{"id":134,"date":"2023-08-01T07:18:40","date_gmt":"2023-08-01T07:18:40","guid":{"rendered":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/?p=134"},"modified":"2023-08-01T07:18:40","modified_gmt":"2023-08-01T07:18:40","slug":"metformin-in-all-its-glory-part-1","status":"publish","type":"post","link":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/metformin-in-all-its-glory-part-1\/","title":{"rendered":"Metformin in All its Glory &#8211; Part 1"},"content":{"rendered":"<p class=\"lkwdFf OFA52E\">Updated:\u00a0<span class=\"time-ago\" title=\"Oct 7, 2022\" data-hook=\"time-ago\">Oct 7, 2022<\/span><\/p>\n<h4 id=\"viewer-84ci2\" class=\"_2k8TI Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><strong>Introduction<\/strong><\/span><\/h4>\n<div id=\"viewer-9lv15\" class=\"QHjDE rzoRKE\">\n<div class=\"jKKp9 xE7K3m xE7K3m\">\n<div class=\"Q6a5A\" tabindex=\"0\" role=\"button\" data-hook=\"imageViewer\">\n<div id=\"new-image16456951\" class=\"vBPBf L9OMM XHhj0\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/static.wixstatic.com\/media\/e21b7bec30ff45e28e5cbd7b4260993c.jpg\/v1\/fill\/w_202%2Ch_135%2Cal_c%2Cq_80%2Cusm_0.66_1.00_0.01%2Cenc_auto\/e21b7bec30ff45e28e5cbd7b4260993c.jpg?ssl=1\" alt=\"\" data-pin-url=\"https:\/\/www.druglesspharmacist.com\/post\/metformin-in-all-its-glory\" data-pin-media=\"https:\/\/static.wixstatic.com\/media\/e21b7bec30ff45e28e5cbd7b4260993c.jpg\/v1\/fill\/w_5000,h_3333,al_c,q_90,usm_0.66_1.00_0.01\/e21b7bec30ff45e28e5cbd7b4260993c.jpg\" data-load-done=\"\" \/><\/div>\n<div class=\"\"><\/div>\n<div class=\"\"><span style=\"font-size: 16px;\">Metformin was approved in the United States in 1994 as a prescription drug to be used along with diet and exercise to lower blood sugar in patients with type 2 diabetes (T2DM). Several off-label uses have been added over the years. Part 1 will explore the side effect profile of metformin, its safety in pregnancy and breastfeeding, and benefits versus risks when used in Type 2 diabetes with an emphasis on its ability to provide protection for the heart. Part 2 will take a closer look at some of its other uses such as prevention of T2DM, gestational diabetes, PCOS weight loss and the current research that&#8217;s looking at its potential use in other major diseases such as dementia and cancer.<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<h4 id=\"viewer-5qfam\" class=\"_2k8TI Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><strong>What you need to know: <\/strong><\/span><\/h4>\n<p id=\"viewer-78s5t\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">WARNING: This medication has a BLACK BOX warning for lactic acidosis, a rare but potentially serious buildup of lactic acid in the blood. Symptoms include muscle pain, trouble breathing, dizziness, feeling weak or tired. This medication should not be used if you have serious kidney disease, metabolic acidosis or liver disease.<\/span><\/p>\n<p id=\"viewer-cse0p\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><u class=\"D-jZk\">Side effects:<\/u><\/span><\/p>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-5rn4d\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">See <u class=\"D-jZk\">https:\/\/www.drugs.com\/metformin.html#side-effects for a <\/u>more complete list.<\/p>\n<\/li>\n<li id=\"viewer-8dpsc\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Gastrointestinal side effects are the most common. About 20-30% of users can expect symptoms like stomach pain, abdominal cramping, nausea, vomiting, diarrhea, bloating, and gas. Take with food to minimize these affects. These symptoms can be intense and for some intolerable. If symptoms do not subside win two weeks, patients should report this to the prescriber for further assistance.<\/p>\n<\/li>\n<li id=\"viewer-9r6qk\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">metallic taste<\/p>\n<\/li>\n<li id=\"viewer-f7aup\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">decreased appetite<\/p>\n<\/li>\n<li id=\"viewer-7le42\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">low blood sugar (more likely to occur when taken with other diabetes medications). Symptoms include excess sweating, extreme hunger, fainting, fatigue, shakiness, nausea or vomiting, anxiety, headache, dry mouth, confusion, blurred vision and lightheadedness. Immediately take some food or drink that contains sugar to alleviate these symptoms.