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Although multiple pathways are involved in mediating tissue damage, including the polyol pathway, advanced glycation end product formation, protein kinase C activation, and the hexosamine pathway, a common feature is increased oxidative stress marked by elevated levels of reactive oxygen species (ROS) (1)

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For example, people who have pernicious anemia, a condition in which they cannot make intrinsic factor which is needed for B12 absorption are not able to use vitamin B12 from foods or dietary supplements

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