Vitamin A is unique among vitamins because it encompasses a broad group of related nutrients. The two primary forms are:

• Retinoids: Found mainly in animal products like meat, these include retinol and retinoic acid.
• Carotenoids: These include alpha, beta, and gamma carotenes found in plants.

Sources of Vitamin A:

• High in Retinoids: Beef liver, eggs
• High in Carotenoids: Green vegetables, tomatoes, mangoes, and red bell peppers
• Vitamin A is essential for healthy skin, a robust immune system, clear vision, and a strong reproductive system. However, its role and importance can vary significantly depending on the life stage.

Life Stages and Vitamin A

• Infancy and Childhood
• Vision Health: Vitamin A deficiency is estimated to cause between half a million and three million cases of irreversible blindness in children each year, with half of these children dying within 12 months of losing their sight.
  
• Golden Rice: A genetically modified rice enriched with beta-carotene (which converts to Vitamin A) has been developed to address these deficiencies.
  
• Immune System Development: During the first six months, breast milk typically provides sufficient Vitamin A (assuming an average daily consumption of 650 ml provides 325 micrograms). Needs vary as children grow. Adolescence
  
• Rapid Growth: This stage puts a significant demand on nutritional resources, including Vitamin A.
  
• Health Risks: Deficiencies can cause lifelong issues. Vitamin A helps prevent eye damage (like night blindness and potential permanent blindness), supports the immune system, affects respiratory health, and prevents abnormal cell growth (hyperplasia) and anemia.
  

Adulthood

• Ongoing Vision Support: Vitamin A continues to support healthy vision.
  
• Additional Health Concerns:Young adults with insufficient Vitamin A may have a higher risk of obesity. Older adults need it to prevent hip fractures and other bone-related issues.
  

Recommended Daily Intake of Vitamin A

• Children: 325 - 400 mcg
• Male Teens (14-18): 900 mcg
• Female Teens (14-18): 700 mcg
• Adult Males: 900 mcg
• Adult Females: 700 mcg

Vitamin A's wide-ranging impact highlights the importance of maintaining adequate levels through diet or supplements, especially considering the varying needs at different life stages. Ensuring sufficient intake helps support essential functions from vision to immune health, across the lifespan.
https://youtube.com/shorts/xXBgAyRU_L0?feature=share
#VitaminA #Nutrition #HealthyLiving #VisionHealth #ImmuneSupport #ChildHealth #AdolescentHealth #AdultHealth #DietaryNeeds #PublicHealth #WellnessJourney #PreventiveHealthcare #NutritionalScience #HealthyDiet

Hi AskDocs, I'm hoping you can help me understand some of the abnormal results I received today from a recent blood test. My doctor specifically brought up the large platelets and low vitamin D in the visit. I'm getting my bloodwork re-done next month. My doctor seemed to say that normally she would wait longer before retesting, but said she is doing it sooner because she knows I struggle with anxiety. I've managed my health-related anxiety pretty well over the last few years, but this is the first bit of spooky medical news I've received in a while.
Here are the abnormal results as they appear on the patient portal:
mLYM%: 51 (High)
mNEUT%: 34 (Low)
mPLT Morph: Large Platelets
VitD25: 24.1 (Low)
Obviously, I'm most concerned with any platelet or wbc numbers that could indicate something scary. From 0 to 10, how worrisome is it?
For the record, I'm vegan (since 2016), in case that could be a relevant factor.
Age: 34
Sex: M
Height: 6'2
Weight: 183 lb
Race: White
Location: USA
Any existing relevant medical issues Depression and anxiety Stress/insufficient sleep IBS
Current medications Bupropion, trazadone, atorvastatin

As many of you know I’m not new here and I’m not a doctor with a fixed school of thought. So I’d like to share some things some of you should search in yourselves for!
EPI may refer to Exocrine Pancreatic Insufficiency, a condition that occurs when the pancreas doesn't release enough digestive enzymes, making it difficult for the small intestine to digest food. (Food isn’t processing which sits and rots in you and the odor comes from your mouth and pores etc) you’ll know because you can’t process fats at all. When you eat fried food you’ll smell like shit!!!
Liver flukes are parasites that can infect humans and cause liver and bile duct disease. There are two families of liver flukes that cause disease in humans: Opisthorchiidae (which includes species of Clonorchis and Opisthorchis) and Fasciolidae (which includes species of Fasciola).
Small intestinal bacterial overgrowth (SIBO) is a condition where there is too much bacteria in the small intestine. It's also known as bacterial overgrowth or small bowel bacterial overgrowth syndrome. (3 diff types)
H. pylori is a common type of bacteria that attacks the stomach lining. It's usually passed from person to person. Most infections are harmless. But the bacteria is to blame for most peptic stomach ulcers, and if it's not treated, it could be a risk factor for cancer. (Really bad breath like shit)
Most of you have gas that smells like shit that’s why you stink. Try Simithicone chewables, moly b and digestive enzymes!
Check your vitamins these conditions are serious and will wreck havoc on your digestive system.
Also don’t ask me for per reviews I’m too lazy to go find them haha :)

Impact of Cystic Fibrosis on Adults

Cystic Fibrosis (CF) is a genetic disorder that primarily affects the respiratory and digestive systems, but it can also have implications for other parts of the body. With advancements in treatment and care, more people with CF are living into adulthood. However, managing the condition in adults involves dealing with a range of challenges and complications.

Respiratory System

1. Chronic Lung Infections: Adults with CF often experience recurrent lung infections due to thick, sticky mucus that traps bacteria. Common pathogens include Pseudomonas aeruginosa and Staphylococcus aureus.
2. Reduced Lung Function: Over time, repeated infections and inflammation can lead to a decline in lung function, making breathing more difficult.
3. Bronchiectasis: The airways become permanently widened, leading to persistent cough, mucus production, and further infections.
4. Respiratory Failure: In severe cases, lung damage can progress to the point where the lungs cannot provide adequate oxygen to the body, requiring advanced interventions like oxygen therapy or lung transplantation.

Digestive System

1. Pancreatic Insufficiency: Thick mucus can block the ducts of the pancreas, preventing digestive enzymes from reaching the intestines. This leads to malabsorption of nutrients, malnutrition, and vitamin deficiencies.
2. Diabetes: CF-related diabetes (CFRD) is common in adults due to the damage to the pancreas. It shares characteristics of both Type 1 and Type 2 diabetes.
3. Liver Disease: Blockages in the bile ducts can lead to liver damage, cirrhosis, and portal hypertension.
4. Intestinal Issues: CF can cause intestinal blockages, gastroesophageal reflux disease (GERD), and distal intestinal obstructive syndrome (DIOS).

Reproductive System

1. Infertility: Most men with CF are infertile due to congenital absence of the vas deferens, which carries sperm from the testes. However, assisted reproductive technologies can help achieve pregnancy.
2. Reduced Fertility in Women: Thick cervical mucus can make it harder for sperm to reach the egg, but many women with CF can still conceive naturally or with assistance.

Musculoskeletal System

1. Osteoporosis: Due to malabsorption of calcium and vitamin D, adults with CF are at higher risk for osteoporosis and fractures.
2. Arthritis: Some adults may develop CF-related arthritis or musculoskeletal pain.

Psychosocial Impact

1. Mental Health: The chronic nature of CF can lead to anxiety, depression, and stress. The need for continuous treatment and hospitalizations can impact quality of life.
2. Social and Work Life: Managing CF often requires time-consuming treatments and frequent medical appointments, which can interfere with work and social activities.

Treatment and Management

1. Medications:

• Bronchodilators: To open the airways.
• Mucolytics: To thin mucus.
• Antibiotics: To treat and prevent infections.
• Pancreatic Enzymes: To aid digestion.
• CFTR Modulators: Target the defective protein in CF and improve its function.

1. Airway Clearance Techniques: Daily physiotherapy to clear mucus from the lungs.
2. Nutritional Support: High-calorie diet, vitamin supplements, and enzyme replacements.
3. Exercise: Regular physical activity to maintain lung function and overall health.
4. Psychological Support: Counseling or therapy to help manage the emotional aspects of living with CF.
5. Advanced Therapies: Lung transplantation may be an option for those with severe lung disease.