<\/p>\n<\/li>\n<li id=\"viewer-95nk0\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\"><u class=\"D-jZk\">Vitamin B12 depletion:<\/u><\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-fo32r\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth2 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Loss of vitamin B12 is an often-overlooked consequence of taking metformin. At risk conditions (i.e. pregnancy, certain neurological disorders, and being over 75 years old) should be supplemented accordingly. In one study, the amount of B12 found in most multivitamin supplements was not effective in preventing Vitamin B 12 deficiency in people with T2DM that were taking metformin. If you&#8217;ve been on metformin for a while, have your provider<a class=\"TWoY9 itht3\" href=\"http:\/\/www.directlabs.com\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-hook=\"linkViewer\"><u class=\"D-jZk\"> check your B12 level<\/u><\/a>. Low B12 can cause numbness\/tingling in hands and feet, fatigue, palpitations, low energy, headache, muscle pain, red\/swollen tongue, brain fog and cognitive decline.<\/span><\/p>\n<div id=\"viewer-ar03\" class=\"QHjDE rzoRKE\">\n<div class=\"gO6aa y8JqQg y8JqQg\">\n<div class=\"Q6a5A\" tabindex=\"0\" role=\"button\" data-hook=\"imageViewer\">\n<div id=\"new-image16456952\" class=\"vBPBf L9OMM XHhj0\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/static.wixstatic.com\/media\/c5cce2_19ff9023ed9b489e971ab61d0d855ff4~mv2.png\/v1\/fill\/w_485%2Ch_273%2Cal_c%2Cq_85%2Cusm_0.66_1.00_0.01%2Cenc_auto\/c5cce2_19ff9023ed9b489e971ab61d0d855ff4~mv2.png?ssl=1\" alt=\"\" data-pin-url=\"https:\/\/www.druglesspharmacist.com\/post\/metformin-in-all-its-glory\" data-pin-media=\"https:\/\/static.wixstatic.com\/media\/c5cce2_19ff9023ed9b489e971ab61d0d855ff4~mv2.png\/v1\/fill\/w_2880,h_1620,al_c,q_95\/c5cce2_19ff9023ed9b489e971ab61d0d855ff4~mv2.png\" data-load-done=\"\" \/><\/div>\n<div class=\"\"><\/div>\n<div class=\"\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div data-hook=\"rcv-block21\"><\/div>\n<p id=\"viewer-8ibfc\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> <strong> Common signs of Vitamin B12 deficiency<\/strong> <\/span><\/p>\n<p id=\"viewer-cmr8\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> <u class=\"D-jZk\">Alcohol:<\/u> <\/span><\/p>\n<p id=\"viewer-4e5dn\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Alcohol use should be limited as it can increase the risk of developing lactic acidosis and hypoglycemia. Consult your provider before using alcohol.<\/span><\/p>\n<p id=\"viewer-d10l2\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> <u class=\"D-jZk\">Pregnancy:<\/u><\/span><\/p>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-65hpt\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth1 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Metformin decreases the maternal weight gain that is seen with insulin use during pregnancy. One study showed that other outcomes improved (i.e., preeclampsia, hypoglycemia risk) but the results were not statistically significant.<\/p>\n<\/li>\n<li id=\"viewer-1teug\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth1 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Metformin does cross the placenta and the levels found in the umbilical cord at delivery can be as high as that of the mother.<\/p>\n<\/li>\n<li id=\"viewer-5kmss\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth1 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\"><em>There is a significant risk of lower birth weight in infants due to fetal growth restriction. <\/em><\/p>\n<\/li>\n<li id=\"viewer-euos7\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth1 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Vitamin B12 and folate levels are lower in expecting mothers who take metformin<\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-ai2lk\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth2 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">o Low levels of these vitamins have a significant impact on fetal growth and development as they are essential nutrients