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

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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)

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In people without deficiency, evidence does not consistently show that additional B12 improves energy, mental performance, or weight control