Conclusion

While cystic fibrosis poses significant challenges for adults, ongoing advancements in medical care and treatment strategies are helping many individuals manage their condition more effectively and lead fuller lives. Comprehensive, multidisciplinary care is essential to address the complex needs of adults with CF, including respiratory, digestive, reproductive, and psychosocial aspects. Regular follow-up with healthcare providers specialized in CF care is crucial for optimizing health outcomes and maintaining quality of life.
Blaze0 notes Impact of Cystic Fibrosis on Adults
Cystic Fibrosis (CF) is a genetic disorder that primarily affects the respiratory and digestive systems, but it can also have implications for other parts of the body. With advancements in treatment and care, more people with CF are living into adulthood. However, managing the condition in adults involves dealing with a range of challenges and complications.

Respiratory System

1. Chronic Lung Infections: Adults with CF often experience recurrent lung infections due to thick, sticky mucus that traps bacteria. Common pathogens include Pseudomonas aeruginosa and Staphylococcus aureus.
2. Reduced Lung Function: Over time, repeated infections and inflammation can lead to a decline in lung function, making breathing more difficult.
3. Bronchiectasis: The airways become permanently widened, leading to persistent cough, mucus production, and further infections.
4. Respiratory Failure: In severe cases, lung damage can progress to the point where the lungs cannot provide adequate oxygen to the body, requiring advanced interventions like oxygen therapy or lung transplantation.

Digestive System

1. Pancreatic Insufficiency: Thick mucus can block the ducts of the pancreas, preventing digestive enzymes from reaching the intestines. This leads to malabsorption of nutrients, malnutrition, and vitamin deficiencies.
2. Diabetes: CF-related diabetes (CFRD) is common in adults due to the damage to the pancreas. It shares characteristics of both Type 1 and Type 2 diabetes.
3. Liver Disease: Blockages in the bile ducts can lead to liver damage, cirrhosis, and portal hypertension.
4. Intestinal Issues: CF can cause intestinal blockages, gastroesophageal reflux disease (GERD), and distal intestinal obstructive syndrome (DIOS).

Reproductive System

1. Infertility: Most men with CF are infertile due to congenital absence of the vas deferens, which carries sperm from the testes. However, assisted reproductive technologies can help achieve pregnancy.
2. Reduced Fertility in Women: Thick cervical mucus can make it harder for sperm to reach the egg, but many women with CF can still conceive naturally or with assistance.

Musculoskeletal System

1. Osteoporosis: Due to malabsorption of calcium and vitamin D, adults with CF are at higher risk for osteoporosis and fractures.
2. Arthritis: Some adults may develop CF-related arthritis or musculoskeletal pain.

Psychosocial Impact

1. Mental Health: The chronic nature of CF can lead to anxiety, depression, and stress. The need for continuous treatment and hospitalizations can impact quality of life.
2. Social and Work Life: Managing CF often requires time-consuming treatments and frequent medical appointments, which can interfere with work and social activities.

Treatment and Management

1. Medications:

• Bronchodilators: To open the airways.
• Mucolytics: To thin mucus.
• Antibiotics: To treat and prevent infections.
• Pancreatic Enzymes: To aid digestion.
• CFTR Modulators: Target the defective protein in CF and improve its function.

1. Airway Clearance Techniques: Daily physiotherapy to clear mucus from the lungs.
2. Nutritional Support: High-calorie diet, vitamin supplements, and enzyme replacements.
3. Exercise: Regular physical activity to maintain lung function and overall health.
4. Psychological Support: Counseling or therapy to help manage the emotional aspects of living with CF.
5. Advanced Therapies: Lung transplantation may be an option for those with severe lung disease.

Conclusion

While cystic fibrosis poses significant challenges for adults, ongoing advancements in medical care and treatment strategies are helping many individuals manage their condition more effectively and lead fuller lives. Comprehensive, multidisciplinary care is essential to address the complex needs of adults with CF, including respiratory, digestive, reproductive, and psychosocial aspects. Regular follow-up with healthcare providers specialized in CF care is crucial for optimizing health outcomes and maintaining quality of life.

Australia is a country of abundant sunshine, but the skin of most Australians is better adapted to gloomy England than the beaches of Brisbane. The country’s predominantly white population has by far the world’s highest rate of skin cancer, and for years the public-health establishment has warned residents about the dangers of ultraviolet light. A 1980s ad campaign advised Australians to “Slip, Slop, Slap”—if you had to go out in the sun, slip on a shirt, slop on some sunscreen, and slap on a hat. The only safe amount of sun was none at all.
Then, in 2023, a consortium of Australian public-health groups did something surprising: It issued new advice that takes careful account, for the first time, of the sun’s positive contributions. The advice itself may not seem revolutionary—experts now say that people at the lowest risk of skin cancer should spend ample time outdoors—but the idea at its core marked a radical departure from decades of public-health messaging. “Completely avoiding sun exposure is not optimal for health,” read the groups’ position statement, which extensively cites a growing body of research. Yes, UV rays cause skin cancer, but for some, too much shade can be just as harmful as too much sun.
une 2024 Issue
SCIENCE Against Sunscreen Absolutism Moderate sun exposure can be good for you. Why won’t American experts acknowledge that?
By Rowan Jacobsen Tanned skin with pale smiley face drawn on it Illustration by Gabriela Pesqueira. Source: Dimarik / Getty. MAY 10, 2024 SHARE & GIFT SAVE Listen to this article
00:00
14:49
Listen to more stories on Curio
Australia is a country of abundant sunshine, but the skin of most Australians is better adapted to gloomy England than the beaches of Brisbane. The country’s predominantly white population has by far the world’s highest rate of skin cancer, and for years the public-health establishment has warned residents about the dangers of ultraviolet light. A 1980s ad campaign advised Australians to “Slip, Slop, Slap”—if you had to go out in the sun, slip on a shirt, slop on some sunscreen, and slap on a hat. The only safe amount of sun was none at all.
Explore the June 2024 Issue Check out more from this issue and find your next story to read.
View More Then, in 2023, a consortium of Australian public-health groups did something surprising: It issued new advice that takes careful account, for the first time, of the sun’s positive contributions. The advice itself may not seem revolutionary—experts now say that people at the lowest risk of skin cancer should spend ample time outdoors—but the idea at its core marked a radical departure from decades of public-health messaging. “Completely avoiding sun exposure is not optimal for health,” read the groups’ position statement, which extensively cites a growing body of research. Yes, UV rays cause skin cancer, but for some, too much shade can be just as harmful as too much sun.
It’s long been known that sun exposure triggers vitamin D production in the skin, and that low levels of vitamin D are associated with increased rates of stroke, heart attack, diabetes, cancer, Alzheimer’s, depression, osteoporosis, and many other diseases. It was natural to assume that vitamin D was responsible for these outcomes. “Imagine a treatment that could build bones, strengthen the immune system and lower the risks of illnesses like diabetes, heart and kidney disease, high blood pressure and cancer,” The New York Times wrote in 2010. “Some research suggests that such a wonder treatment already exists. It’s vitamin D.” By 2020, more than one in six adults were on that wonder treatment in the form of daily supplements, which promise to deliver the sun’s benefits without its dangers.
une 2024 Issue
SCIENCE Against Sunscreen Absolutism Moderate sun exposure can be good for you. Why won’t American experts acknowledge that?
By Rowan Jacobsen Tanned skin with pale smiley face drawn on it Illustration by Gabriela Pesqueira. Source: Dimarik / Getty. MAY 10, 2024 SHARE & GIFT SAVE Listen to this article
00:00
14:49
Listen to more stories on Curio
Australia is a country of abundant sunshine, but the skin of most Australians is better adapted to gloomy England than the beaches of Brisbane. The country’s predominantly white population has by far the world’s highest rate of skin cancer, and for years the public-health establishment has warned residents about the dangers of ultraviolet light. A 1980s ad campaign advised Australians to “Slip, Slop, Slap”—if you had to go out in the sun, slip on a shirt, slop on some sunscreen, and slap on a hat. The only safe amount of sun was none at all.
Explore the June 2024 Issue Check out more from this issue and find your next story to read.
View More Then, in 2023, a consortium of Australian public-health groups did something surprising: It issued new advice that takes careful account, for the first time, of the sun’s positive contributions. The advice itself may not seem revolutionary—experts now say that people at the lowest risk of skin cancer should spend ample time outdoors—but the idea at its core marked a radical departure from decades of public-health messaging. “Completely avoiding sun exposure is not optimal for health,” read the groups’ position statement, which extensively cites a growing body of research. Yes, UV rays cause skin cancer, but for some, too much shade can be just as harmful as too much sun.
It’s long been known that sun exposure triggers vitamin D production in the skin, and that low levels of vitamin D are associated with increased rates of stroke, heart attack, diabetes, cancer, Alzheimer’s, depression, osteoporosis, and many other diseases. It was natural to assume that vitamin D was responsible for these outcomes. “Imagine a treatment that could build bones, strengthen the immune system and lower the risks of illnesses like diabetes, heart and kidney disease, high blood pressure and cancer,” The New York Times wrote in 2010. “Some research suggests that such a wonder treatment already exists. It’s vitamin D.” By 2020, more than one in six adults were on that wonder treatment in the form of daily supplements, which promise to deliver the sun’s benefits without its dangers.
But sunlight in a pill has turned out to be a spectacular failure. In a large clinical trial that began in 2011, some 26,000 older adults were randomly assigned to receive either daily vitamin D pills or placebos, and were then followed for an average of five years. The study’s results were published in The New England Journal of Medicine two years ago. An accompanying editorial, with the headline “A Decisive Verdict on Vitamin D Supplementation,” noted that no benefits whatsoever had been found for any of the health conditions that the study tracked. “Vitamin D supplementation did not prevent cancer or cardiovascular disease, prevent falls, improve cognitive function, reduce atrial fibrillation, change body composition, reduce migraine frequency, improve stroke outcomes, decrease age-related macular degeneration, or reduce knee pain,” the journal said. “People should stop taking vitamin D supplements to prevent major diseases or extend life.”
Australia’s new guidance is in part a recognition of this reality. It’s also the result of our improved understanding of the disparate mechanisms through which sunlight affects health. Some of them are intuitive: Bright morning light, filtered through the eyes, helps regulate our circadian rhythms, improving energy, mood, and sleep. But the systemic effects of UV light operate through entirely different pathways that have been less well understood by the public, and even many health professionals. In recent years, that science has received more attention, strengthening conviction in sunlight’s possibly irreplaceable benefits. In 2019, an international collection of researchers issued a call to arms with the headline “Insufficient Sun Exposure Has Become a Real Public Health Problem.”
https://www.theatlantic.com/magazine/archive/2024/06/sun-exposure-health-benefits/678205/