for these processes. Altered gene expression is one implication. <\/span><\/p>\n<p class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth2 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">o Low folate can cause premature labor, stillbirth, and neural tube defects<\/span><\/p>\n<p id=\"viewer-6hick\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth2 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">o Supplementing with folate is already a requirement for prenatal care. When on metformin, a higher dosage may be necessary, however, levels should be checked to guard against overdosing. <\/span><\/p>\n<div data-hook=\"rcv-block33\"><\/div>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-v0io\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth1 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">The effects of metformin vary depending on the tissue involved and tissue concentrations. For example, it can have a promising anti-tumor effect in one scenario and cause restricted fetal growth in another scenario.<\/p>\n<\/li>\n<\/ul>\n<div id=\"viewer-49pt8\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">\u00a0<\/span><\/div>\n<div data-hook=\"rcv-block35\"><\/div>\n<div id=\"viewer-cq5qc\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">\u00a0<\/span><\/div>\n<div data-hook=\"rcv-block36\"><\/div>\n<div id=\"viewer-bhkot\" class=\"QHjDE rzoRKE\">\n<div class=\"gO6aa y8JqQg y8JqQg flaqF\">\n<div class=\"Q6a5A\" tabindex=\"0\" role=\"button\" data-hook=\"imageViewer\">\n<div id=\"new-image16456953\" class=\"vBPBf L9OMM XHhj0\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/static.wixstatic.com\/media\/c5cce2_3f046942769341a59c1db3e913cb4738~mv2.jpg\/v1\/fill\/w_740%2Ch_438%2Cal_c%2Cq_80%2Cusm_0.66_1.00_0.01%2Cenc_auto\/c5cce2_3f046942769341a59c1db3e913cb4738~mv2.jpg?ssl=1\" alt=\"\" data-pin-url=\"https:\/\/www.druglesspharmacist.com\/post\/metformin-in-all-its-glory\" data-pin-media=\"https:\/\/static.wixstatic.com\/media\/c5cce2_3f046942769341a59c1db3e913cb4738~mv2.jpg\/v1\/fill\/w_932,h_552,al_c,lg_1,q_85\/c5cce2_3f046942769341a59c1db3e913cb4738~mv2.jpg\" data-load-done=\"\" \/><\/div>\n<div class=\"\"><\/div>\n<div class=\"\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div data-hook=\"rcv-block37\"><\/div>\n<p id=\"viewer-24ii\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> Summary of Proposed Mechanism for metformin effects on placenta and fetus. Figure created using Biorender.com.<\/span><\/p>\n<p id=\"viewer-9omk0\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> Ref 7, an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license(<a class=\"TWoY9 itht3\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-hook=\"linkViewer\"><u class=\"D-jZk\">https:\/\/creativecommons.org\/licenses\/by\/4.0\/<\/u><\/a>). <\/span><\/p>\n<div data-hook=\"rcv-block40\"><\/div>\n<p id=\"viewer-a8rr5\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><u class=\"D-jZk\">Breastfeeding:<\/u> <\/span><\/p>\n<p id=\"viewer-14ql8\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Metformin is absorbed in breast milk at less than 1% of the mother\u2019s dose which is well within the established safe limit of 10%. No adverse effects have been found but use caution in newborns and pre-mature infants with poor kidney function.<u class=\"D-jZk\">10.1007\/s00125-002-0939-x<\/u><\/span><\/p>\n<p id=\"viewer-cpg5i\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><strong>How does metformin work?<\/strong><\/span><\/p>\n<div data-hook=\"rcv-block45\"><\/div>\n<div id=\"viewer-auum\" class=\"QHjDE rzoRKE\">\n<div class=\"jKKp9 xE7K3m xE7K3m UAgbc OXFdk4 OXFdk4\">\n<div class=\"Q6a5A\" tabindex=\"0\" role=\"button\" data-hook=\"imageViewer\">\n<div id=\"new-image16456954\" class=\"vBPBf L9OMM XHhj0\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/static.wixstatic.com\/media\/c5cce2_78eb5d8f8777471a8b986506aa2fef6f~mv2.jpg\/v1\/fill\/w_360%2Ch_240%2Cal_c%2Cq_80%2Cusm_0.66_1.00_0.01%2Cenc_auto\/c5cce2_78eb5d8f8777471a8b986506aa2fef6f~mv2.jpg?ssl=1\" alt=\"\" data-pin-url=\"https:\/\/www.druglesspharmacist.com\/post\/metformin-in-all-its-glory\" data-pin-media=\"https:\/\/static.wixstatic.com\/media\/c5cce2_78eb5d8f8777471a8b986506aa2fef6f~mv2.jpg\/v1\/fill\/w_738,h_492,al_c,q_85\/c5cce2_78eb5d8f8777471a8b986506aa2fef6f~mv2.jpg\" data-load-done=\"\" \/><\/div>\n<div