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FIGURE 2 Vitamin B12 Inhibited ER Stress Signaling Pathway Under chronic ER stress, the associated apoptosis may contribute to pathophysiological processes involved in a number of prevalent diseases, including neurodegenerative diseases, diabetes, atherosclerosis and renal disease (Tabas and Ron, 2011)

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Some vitamins and their metabolites are excreted through the kidneys, and accumulation may occur in severe renal impairment

Commonly discussed options include injectable, oral, and topical forms

Common causes include dietary deficiency (eg, vegan or vegetarian diet, low intake of meat or dairy products), use of proton-pump inhibitors or H2 blockers, and poor B12 absorption due to age-related changes in the stomach (eg, atrophic gastritis)