My wife (31 YO) and I (32 YO) have been TTC since mid-2022. We conceived in the first month of tracking with OPK (Sept 2023) but my wife had a spontaneous miscarriage at 6 weeks. The doctors were concerned about a potential molar pregnancy due to an abnormal scan, but it was ruled out after the D&C and further ultrasound review. My wife’s hormones took a very long time to get back to normal and she didn’t have a period again for about 5 months. Her OB wasn’t concerned at the time because the HCG was going down and the post-D&C scan looked normal.
We started trying again in mid-2023 and conceived in Oct 2023 after 5 cycles. We had a normal 6.5 week scan with heartbeat, but MMC measured 7.5 weeks at 9 week scan. POC tested normal and then we began RPL testing. Everything returned completely normal, including checks on hormones, clotting disorders, karyotyping, etc. HSG was performed and was normal. Only thing that flagged was her being vitamin D insufficient, but doctors weren’t concerned that was a risk factor. I did a sperm analysis and DNA Fragmentation test, and both returned okay.
Multiples REs tried to push IVF on us, claiming it was best to bank embryos if we wanted multiple children and to prevent potential chromosomal issues. But my wife’s OB and an MFM she met with thought it was a ridiculous recommendation, since nothing came up in testing that indicated IVF would be helpful in our situation.
So now we are back where we started and TTC. We were unsuccessful in the first cycle last month. My wife has adopted an attitude of “whatever happens, happens” and was not open to any further testing. The only thing I was trying to push for our docs to check was an endometrial biopsy, I keep just going back to the hard recovery after the first loss and how long it took for my wife’s cycle to return. Not sure if that could have been caused by retained tissue or an infection/inflammation after first D&C. Maybe I’m just grasping at straws because nothing has stood out in the testing. The docs weren’t open to testing (REs, OB, MFM), as my wife was not showing any symptoms. After the 2nd D&C, my wife’s cycle returned in normal time and she started ovulating right away.
The only thing different this time around is my wife is taking baby aspirin and a bunch of supplements (fish oil, vitamin D, methylfolate – on top of prenatal). So at this point, we’re just hoping for the best – but very scared since we didn’t find anything and it just feels like a game of chance.
Any advice on keeping sane during this period?

I am a 38-year-old man who weight 240lbs (40 BMI and 5'5" tall, so yes, my skin is pretty much expanded), and yes, my skin has lost some of its elasticity, I've done the skin pinch test, but is still pretty elastic.
Anyway, I have been theorizing, that even if I had loose skin, it might go away if I keep training and weightlifting for another 3 years. That'll allow more skin to break down and trigger the production more collagen, all while taking the collagen and Vitamin C supplements. I have tried to search on the internet, but the information is still insufficient, so I'm asking anyone whether someone can confirm my suspicion. I'm trying to make skin extraction surgery to be my last resort. I don't like scars.
I would appreciate any answer. Thank you.

Hello everyone!

General Info

I'm a 24M, Italian, having sudden IBS and mild IBS-related and social anxiety since 3-4 years. Also feel fatigued and lacking energies, like ''I could do better''. Never had any of these issues before this period of time.
Major changes at the start of this period – 3-4 years ago – were:
· quitting smoking cannabis (not gradually) · being on an hypo-caloric diet for some months and losing some weight · mild stress related to post pandemic/university/breakup (not ongoing).
Always done super good in social and relationships, never missed social gatherings, staying away from home even for several days – partying, staying at friends etc – this all seems an old version of me.
My relationships are good, I'm not totally ''anxiety-impaired'' (can travel, go out and have a drink etc), but I tend to avoid certain situations and I'm quite ruminating and over-analyzing future events. I have a girlfriend and have regular sex, I seem to work good under stress – even if it depletes my energies – and alternate between periods of good sleep pattern and light intermittent sleep (e.g. waking up after 3-4 hours of sleep). I don't usually exercise, aside from some cardio 1-2 times a week (running or soccer match), as intense exercise can make me feel really good or really depressed-like. I'm actually trying to do full body dumbbells routines and it feels good.

Diet

At the moment I'm on a dairy-free and gluten-free diet, I will give further info about it later.
I eat lots of bananas, tangerines, walnuts, sheep and goat greek yogurt, honey, chicken, beef and pig meat, eggs, fish, rice, potatoes, bio-chocolate spreads, olive oil and gluten-free cereals/bread, pasta or baked products, with ''dairy free'' natural cheeses (like 36 month Parmigiano Reggiano) or dairy free cheese spreads. As greens, I mainly eat ''light'' salads as lamb's lettuce, rocket, etc. I can't digest vegetables well due to my GI symptoms, so less often i eat broccoli, cauliflower, string beans, pumpkin, chickpeas. I drink vegetal milks and matcha from time to time. Protein makes me really bloated.
Masterjohn's Genetic Choline Calculator recommends 8 eggs yolks.

Supplements Stack

I'm currently taking:
· DS-01 Daily Synbiotic by Seed (probiotic) or other Life Extensions probiotics + enzymes. · L-Glutamine powder (10 g daily on an empty stomach) · Magnesium (only one form at a time): · Magnesium L-Threonate (144 mg elemental mag from 2000 mg of magtein) · Magnesium Acetyl-Taurinate (45 mg elemental mag from 750 mg of atamg) · Magnesium Bisglycinate Fully Chelated (315 mg elemental mag) · Omega-3 + EPA + DHA (700 mg of EPA, 500 mg of DHA, 2000 mg of pure+ wild fish oil) · Bioactive B-Complex *only 3-4 times a week
The B-Complex includes: · 100 mg of B1 as thiamine HCl · 75 mg of B2 as riboflavin and R5P · 100 mg of B3 as niacinamide and niacin · 100 mg of B6 as pyridoxine HCl and P5P · 400 mcg of B9 as L-methyltetrahydrofolate calcium salt · 300 mcg of B12 as methylcobalamin · 1000 mcg of B8 · 500 mg of B5 as D-calcium-pantothenate · 100 mg of inositol · 50 mg of PABA
Never seem to have had any issues with taking this 3-4 times a week – no increased anxiety or anything. As a matter of fact, I've started supplementing 2 months ago and I'm not noticing shifts in anxiety levels.
The only thing which seems to improve my anxiety and gut symptoms is definitely L-Glutamine. It makes night and day difference for me. Supports regular bowel movements and makes me feel calm and more ''ready to go'' (e.g. I don't ruminate much before leaving the house). I'm also adding 5 g of creatine for workouts and general energy.

Lab Results

(technique) [reference values]
Ironemia (Ferrozine) 137 ng/dL [61 - 157]
Testosterone (CLIA) 5.20 ng/ml [2.00 - 9.80]
17-Beta-Estradiol (ECLIA) 11.1 pg/ml [7.63 - 42.6]
Vitamin D 25-OH (ECLIA) 30 ng/ml [Deficiency <10 *Insufficiency 10 - 30* *Sufficiency 30 - 100*]
Vitamin B12 (ECLIA) 410 pg/ml [191 - 663]
Folic Acid / Vitamin B9 (ECLIA) 14.2 ng/ml [2.00 - 16.8]
Homocysteine (HPLC) 11.3 mmol/l [5 - 14]
Histamine (E.I.A) 0.9 ng/ml [0.2 - 1.0]
Vitamin B2 / FAD (HPLC) 301 microgl [137 - 370]
Vitamin B1 (HPLC) 72.4 microgl [28 - 85]
Vitamin B6 (HPLC) 16.9 microgl [8.7 - 27.2]
Copper (GFAAS) 85 mcg/dl [70 - 140]
Zinc (GFAAS) 88 microgdl [68 - 107]

Genetic Reports

https://preview.redd.it/an3ae7sws7yc1.jpg?width=8263&format=pjpg&auto=webp&s=60f503cb41f38f2b554a13e7ca9e286eb4c12423
https://preview.redd.it/04e3m7sws7yc1.jpg?width=11692&format=pjpg&auto=webp&s=524069d1126a6e531f8241414cc388be1d824638
https://preview.redd.it/2gpdmcsws7yc1.jpg?width=11692&format=pjpg&auto=webp&s=ba50d68dc0bc8acf0d7e297484f0abc9c72f30e2
https://preview.redd.it/x2qnc9sws7yc1.jpg?width=11692&format=pjpg&auto=webp&s=f3e2939f0d4498a6631ecd350a65f3e9347fe4ca
https://preview.redd.it/3zxdyzbys7yc1.jpg?width=8263&format=pjpg&auto=webp&s=e9146099d2bbee6f16ea8f5e7365393e0670fc4e
https://preview.redd.it/s188oojzs7yc1.jpg?width=5088&format=pjpg&auto=webp&s=ffe4ed7ed7aa69c17b403c6e4144acd73ef07fb3
Thank you all for your time, patience and support!
This is all new to me and I'm excited to start dive into this, so please, be kind!
Saw a lot of incredible answers on this sub by many users, would *love* to hear u/Tawinn's opinion on this!

Sharing this for anyone who may have a hernia or suspects one. I had severe pelvic floor pain three years ago. They thought I had strep b and I was put on antibiotics. Not common in non-pregnant women, but I had auto-immune issues and had been on treatment for 10 years. Skip to, the pain never left and i was always dry and irritated. i was diagnosed with vaginal atrophy, vulvodynia and hypertonic pelvic floor. I have been doing pelvic floor therapy off and on for 3 years but finally committed this year. I realized due to SA, growing up extremely catholic and sex being a no no topic in my house, I was ashamed and embarrassed I had this issue and didn't do the work like I should. I have a very supportive partner, however given my past trauma and history, I always felt bad and ashamed I am unable to have sex all the time or give him what he needs. I am learning to accept kindness and learning it is a health aspect of a relationship. I can have sex, but it hurts. The wand, from intimate rose helps me the most.
Estradiol topical helped with the atrophy but not the pain. I switched to intrarose which helped for awhile but lately I have been flared. I had low testostrone and was apprehensive to trt. I saw Millheiser at stanford and was left really unimpressed. She was very dismissive and recommended a lube I hated and trt. She wanted me back on birthcontrol which i was on for 16 years and didn't want to go back on after it caused vaginal atrophy. Instead, I took high doses of vitamin d, approved and monitored by doctor for chronic pain, and it increased my testosterone to normal levels. I use suppository baclofen, flexeril and intrarose currently. For moisture I use Yes, ah and love their lube too. This helped for a while, but lately I have been extremely flared. Two months ago I was diagnosed with having either an inguinal or femoral hernia( ultrasound couldn't distinguish between the two and when the doctor examined me he was not convinced it was inguinal). After much research, most women do not know they have one and this can be a cause for pelvic floor pain. I'm 5'4 and about 110-115 lbs and the bulge was not as noticeable to doctors until i pointed it out. I am waiting for my insurance to approve a specialist surgeon in los angeles who focus on women and hernia repairs. I'm opting for no mesh as this can cause more pain for women in the future. I hope to keep everyone updated.
I will continue to do my treatments even after surgery, however if the pain persist, I will be looking to treat my endometriosis as I have it. In the meantime I hope to work with a naturopath that specializes in women's hormones. My hormone test have come back all within range, but those are ranges and may not be in range for my body.
I decided to take the summer off from school (after nearly dying from adrenal insufficiency, I stabilized a few years ago and decided to go back to school to become a pa in hopes I could help patients in a way I felt doctors ignored me when I was at my sickest). This summer I will be focusing on doing not only hrt, pelvic floor therapy and my own daily internal work, but getting comfortable with my own body and processing my past trauma. I'm in the midst of finals, but try and get in 10-20 min a day and notice a huge difference. Instead of fearing the pain, I have been recognizing it as a sensation, and staying calm and trying to do a few minutes of breathing to get through it. I'm noticed manual massage in different positions help, especially when standing, I can relieve a lot more spastic/tight muscles than i would lying down. I've gone on reddit for the last 3 years reading other women's stories and felt like I should post as a way to get comfortable with everything.
Also: extremely open to any suggestions or tips. It's been a long three years of trial and error and feeling hopeless, however I do feel like there is light at the end of the tunnel.

Vitamin D, often referred to as the "sunshine vitamin," plays a crucial role in supporting overall health, with its influence extending beyond bone health to immune function. In this comprehensive guide, we'll explore the multifaceted role of vitamin D in our bodies, the importance of maintaining optimal levels, and how you can ensure you're getting enough of this vital nutrient.

Understanding Vitamin D
1. Sunlight Synthesis:
The primary source of vitamin D is sunlight. When our skin is exposed to ultraviolet B (UVB) rays from the sun, it synthesizes vitamin D3, the active form of the vitamin .
2. Dietary Sources:
While sunlight is the natural source, vitamin D can also be obtained from certain foods such as fatty fish (e.g., salmon, mackerel), fortified dairy products, egg yolks, and vitamin D supplements .
3. Vitamin D Metabolism:
Once synthesized or ingested, vitamin D undergoes a series of metabolic processes in the liver and kidneys to become the active form that the body can use .
The Crucial Role of Vitamin D in Immunity
1. Immune Function Modulation:
Vitamin D is known for its immunomodulatory effects, influencing both the innate and adaptive immune systems. It helps regulate the expression of genes involved in immune response and enhances the function of immune cells .
2. Defense Against Infections:
Adequate levels of vitamin D have been associated with a reduced risk of respiratory infections, including the common cold and influenza. It plays a role in the production of antimicrobial peptides that defend against pathogens .
3. Autoimmune Conditions:
Research suggests a link between vitamin D deficiency and autoimmune diseases. Maintaining optimal levels may help reduce the risk of conditions like rheumatoid arthritis, multiple sclerosis, and lupus .
Vitamin D and Bone Health
1. Calcium Absorption:
Vitamin D is essential for the absorption of calcium from the intestines. Without sufficient vitamin D, the body cannot absorb the calcium needed for maintaining strong and healthy bones.
2. Bone Mineralization:
Vitamin D promotes bone mineralization by regulating the levels of calcium and phosphorus in the blood. It is crucial for the formation and maintenance of bone structure .
3. Prevention of Bone Disorders:
A deficiency in vitamin D can lead to conditions such as rickets in children and osteomalacia in adults, both characterized by weakened and malformed bones .
Assessing and Maintaining Vitamin D Levels
1. Sun Exposure:
Aim for regular, moderate sun exposure, particularly during peak sunlight hours. The duration needed depends on factors like skin type, location, and time of day.
2. Dietary Intake:
Include vitamin D-rich foods in your diet, such as fatty fish, fortified dairy products, and egg yolks. Dietary supplements may be recommended for individuals with limited sun exposure or difficulty obtaining sufficient vitamin D from food .
3. Supplementation:
Vitamin D supplements are commonly recommended, especially for individuals with insufficient sun exposure or difficulty meeting their vitamin D needs through food alone. Consult with a healthcare professional to determine the appropriate dosage .
Potential Factors Affecting Vitamin D Levels
1. Geographical Location:
People living in regions with limited sunlight, especially during the winter months, may be at a higher risk of vitamin D deficiency .
2. Skin Pigmentation:
Individuals with darker skin pigmentation may require more extended sun exposure to produce the same amount of vitamin D as those with lighter skin. This can increase the risk of deficiency in certain populations .
3. Age:
As we age, the skin's ability to synthesize vitamin D decreases. Older adults may need more sun exposure or higher dietary intake to maintain optimal levels .
4. Clothing and Sunscreen Use:
Wearing sunscreen and protective clothing blocks UVB rays, reducing the skin's ability to produce vitamin D. Balancing sun protection with adequate exposure is essential .
Conclusion
Vitamin D plays a pivotal role in supporting both immune function and bone health. Ensuring you receive an adequate amount of sunlight, incorporating vitamin D-rich foods into your diet, and considering supplementation when necessary are key strategies to maintain optimal levels.
Regular monitoring of vitamin D levels, especially for individuals at higher risk of deficiency, can help prevent associated health issues. Remember, achieving a balance between sun exposure, dietary intake, and, when needed, supplementation is essential for overall well-being.
Are you getting enough vitamin D? Assess your lifestyle, consider potential risk factors, and take steps to support your body's vitamin D needs for a healthier and stronger you.

I was just wondering what vitamins/ minerals/ amino acids play an important role in hormone function, I have been trying to eat healthier lately and although I think I get a very decent nutrient intake from my diet, I always worry I’m deficient or lacking in something. I hear magnesium is important and I take omega 3 fish oil daily along with Greek yogurt and collagen (it absolutely makes a difference in my overall health). I even recently heard about something called “sero-vital” that claims to greatly boost HGH levels, but there seems to be insufficient studies or evidence behind this. Just wondering if anyone had any recommendations of study-backed supplements!

I am a 67yo white Male, 5'10" and 220lbs. I have controlled hypertension and depression with atenolol and Prozac. In the past, I have had kidney stones and had my gallbladder removed. I reside in New York, USA. My diet is not balanced, I don't exercise anymore; I've never taken drugs and have always rarely drank alcohol. My CBC was normal, cholesterol basically fine, the metabolic panel is of concern. I got tested bc of some fatigue and an often urge to pee. My gallbladder was removed years ago, but before my last bloodwork exam which was 15 months ago and all of these numbers were normal pretty much.
Bilirubin, Albumin, electrolytes, glucose all normal. Abnormal:
eGFR: 52 mL/min ALT: 91 U/L AST: 49 U/L Alkaline Phosophtase (ALP): 347 U/L Creatinine: 1.46 mg/DL Blood Urea Nitrogen: 43 mg/DL Vitamin D 25: Insufficient (27ng)
The thyroid test came back as invalid so it will have to be retested. Doctor ordered a renal and liver ultrasound to look further and go from there. I don't have family history of liver or kidney issues, and I rarely use alcohol and never drugs. SO .... am pretty nervous over here, but want to hear opinions on what you were thinking/what it could be? Thank you.

Boron is a trace mineral found in fertile soil and absorbed by plant foods that humans consume.
This micronutrient is vital for regulating metabolic processes and has been linked to various health benefits, including bone health, hormone balance, and brain function.
Discover five incredible boron benefits and learn how to incorporate this trace mineral into your diet.

What is boron?

Boron is a trace mineral found in soil, similar to copper, iron, zinc, and manganese.
The boron in plant foods occurs mainly in boric acid form, which is essential for plant growth, seed formation, and pollination.
In addition to promoting the development of plants, boron also has been found to have profound health benefits for humans.
Boron is classified as a micronutrient, meaning only a small amount is needed to support human health, though it hasn’t been determined if boron is an essential nutrient.
Despite little being known about boron’s biological purpose in humans, 80 to 90 percent of boron is absorbed by the intestines, and adequate boron levels are associated with healthy bone formation and hormonal balance.
Watch the video below to learn why boron deficiency is a widespread issue.
Benefits of Boron, One of the Most Deficient Trace Minerals

5 benefits of boron

It is believed that boron plays a role in bone formation, reproductive processes, and may help lower the risk of health conditions linked to chronic inflammation.
Here are five incredible benefits of boron.

1. Promotes bone health

Boron may reduce the risk of bone-related diseases and deformities by supporting bone strength and calcium metabolism, which are vital for developing and maintaining healthy bones.
A study published in the Journal of Trace Elements in Medicine and Biology confirms the benefits of boron for skeletal health and suggests that boron supplementation enhances bone formation.
In addition, researchers found that boron deficiency resulted in decreased bone strength, abnormal limb development, and slow growth plate maturation, which impacted bone growth.

2. Supports hormone balance

Data published in Environmental Health Perspectives found that boron supplementation balances estradiol and testosterone levels in postmenopausal women. This may help relieve menopausal symptoms such as hot flashes and mood changes.
This research also found that boron reduces excessive urinary calcium excretion, which is common in postmenopausal women and linked to an increased risk of kidney stones.

3. May improve arthritis

Cartilage is a type of connective tissue that prevents bones from grinding together. Arthritis is a result of cartilage breakdown, leading to joint pain and inflammation.
Boron may help manage arthritis symptoms by supporting calcium integration into the joints, which helps protect against cartridge deterioration.
Research published in Environmental Health Perspectives found, "Areas of the world with low boron intakes have a significantly higher incidence of arthritis compared to regions with generally higher boron consumption.”

4. Enhances vitamin D absorption

Vitamin D is essential for strong bones, immune defenses, brain and emotional health, and inflammation regulation.
Studies suggest that boron promotes the bioavailability of vitamin D, allowing it to stay in the body for longer and enhancing its effectiveness.
In addition, a study published in Integrative Medicine found that boron supplementation helps increase vitamin D3 status in vitamin D-deficient individuals.

5. Promotes brain function

Lack of adequate boron has been linked to impaired cognition and poor information retention.
Studies suggest that boron may play a role in mineral metabolism and cell membrane function, which help protect the brain from degeneration.
Research published in Environmental Health Perspectives found that low boron intake reduced hand-eye coordination, attention, and short-term and long-term memory. In addition, the authors stated that those who received boron supplementation saw significant improvements in various psychomotor skills and memory tests.

Symptoms of boron deficiency

Symptoms of insufficient boron haven’t been well established. However, animal studies have linked boron deficiency to abnormal bone growth and weakness.
Some data suggest low boron intake can also impair brain function, alertness, and memory.
Boron deficiency may also increase the risk of vitamin D deficiency, which is linked to various health issues, including bone pain, muscle weakness, fatigue, and depression.
Additionally, a low boron diet may contribute to excessive urinary calcium excretion, which increases the risk of kidney stones, especially in postmenopausal women.

What causes boron deficiency?