class=\"\"><\/div>\n<div class=\"\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div data-hook=\"rcv-block46\"><\/div>\n<div id=\"viewer-15l40\" class=\"QHjDE rzoRKE\">\n<div class=\"VcB4o\">\n<div class=\"x0rQE\">\n<table class=\"okQLv\">\n<colgroup>\n<col \/><\/colgroup>\n<thead><\/thead>\n<tbody>\n<tr>\n<td class=\"-yfd8\" colspan=\"1\" rowspan=\"1\" data-hook=\"table-plugin-cell\">\n<div class=\"bLarR Xg7Y3\">\n<div class=\"fMrCg p9bIe\">\n<div class=\"itVXy _8a1b4\" dir=\"ltr\">\n<div class=\"mhGZq UMsJ3 EjYv0 cv0sq\">\n<p id=\"viewer-5szffzvkp\" class=\"xVISr Y9Dpf OZy-3 lnyWN public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">\u200bMetformin reduces the amount of glucose absorbed from food, reduces the amount of glucose made by the liver and improves the body&#8217;s response to insulin. <\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"\"><\/div>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"-yfd8\" colspan=\"1\" rowspan=\"1\" data-hook=\"table-plugin-cell\">\n<div class=\"bLarR Xg7Y3\">\n<div class=\"fMrCg p9bIe\">\n<div class=\"itVXy _8a1b4\" dir=\"ltr\">\n<div class=\"mhGZq UMsJ3 EjYv0 cv0sq\">\n<p id=\"viewer-st5i4qbw3\" class=\"xVISr Y9Dpf OZy-3 _40ACk public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">We now have a deeper understanding of its mechanism of action<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"\"><\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/div>\n<p id=\"viewer-ao60b\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><strong>Common uses for metformin<\/strong><\/span><\/p>\n<p id=\"viewer-8ud86\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><u class=\"D-jZk\">Treatment:<\/u> <\/span><\/p>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-biv8b\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Diabetes<\/p>\n<\/li>\n<li id=\"viewer-52pf3\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Polycystic Ovarian Disease (PCOS)<\/p>\n<\/li>\n<li id=\"viewer-2u6c1\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Gestational Diabetes (GDM)<\/p>\n<\/li>\n<li id=\"viewer-okvm\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Prediabetes with high body mass index (BMI)<\/p>\n<\/li>\n<li id=\"viewer-emnej\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Weight loss in obese patients<\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-fv3hi\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><u class=\"D-jZk\">Prevention<\/u>: <\/span><\/p>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-1dge9\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Type 2 Diabetes<\/p>\n<\/li>\n<li id=\"viewer-3q0td\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Weight gain associated with atypical antipsychotics (a newer class of antipsychotics that causes less movement disorders as a side effect but tend to cause more weight gain)<\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-8oe5n\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> <strong>Complications of type 2 diabetes: <\/strong><\/span><\/p>\n<p class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span style=\"font-size: 16px;\">People with T2DM, are 2 to 4 times as likely to have a heart attack or stroke that leads to death. T2DM is a disease of diet and lifestyle. In most instances the diet is too rich in simple carbohydrates, added sugars, and processed foods. This type of inflammatory diet damages the blood vessels leading to all organs producing very serious complications like:<\/span><\/p>\n<div data-hook=\"rcv-block61\"><\/div>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-14su0\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">heart attack<\/p>\n<\/li>\n<li id=\"viewer-dqnn2\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">stroke<\/p>\n<\/li>\n<li id=\"viewer-5au34\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">blindness<\/p>\n<\/li>\n<li id=\"viewer-9ia6q\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">kidney disease<\/p>\n<\/li>\n<li id=\"viewer-75bmh\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">nerve damage<\/p>\n<\/li>\n<li