointments