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4,5 Dietary insufficiency, pernicious anemia (i.e., an autoimmune process that reduces available intrinsic factor and subsequent absorption of vitamin B 12 1,2,6,7 ), and long-term use of metformin or acid-suppressing medications have been implicated in B 12 deficiency
One of the pathways for NAD+ synthesis is the kynurenine pathway, whereby NAD+ is synthesized from the essential amino acid tryptophan
Smoday IM et al
Patients often delay treatment or are misdiagnosed as having a wrist sprain that fails to get better
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