id=\"viewer-peul\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">poor wound healing<\/p>\n<\/li>\n<li id=\"viewer-6l106\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">decreased sexual function<\/p>\n<\/li>\n<li id=\"viewer-6ddkd\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">cognitive decline<\/p>\n<\/li>\n<li id=\"viewer-qnaq\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Fatty liver disease<\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-bh7s7\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> <strong>Metformin for Treatment of Diabetes <\/strong><\/span><\/p>\n<p id=\"viewer-c2t6j\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Metformin remains the first choice for the treatment of T2DM. The typical starting dose is 1000mg a day with food and then gradually increased until glucose is controlled. There is usually no benefit beyond 2000mg a day. It is recommended to be used in combination with diet and lifestyle to control symptoms and limit progression of the disease.<\/span><\/p>\n<p id=\"viewer-7o7e0\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><u class=\"D-jZk\">Benefits:<\/u><\/span><\/p>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-4mc5r\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">On average, metformin, provides a 1-2% reduction in the HbA1c (average blood glucose over 3 months). According to Hirst et al, the lower dose range (1000-1500mg) will provide a 1.12% decrease in HbA1c. When increased to 2000mg an additional 0.26% reduction was achieved. When added to insulin therapy, the HbA1c was reduced 0.83%.<\/p>\n<\/li>\n<li id=\"viewer-1djes\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">It is taken by mouth, is inexpensive, does not cause weight gain and does not have the storage issues associated with insulin. It has less risk of causing low blood sugar compared to the older sulfonylurea drugs (i.e., glyburide, glipizide) and insulin.<\/p>\n<\/li>\n<li id=\"viewer-2eugq\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">It can be used in combination with other diabetes medications. Preferentially, the added medication should be one that also targets any other co-existing diseases such as heart failure or kidney disease.<\/p>\n<\/li>\n<li id=\"viewer-9eanb\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Metformin does appear to offer some level of protection from cardiovascular events.<\/p>\n<\/li>\n<li id=\"viewer-eae18\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">It shows promise in improving cancer treatment modalities<\/p>\n<\/li>\n<li id=\"viewer-8udfa\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">It decreases maternal weight gain during pregnancy as compared to insulin (however, there are risks to the fetus, see Pregnancy section)<\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-8bi2t\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> <u class=\"D-jZk\">Risks:<\/u><\/span><\/p>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-b7cao\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">The gastrointestinal effects can be severe enough to decrease appetite leading to weight loss.<\/p>\n<\/li>\n<li id=\"viewer-cjjlq\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">There are many other potential side effects, of which lactic acidosis is the most severe. Anyone with severely impaired kidney function should not use this medication. Any evidence of liver disease may warrant avoiding metformin as well due to a decreased ability to eliminate the lactic acid with liver impairment.<\/p>\n<\/li>\n<li id=\"viewer-anip2\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Metformin has the potential for a large number of drug interactions. According to <a class=\"TWoY9 itht3\" href=\"http:\/\/drugs.com\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-hook=\"linkViewer\">Drugs.com<\/a> there are 355 drug interactions with metformin, 19 being major and 307 moderate, and 29 minor. Many are due to additive hypoglycemic effects.<\/p>\n<\/li>\n<li id=\"viewer-3kl0i\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Development of vitamin B12 deficiency can lead to or aggravate nerve pain<\/p>\n<\/li>\n<li id=\"viewer-anc8k\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Low levels of B12 and folate could cause individuals with single nucleotide polymorphisms (SNPs) (gene variations) that involve folate or B12 to be at a greater risk for altered gene expressions.