Boron deficiency in humans is linked to inadequate consumption of boron-containing whole foods. Even a plant-rich diet can lead to boron deficiency due to mineral-depleted soils.
“Boron is a trace mineral, and if it’s not in the soil, it can’t be absorbed by plants, increasing the risk of widespread deficiency,” explains Dr. Berg.
Soil degradation is the most common cause of boron deficiency and is generally associated with conventional farming and soil cultivation practices.
These practices involve growing large amounts of single-crop produce without replacing the nutrients and microdiversity after harvest, which leads to soils depleted of nutrients, including boron.

Best sources of boron

Boron is found in various plant foods, including vegetables, nuts, and certain fruits.
Additionally, boron can be found in small amounts of animal protein, including beef, chicken, turkey, and dairy products.
Here are some of the best boron-rich foods:

• Avocados
• Peanuts
• Broccoli
• Lettuce
• Carrots
• Almonds
• Hazelnuts
• Chickpeas

Organically grown produce contains higher levels of nutrients than conventionally harvested options, making them superior sources of boron.
According to a study published in Alternative Medicine Review, organic foods have significantly higher levels of various nutrients and antioxidants, which are needed to maintain general health and well-being.
Researchers also found lower levels of pesticide residues in organic produce, which are linked to cancer, hormonal imbalance, and other health risks.

How much boron should you take?

Most people can get boron from food, especially those consuming large volumes of high-quality, organic produce.
There is limited data on boron’s biological function in the body and no consensus on the dietary reference intake recommendation.
However, the Food and Nutrition Board of the Institute of Medicine (FNB), which establishes guidelines for good nutrition, has set upper intake levels for boron.
These upper limits are the maximum recommended dosages that aren’t expected to induce adverse effects.
According to the FNB, these are the upper limits for boron based on age:

• 1 to 3 years: 3 milligrams (mg)/day
• 4 to 8 years: 6 mg/day
• 9 to 13 years: 11 mg/day
• 14 to 18 years: 17 mg/day
• 19+ years: 20 mg/day

Safety data on boron has not been established for infants younger than one year.
To reduce the risk of unwanted side effects, it’s important to follow the instructions of the boron supplement you plan to use.

Possible downsides of boron supplementation

Infants shouldn’t be given boron, except through breast milk, formula, or food, as there is no safety data in children younger than one.
The most common instances of boron toxicity were reported in children younger than six ingesting boron-containing cleaning substances, leading to vomiting, convulsions, and cardiovascular issues.
Though boron toxicity in adults is rare, large doses can cause headaches, restlessness, and fatigue. High boron levels from supplementation have also been linked to nausea, rashes, gastrointestinal discomfort, and alopecia in extreme cases.
Boron supplements can increase estrogen levels and aren’t recommended for those with hormone-related diseases, including breast, ovarian, and prostate cancer.
To minimize the risk of adverse health effects, it’s vital to consult your healthcare provider before introducing new supplements into your routine.

I am very prone to brain fog and have experienced it many times and succesfuly cured it. Here i will list common things that can trigger it. You might have completely different reasons that i don't know so i can't offer a cure for everybody, but hope it helps some of you.

1. Low vitamin b1. I have pancreatic insufficiency so i am very prone to vitamin deficiencies, however i have seen this develop in "healthy individual" after pneumonia and covid. Subclinical b1 deficiency is very common because processed carbs deplete it, alcohol consumption reduces absorbtion by 50%+ and it has very low bioavailability. High metabolic states like disease or withdrawal increase the need for it several fold so it's very common for symptoms to arise after illness. Once it develops you won't be able to fix it with 100 mg or less oral b1 because of very low bioavailability. Blood test will usually not show it because you need to test it in blood cells to measure it accurately. Other symptoms of low b1 are low appetite, insomnia and depression. To cure it, you need injectable b1, 500 mg 3 times daily to restore it. If you have it you will feel immediate relief after about 3 hours post injection.
   
2. Sleep apnea and UARS (upper airways resistance syndrome). UARS is not detectable by normal sleep study and is probably much more common. It means you wake up tens of times an hour from deep sleep to light sleep or to fully awake, but these breathing interuptions don;t last 10 sec + (like in sleep apnea). Symptoms are insomnia (not always), bad fatigue in morning/afternoon with somewhat improvement in the evening, body aches (expecially for women), hypothyroidism (again for women), IBS. To cure it you need to fix the airways. Usually there is obstruction in the nose and/or in the throat so unfortunatly sugery is usually the only way. Good thing that once you stop walking up you will make a full recovery in a couple of days.
   
3. SIBO (small intestine bacterial overgrowth). Symptoms are extreme bloating, chronic diahrea or constipation or both , exccesive gas. It is often accompanied or maybe even caused by vitamin 1 defficiency. Bacteria in the gut produces methane that dissolves in the blood and produces brain fog. They probably do other things that are yet to be discovered that causes cognitive issues. There is test for SIBO. If you have it, treatment is 600 mg 3 times a day of rixafimin ( not absorbable antibiotic) for a week.
   
4. Low free testosterone/estradiol for men . Hypogonadism for men is very common but underdiagnosed due to incorrect blood test. You need to test free testosterone and not total. If you can't test free, test total testosterone, SHBG, estradiol and albumin. From these you can calculate your free testosterone. A lot of people have their testosterone in range but high shbg ( >50) so their free testosterone is low and they have the common symptoms of low libido, brain fog, depression, anxiety, insomnia. If the blood test confirms, treatment is either fixing why testosterone is low/ shbg high or going on Hormone replacement therapy. Improvment is very quick once the optimal free testosterone and estradiol levels are reached.
   
5. Drugs and supplements. There are probably numerous drugs and supplements that can induce brain fog. I will list some that i know could cause it : high dose zinc, probiotics, DHEA. Proton pump inhibitors like omeprezole, DPP-4 inhibitors like sitagliptin. These have caused issues for me, there are probably numerous others so if you can trace your brain fog starting when you started some drug or even some "innocent" supplement, try stop using it. Obviously don't stop using drugs if you have a serious health issue and talk to your doctor.
   
6. Autoimmune conditions. Like MS or Chron's. I have no experience with it but i know people who have it and complain of brain fog. It can also be allergies like lactose intolerance or gluten sensitivity.
   

Is it possible to pass LOTS of biofilms in stool with no other symptoms? No cramping or bloating just some diarrhea with what I think is biofilms. I actually have increased energy. I did get lots of Vitamin D (I have insufficient Vit D and working on that) a few days ago as we went to the beach and I also used lots of garlic in dinner the night before this started happening. I guess hormones could play a role in this too?

