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The liver is key in making sure Vitamin B12 gets to all parts of the body

if there is inflammatory disease, blood disorders, kidney problems, liver disease, neoplasms, and other situations that could cause this, as well as assessing another possibility: if there has been previous supplementation, excessive continuous doses, what doses, for how long, etc

in the event of a deficiency of B12, B9, or both, cells are unable to successfully duplicate DNA and there is a delay in cell division, which leads to an alteration of this process, stalling in the growth phase and being unable to move on to the mitosis phase

Without enough B12, this process can slow down, leading to fatigue

Cell-death signaling and human disease