<\/p>\n<\/li>\n<li id=\"viewer-9fijs\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">There is no data available which conclusively determined that metformin provides the level of cardiovascular protection that the newer anti-diabetic drugs offer.<\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-58sj5\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> <strong>Benefit vs Risk <\/strong><\/span><\/p>\n<p id=\"viewer-9mk4f\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Metformin is credited with preventing many of the complications associated with T2DM. It&#8217;s ease of use, cost-effectiveness and ability to lower blood sugar keep it at the top of the list of drugs to treat T2DM. Being able to provide cardio-protection is an important consideration in drug therapy for T2DM. As of 2008, manufacturers of new diabetes drugs (i.e., Trulicity*, Victoza*, Ozempic*) were required to show that these medications decreased the risk of Atherosclerotic Cardiovascular Disease (ASCVD) and not just blood sugar. Metformin was not a part of this process and that might put it at a disadvantage when it comes to choosing a drug therapy that meets these requirements. <\/span><\/p>\n<p id=\"viewer-5a8ks\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">However, consider the following by Ding Y, et al: <\/span><\/p>\n<p id=\"viewer-1secq\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">a) the atherosclerotic risk factors seen in patients with T2DM (hyperglycemia, high insulin, insulin resistance and elevated lipids) are what produce cardiovascular events<\/span><\/p>\n<p id=\"viewer-7h3gr\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">b) the ability to reduce hyperglycemia had the greatest impact on whether there was damage to the lining of the blood vessels. <\/span><\/p>\n<p id=\"viewer-873nq\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">c) hyperglycemia is linked to excessive inflammation and clot formation due to its direct effect on plaque destabilization and rupture.<\/span><\/p>\n<p id=\"viewer-5lja5\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Based on this information, one could infer that metformin provides cardio-protection. <\/span><\/p>\n<p id=\"viewer-cmaqu\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Additional suggestions that metformin provides cardio-protection are:<\/span><\/p>\n<div data-hook=\"rcv-block101\"><\/div>\n<ul class=\"public-DraftStyleDefault-ul\">\n<li id=\"viewer-7v2aq\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth1 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">The Prospective Diabetes Study which reported that metformin not only treats hyperglycemia and lowers insulin but also reduces oxidative stress (cellular damage), inflammation, lipoprotein (LDL, HDL like substances) metabolism and clot production.<\/p>\n<\/li>\n<li id=\"viewer-6mq7v\" class=\"bCMSCT Unmlxj s-SEY public-DraftStyleDefault-unorderedListItem public-DraftStyleDefault-depth1 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">A review that looked at over 11,000 patients on oral diabetes medications concluded that metformin offers moderate cardiovascular protection.<\/p>\n<\/li>\n<\/ul>\n<p id=\"viewer-4tnge\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth1 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Taking care to intervene by drug therapy or lifestyle is critical to managing the potential risks for ASCVD. It is critical to get high risk patients into the safe zone as quickly as possible to minimize the risk of having a cardiovascular event. <\/span><\/p>\n<div id=\"viewer-6nm17\" class=\"QHjDE rzoRKE\">\n<div class=\"jKKp9 xE7K3m xE7K3m\">\n<div class=\"Q6a5A\" tabindex=\"0\" role=\"button\" data-hook=\"imageViewer\">\n<div id=\"new-image16456955\" class=\"vBPBf L9OMM