Sole biguanide agent in the US.
Available in short and sustained-release formulations.
Has the best benefit-risk profile for glycemic control, weight loss and safety.
Recommended as initial treatment for type 2 diabetes.
Metformin, compared with lifestyle modification alone, is associated with a 39% reduction in myocardial infarction and a 36% reduction in all-cause mortality in type 2 diabetes.
Works primarily by decreasing hepatic glucose output and a relatively minor effect on increasing insulin sensitivity.
Hepatic gluconeogenesis may be reduced by 75%.
It decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb.
Its pleitropic affects, include decreased inflammation, increase insulin and leptin sensitivity, and decreased hunger and gherlin levels, especially with twice daily dosing.
Acts in the liver where it inhibits gluconeogenesis by blocking a mitochondrial redox shuttle.
It is an insulin sensitize and likely acts in the lumen through multiple mechanisms.
Metformin, taken with diet and exercise changes to prevent diabetes in people who are at high risk for becoming diabetic.
It is frequently used in patients with pre-diabetes, polycystic, ovary syndrome, and overweight/obesity to mitigate weight gain due to antipsychotic medications.
It increases the effects of insulin, and is termed an “insulin sensitizer”.
A biguanide, is the most widely used oral antidiabetic drug that is generally
Recommended for first-line medical treatment of type 2 diabetes.
Early initiation of metformin at the time of diagnosis, when glycosylated hemoglobin levels are not significantly elevated, has been associated with improved glycemic control over time and decreased long-term complications.
Metformin is believed to activate AMP-activated protein kinase (AMPK), a major cellular regulator of lipid and glucose metabolism.
Metformin has been shown to be highly effective at reducing the onset ofdiabetes by 31% in 3234 prediabetic adults over a period of 2.8 years in the DPP (Diabetes Prevention Program) study 72 and at reducing systemic inflammation.
Also suppresses the endogenous glucose production by the liver, which is mainly due to a reduction in the rate of gluconeogenesis and a small effect on glycogenolysis.
It activates the enzyme adenosine monophosphate kinase (AMPK) inhibiting enzymes involved in gluconeogenesis and glycogen synthesis in the liver while stimulating insulin signaling and glucose transport in muscles.
Metformin is believed to activate AMP-activated protein kinase (AMPK), a major cellular regulator of lipid and glucose metabolism.
Improves glycemic control without inducing hypoglycemia or weight gain.
Metformin has modulating effects on a pathway known to play a major role in lifespan extension.
Metformin also upregulates peroxisome proliferator–activated receptor gamma coactivator 1-alpha, a master regulator of mitochondrial function, and a transcription factor that controls antioxidant programs.
Because these molecules (AMPK, mammalian target of rapamycin, and peroxisome proliferator–activated receptor gamma coactivator 1-alpha) are interconnected through cellular signaling networks implicated in the modulation of the aging process, it has been postulated that metformin could slow aging and age-related diseases.
Metformin is believed to activate AMP-activated protein kinase (AMPK), a major cellular regulator of lipid and glucose metabolism.
Metformin has modulating effects on a pathway known to play a major role in lifespan extension.
Metformin also upregulates peroxisome proliferator–activated receptor gamma coactivator 1-alpha, a master regulator of mitochondrial function, and a transcription factor that controls antioxidant programs.
Observational studies indicate that metformin reduces mortality and frailty.
Use associated with lower rate of atrial fibrillation.
Use associated with lower incidence of atrial fibrillation.
Use associated with lower fasting insulin concentrations.
One of the few drugs that shows a significant reduction of macrovascular events and diabetes related mortality.
Antioxidants have beneficial effects such as anticancer, antidiabetes and antiatherosclerosis properties.
It has been shown to reduce visceral adiposity and insulin resistance after 8 weeks of drug therapy.
Trade name Glucophage.
Use associated with weight loss.
Metformin is associated with approximately 3% weight loss in approximately 25 to 50% of participants achieve at least 5% weight loss.
Long-term use associated with anemia-6% higher risk of anemia for every cumulative yer of metformin exposure (Donnelly L).
Decreases HgbA1C by 1 to 2%.
As much as 88% of weight loss is body fat mass.
Primarily used for the treatment of type 2 diabetes mellitus, particularly in obese.patients.
Reduce diabetes mortality and complications by thirty percent compared to insulin, and chlorpropamide.
Reduces serum glucose level by several different mechanisms, notably through nonpancreatic mechanisms without increasing insulin secretion.
Drug use contraindicated in many patients with impaired kidney function because of concerns of lactic acidosis.
The occurrence of dehydration can increase the risk of lactic acidosis.
The elderly may be at greater risk for hypoglycemia or lactic acidosis.
Its pharmacokinetics are affected by pregnancy, related to the changes in renal filtration and net tubular transport.
A fetus is exposed to variable concentrations of metformin.
Infant exposure to metformin through the breast milk is low.
Has nephroprotective activity against nephrotoxic agents.
Use in patients with diabetes and advanced chronic kidney disease is associated with greater mortality risk.
Side effects include: Nausea, vomiting, stomach upset, diarrhea, weakness, or a metallic taste in the mouth may occur.
It usually does not cause hypoglycemia; however, low blood sugar may occur if this drug is used with other anti-diabetic drugs.
Hypoglycemia is more likely to occur with metforminn with heavy exercise, drinking large amounts of alcohol, or not consuming enough calories from food.
Previous data suggesting it should be contraindicated in patients with impaired kidney function, but more up-to-date information suggests that can be used cautiously in mild to moderate chronic kidney disease.
Use in patients with advanced chronic kidney disease reveals all cause mortality is significantly higher (and is dose-dependent) than in patients with chronic kidney disease in diabetics and non-users of metformin.
Patients with diabetes and reduced kidney function persisting with monotherapy, treatment with metformin compared with a sulfonylurea is associated with a lower risk of major adverse cardiac events.
The presence of hyperinsulinemia has been noted in many patients with cardiac syndrome X, and metformin has been shown to improve vascular function and decrease myocardial ischemia in nondiabetic women with chest pain and angiographically normal coronary arteries.
Although renally cleared drug levels generally remain within the therapeutic range and lactate concentrations are not not substantially increased when used in patients with mild-moderate chronic kidney disease (estimated GFR 30-60 mils per minute per 1.73 m²) (Inzucchi SE et al).
Incidence of lactic acid doses in metformin users is approximately 3 per 100,000-person-years to 10 per 100,000 person years and is indistinguishable from the background rate in th overall population with diabetes.
Lactic acid levels do not increase in patients with normal renal function.
Recent studies suggest no increase in lactic acidosis with mild to moderate chronic kidney disease or congestive heart failure.
Major clinical effect is decreased fasting glucose levels..
Most patients have approximately 1.5 reduction in HbA1C.
Referred to as an antihyperglycemic agent rather than a hypogolycemic drug.
Incidence of associated hypoglycemia is low.
May modestly decrease triglycerides because of decreased very low density lipoprotein production.
Must be stopped 48 hours after intravenous contrast administration and restarted when normal renal function is documented to decrease the chance of lactic acidosis.
Lactic acidosis is the most severe adverse affect and is associated with older age, cardiac disease, the compensated congestive heart failure, renal insufficiency, chronic pulmonary disease, and hypoperfusion.
Can rarely cause lactic acidosis with risk related to sepsis, dehydration, excess alcohol intake liver insufficiency renal impairment and acute congestive heart failure.
Incidence of lactic acidosis very low, approximately 0.03 cases/1,000 patient- years with approximately 0.015 fatal cases/1,000 patient-years.
Lowers blood glucose levels by sensitizing the liver to the effects of insulin, thus suppressing hepatic glucose output.
Decreases the amount of glucose produced by the liver and reduces blood stream level and cellular uptake of insulin.
Improves peripheral insulin sensitivity so that it improves skeletal muscle glucose utilization.
In type 2 diabetics improves both basal and postprandial plasma glucose.
Metformin stimulates AMP-activated protein kinase and reduces hepatic glucose production.
It reduces insulin stimulation resulting in reduced activation of insulin receptors on cell membranes, triggering intracellular molecular effects such as down regulation of the RAS/RAF/MEK/ERK and P13K/AKT/mtor signaling pathways.
Upregulates AMP-activated protein kinase, a key molecule in glucose and insulin regulation and also an inhibitor of mTOR.
Activates AMP-activated protein kinase, a major sensor cellular energy levels and a key enzymes limiting growth during times of cellulitis stress.
Activated AMP protein kinase PX protein, cholesterol, and fatty acids synthesis and inhibits mTOR.
Reverses hyperinsulinemia, leading to the down regulation of insulin-like4 growth factors that can promote tumorogenesis by activating of the phosphatidylinositol 3 kinase/protein kinase B pathway.
Enhances phosphorylation of AMP-activated protein kinase,, inducing changes in the intracellular pathways, ALT is mitochondrial function and may result in improved systolic and diastolic function.
Observation studies of acute myocardial infarction and treatment with metformin is associated with lower peak CK levels, troponins and improve survival after STEMI in patients type 2 diabetes, compared with other anti-glycemic strategies.