XHhj0\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/static.wixstatic.com\/media\/c5cce2_8d3916088836429d832f615f20d30476~mv2.jpg\/v1\/fill\/w_395%2Ch_222%2Cal_c%2Cq_80%2Cusm_0.66_1.00_0.01%2Cenc_auto\/c5cce2_8d3916088836429d832f615f20d30476~mv2.jpg?ssl=1\" alt=\"\" data-pin-url=\"https:\/\/www.druglesspharmacist.com\/post\/metformin-in-all-its-glory\" data-pin-media=\"https:\/\/static.wixstatic.com\/media\/c5cce2_8d3916088836429d832f615f20d30476~mv2.jpg\/v1\/fill\/w_729,h_410,al_c,lg_1,q_80\/c5cce2_8d3916088836429d832f615f20d30476~mv2.jpg\" data-load-done=\"\" \/><\/div>\n<div class=\"\"><\/div>\n<div class=\"\"><span style=\"font-size: 16px;\">Metformin use in T2DM should be monitored for side effects, drug interactions and serious complications associated with its use. There are risks in relying on metformin to treat T2DM. The high degree of gastrointestinal side effects is often the determining factor as to whether this medication will be used. The nutrient depletions caused by metformin have the potential to cause serious health issues if the deficiencies are not addressed. It may provide major immediate benefits to the mother during pregnancy, but it poses an elevated risk to the fetus for growth and developmental issues and may have life-long implications as well.<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p id=\"viewer-f5g2h\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"><strong>Treatment or Cure? <\/strong><\/span><\/p>\n<p id=\"viewer-a6c54\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Research and clinical data support the fact that diet and lifestyle are the most effective means to address the underlying causes of diabetes. It is the destructive inflammatory diets and lifestyles that produce these events. <\/span><\/p>\n<p id=\"viewer-7f0bj\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">In the current healthcare system, treatment means disease management. It does not mean cure. Herein lies the problem with the drug therapy approach to this disease. Patients are told that they will be on these drugs for the rest of their lives. Why is this the case? When drugs work to lower blood sugar, lower insulin resistance and decrease the risk for cardiovascular events, they only act like band-aids while the causative factors remain and continue to wreak havoc on the body. <\/span><\/p>\n<p id=\"viewer-8vrgf\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">Not all patients are willing to go the diet and lifestyle route to address the root cause of T2DM or would prefer to accept drug therapy alone. It should ultimately be their decision and that decision should be made with as much available information as possible on all available proven treatments. <\/span><\/p>\n<div data-hook=\"rcv-block116\"><span style=\"font-size: 16px;\">For those patients who do employ intense diet and lifestyle as an integral part of their therapy, the outcome is likely to be much more beneficial. Without appropriate diet and lifestyle changes drugs will need to be taken forever. It would be very interesting to know how patients really feel about the <\/span><a class=\"TWoY9 itht3\" style=\"font-size: 16px; background-color: #ffffff;\" href=\"http:\/\/www.nutritionalpathways.com\/emerge-light\" target=\"_blank\" rel=\"noopener noreferrer\" data-hook=\"linkViewer\"><u class=\"D-jZk\">possibility of reversing this disease<\/u><\/a><span style=\"font-size: 16px;\"> and if they would if they had the opportunity.<\/span><\/div>\n<div id=\"viewer-abc9q\" class=\"QHjDE rzoRKE\">\n<div class=\"gO6aa y8JqQg y8JqQg\">\n<div class=\"GI8Lr\" dir=\"ltr\">\n<div class=\"\">\n<p class=\"DrDeS B6OCv fF3ow _2Npmn\"><span class=\"XwFUQ\">POLL: Would you choose drugs or a non-drug method to reverse diabetes?<\/span><\/p>\n<\/div>\n<ul class=\"jcqJP _7LIiZ\">\n<li class=\"MqXv2\">\n<div class=\"PzinH _8N--T joFKN\" tabindex=\"0\" role=\"button\" aria-label=\"unchecked\">\n<div class=\"X-q8l\"><\/div>\n<div class=\"FvNFY\">\n<div class=\"-qWIx _07TNg antiz\" tabindex=\"-1\" role=\"button\" aria-hidden=\"true\"><label><label><input class=\"aDGSh\" tabindex=\"-1\" accept=\"image\/*\" disabled=\"disabled\" type=\"file\" \/><\/label><\/label><\/p>\n<div class=\"prTAQ\"><\/div>\n<\/div>\n<p class=\"DrDeS ElRZW\"><span class=\"XwFUQ\">I would choose a non-drug method to reverse diabetes<\/span><\/p>\n<\/div>\n<\/div>\n<\/li>\n<li class=\"MqXv2\">\n<div class=\"PzinH _8N--T joFKN\" tabindex=\"0\" role=\"button\" aria-label=\"unchecked\">\n<div class=\"X-q8l\"><\/div>\n<div