Among patients without diabetes and who presented with a STEMI and undergo primary PCI, the use of metformin compared with placebo does not improve left ventricular ejection fraction after 4 months (Lexis CP et al.
Associated with a 31% reduction in diabetes compared to placebo in patients with impaied glucose tolerance (DDP Research Group).
Increases GLP-1 secretion and inhibits GLP-1 degradation.
Among obese adolescents with type one diabetes the addition of metformin to insulin does not improve glycemic control (Libman IM et al).
Lowers cholesterol, triglyceride, and reduces hyperinsulinemeia, improves insulin sensitivity, and assists with weight reduction.
Decreases overall mortality in overweight Type 2 diabetics.
The international Reduction of Atherothrombosis for Continued Health (REACH) Registry indicated that the use of metformin as a means of secondary prevention in diabetes was associated with a 24% reduction in all-cause mortality after two years follow-up.
In obese diabetic patients uses so Siri Siri 2% reduction in the diabetes-related endpoint, 42% reduction in diabetes related death, and 36% reduction in mortality (UKPDS).
In the above study patients receiving metformin had a 39 percent reduction in the risk of nonfatal MI.
Other studies on metformin have not shown improvement in microvascular with macrovascular morbidity or mortality.
Associated with lactic acidosis, anorexia, nausea and diarrhea.
May be associated with metallic taste, nausea, diarrhea, and abdominal pain.
Symptoms can be minimized by starting with a low dose and titrating slowly, dividing doses and taking the drug with food.
Decreased vitamin B12 levels have occurred in patients on long-term treatment and rarely has been associated with anemia.
Metformin, might reduce the absorption of vitamin B12, possibly through alterations in intestinal mobility, increased bacterial overgrowth, or alterations in the calcium-dependent uptake by ileal cells of the vitamin B12-intrinsic factor complex.
10%–30% of patients who take metformin have reduced vitamin B12 absorption.
Contraindicated: in patients older than 80 years unless normal creatinine is present, in patients with abnormal renal or hepatic function and in patients taking medications for congestive heart failure.
Improves ovarian function in polycystic ovarian syndrome.
In women with polycystic ovarian syndrome, it may make menstrual cycles more regular and increase fertility.
In a large review using 27 clinical trials found metformin was not associated with any increase in the number of live births; however, it improved ovulation rates, especially when it was used in combination with clomiphene in polycystic ovarian disease.
With polycystic ovary syndrome, it is a first choice because of positive effects on insulin resistance, hirsutism, anovulation and obesity.
Metformin improves endothelial function in women with PCOS and endothelial dysfunction independent of changes in glucose metabolism metabolism, dyslipidemia or presence of pre-diabetes.
Metformin has a direct effect on endothelial function in PCOS.
In conjunction with clomiphene citrate acts to increased ovulation and pregnancy rates in polycystic ovarian syndrome.
May reduce rate of spontaneous abortion rate.
Decreases free circulating testosterone through an effect on liver sex hormone binding globulin, modulates adrenal androgen production and decreases ovarian androgen production associated well.
Can improve hirsutism.
Crosses the placenta.
Utilization in gestational diabetes alone, or with supplemental insulin, not associated with increased perinatal complications compared to the use of insulin alone.
Metformin
Observational studies indicate the outcomes for individuals with type two diabetes receiving Metformin while undergoing cancer treatment are improved.
Metformin reduces insulin signaling through the PIK3 and RAS pathways and activates AMPK, which inhibits downstream AKT/mTOR, impairing cancer cell growth.
There is strong evidence for a lack of benefit from metformin treatment in metabolically healthy individuals.
Use probably protects against liver cancer, lower risk for oral cancer, improves prognosis of pancreatic cancer in diabetic patients, increases response rate in melanoma treated tumors with BRAF mutations and chemotherapy agents.
The risk of pancreatic cancer in patients taking metformin is a 62% lower than in placebo group who did not use metformin.
While diabetic participants having sulfonylureas or insulin were found to have a 2.5-fold and 5-fold higher risk of pancreatic cancer, respectively, in comparison to placebo group.
Diabetic patients using metformin may have a lower the risk of cancer compared to those using other anti-diabetic drugs.
Has strong antiproliferative effects on colon, pancreatic, breast, ovarian, prostate and lung cancer cells.
Diabetes is a common disease that may occur throughout human life, and can increase the likelihood of the occurrence of various types of cancer, such as colon, rectum, pancreas and liver cancers, compared to non-diabetic patients.
Metformin inhibits mTOR activity by activating ATM (ataxia telangiectasia mutated) and LKB1 (liver kinase B1) and then adenosine monophosphate-activated kinase (AMPK), and thus prevents protein synthesis and cell growth.
mTOR is a protein kinase regulating cell growth, survival, metabolism, and immunity.
metformin can activate p53 by activating AMPK and thereby ultimately stop the cell cycle.
Metformin in nondiabetic, unresectable stage III non-small cell lung cancer (NSCLC) treated with chemoradiation: survival exceeded expectations in both groups, those who received chemoradiation alone vs chemoradiation and metformin: however, the addition of metformin to chemoradiation did not improve overall or progression-free survival.
Addition of metformin to chemoradiotherapy, as a concurrent treatment as well as consolidation therapy, in patients without diabetes who have locally advanced non-small cell lung cancer
addition of metformin to chemoradiotherapy was associated with worse treatment efficacy and increased toxic effects compared with chemoradiotherapy alone.
The proportion of patients who experienced a failure event within 1 year with locoregional disease progression, distant metastases, death, or withdrawal was 69.2% in the metformin arm vs 42.9% in the control arm.
Metformin is not recommended as an adjunct to chemoradiotherapy for the treatment of unresected locally advanced non-small cell lung cancer in patients who do not have diabetes.
Addition of metformin to standard breast cancer treatment
a randomized controlled trial (RCT) found addition of metformin to standard breast cancer treatment did not improve invasive disease free survival vs placebo among patients with high-risk operable disease who did not have diabetes.
Strong evidence for a lack of benefit from metformin treatment in metabolically healthy individuals.
A review found metformin use did not have a significant effect on cancer incidence in subjects with overweight/obesity and/or prediabetes/diabetes.
A clinical trial has demonstrated a beneficial effect in colon and breast cancers.
It possesses antioxidant activity.
Use associated with impaired cognitive performance.
Compared with Sulfonylureas, metformin is associated with reduced risk of major adverse cardiac events among patients with type two diabetes and reduced kidney function.
In non diabetics does not improve carotid intima-media thickness or carotid plaque scores.
May have a Preventative role In peripheral neuropathy induced by diabetes
Treatment with metformin prevents axonal atrophy and fiber degeneration.
Metformin stimulates the expression of neurotrophic and angiogenic factors in the peripheral nerve.
Metformin attenuates inflammation of nerve tissue exposed to chronic hyperglycemia.
Metformin increases the expression of anti-inflammatory markers.
Studies have shown in patients with prostate cancer, colorectal cancer, pancreatic cancer, triple negative breast cancer,, HER2 positive breast cancer, multiple myeloma the median overall survival durations are increased in patients taking metformin than in patients who are not.
Among patients with high-risk operable breast cancer without diabetes, the addition of Met Forman versus placebo to standard breast cancer treatment did not significantly improve invasive disease free survival (Goodwin PJ).
Long-term metformin use is associated with a significantly lower risk of new onset prostate cancer and all cause mortality in patients with type two diabetes than sulfonylureas and more protective against prostate cancer but less protective against all cause mortality in those less than 65 years of age.
Metformin affects multiple key processes related to cell growth, proliferation, and survival.
Epidemiological studies suggest a decreased risk of lung cancer in diabetic patients treated with antidiabetic drugs, including metformin-39-45% decreased risk.
Lung cancer patients treated with first-line chemotherapy and metformin have superior outcomes to those treated with chemotherapy and other diabetic medications.
A study suggests patients using metformin before a diagnosis of COVID-19 only had a third of the mortality risk of their counterparts with no reported use of the drug.
In a study, which included more than 300,000 participants aged 55 or older, the use of low dose metformin was associated with a lower incidence of age-related macular degeneration (AMD).
The use of metformin was associated with a reduction in odds of developing AMD.
The association is dose-dependent, with low to moderate doses of metformin being associated with the greatest benefit.
When assessing doses greater than 1080 g, there was no association with reduced odds of developing AMD at 2 years.
Among patients with diabetes, metformin use was associated with a decreased risk of AMD in patients without existing diabetic retinopathy, but was considered a risk factor for patients with existing diabetic retinopathy.
Metformin use over 2 years in adults aged 55 years and older is associated with 5% to 10% reduced odds ratio of developing AMD.
A dose-dependent association of this potential protective effect is present, with low to moderate doses of metformin being associated with the lowest odds ratio for the development of AMD.
https://standardofcare.com/metformin/
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