class=\"FvNFY\">\n<div class=\"-qWIx _07TNg antiz\" tabindex=\"-1\" role=\"button\" aria-hidden=\"true\"><label><label><input class=\"aDGSh\" tabindex=\"-1\" accept=\"image\/*\" disabled=\"disabled\" type=\"file\" \/><\/label><\/label><\/p>\n<div class=\"prTAQ\"><\/div>\n<\/div>\n<p class=\"DrDeS ElRZW\"><span class=\"XwFUQ\">Not sure, need more information<\/span><\/p>\n<\/div>\n<\/div>\n<\/li>\n<li class=\"MqXv2\">\n<div class=\"PzinH _8N--T joFKN\" tabindex=\"0\" role=\"button\" aria-label=\"unchecked\">\n<div class=\"X-q8l\"><\/div>\n<div class=\"FvNFY\">\n<div class=\"-qWIx _07TNg antiz\" tabindex=\"-1\" role=\"button\" aria-hidden=\"true\"><label><label><input class=\"aDGSh\" tabindex=\"-1\" accept=\"image\/*\" disabled=\"disabled\" type=\"file\" \/><\/label><\/label><\/p>\n<div class=\"prTAQ\"><\/div>\n<\/div>\n<p class=\"DrDeS ElRZW\"><span class=\"XwFUQ\"> I would prefer to take the drugs prescribed by my doctor<\/span><\/p>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<p id=\"viewer-72n9i\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">*Registered trademarks<\/span><\/p>\n<p id=\"viewer-490gq\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\"> REFERENCES <\/span><\/p>\n<ol class=\"public-DraftStyleDefault-ol\">\n<li id=\"viewer-6nc51\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size public-DraftStyleDefault-reset OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Brand KMG, Saarelainen L, Sonajalg J, et al. Metformin in pregnancy and risk of adverse long-term outcomes: a register-based cohort study. BMJ Open Diab Res Care 2022;10:e002363. doi:10.1136\/ bmjdrc-2021-002363<\/p>\n<\/li>\n<li id=\"viewer-1bceb\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Corcoran C, Jacobs TF. Metformin. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. A<\/p>\n<\/li>\n<li id=\"viewer-46h19\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Ding Y, Zhou Y, Ling P, Feng X, Luo S, Zheng X, Little PJ, Xu S, Weng J. Metformin in cardiovascular diabetology: a focused review of its impact on endothelial function. Theranostics. 2021 Sep 9;11(19):9376-9396. doi: 10.7150\/thno.64706. PMID: 34646376; PMCID: PMC8490502.<\/p>\n<\/li>\n<li id=\"viewer-12hlu\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Hale TW, Kristensen JH, Hackett LP, Kohan R, Ilett KF. Transfer of metformin into human milk. Diabetologia. 2002 Nov;45(11):1509-14. doi: 10.1007\/s00125-002-0939-x. Epub 2002 Sep 25. PMID: 12436333.<\/p>\n<\/li>\n<li id=\"viewer-5ofg0\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Hirst JA, Farmer AJ, Ali R, Roberts NW, Stevens RJ. Quantifying the effect of metformin treatment and dose on glycemic control. Diabetes Care. 2012 Feb;35(2):446-54. doi: 10.2337\/dc11-1465. PMID: 22275444; PMCID: PMC3263873.<\/p>\n<\/li>\n<li id=\"viewer-egiqv\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. <em>N Engl J Med<\/em>. (2002) 346:393\u2013403.<\/p>\n<\/li>\n<li id=\"viewer-ei4i2\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Owen MD, Baker BC, Scott EM, Forbes K. Interaction between Metformin, Folate and Vitamin B12 and the Potential Impact on Fetal Growth and Long-Term Metabolic Health in Diabetic Pregnancies. Int J Mol Sci. 2021 May 28;22(11):5759. doi: 10.3390\/ijms22115759. PMID: 34071182; PMCID: PMC8198407.<\/p>\n<\/li>\n<li id=\"viewer-1l7ec\" class=\"bCMSCT vBYpX public-DraftStyleDefault-orderedListItem public-DraftStyleDefault-depth0 public-DraftStyleDefault-list-ltr fixed-tab-size OZy-3 lnyWN yMZv8w bCMSCT\">\n<p class=\"Y9Dpf OZy-3 lnyWN yMZv8w bCMSCT\">Tarry-Adkins, J.L., Ozanne, S.E. &amp; Aiken, C.E. Impact of metformin treatment during pregnancy on maternal outcomes: a systematic review\/meta-analysis. <em>Sci Rep<\/em> <strong>11<\/strong>, 9240 (2021). https:\/\/doi.org\/10.1038\/s41598-021-88650-5<\/p>\n<\/li>\n<\/ol>\n<div data-hook=\"rcv-block136\"><\/div>\n<div id=\"viewer-dhl5j\" class=\"QHjDE rzoRKE\">\n<div class=\"-jC8z WT9QiX WT9QiX\">\n<div class=\"Q6a5A\" tabindex=\"0\" role=\"button\" data-hook=\"imageViewer\">\n<div id=\"new-image16456956\" class=\"vBPBf L9OMM XHhj0\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/static.wixstatic.com\/media\/c5cce2_839bf6afc4a342acace236dbc9b7dbaa~mv2.png\/v1\/fill\/w_207%2Ch_46%2Cal_c%2Cq_85%2Cusm_0.66_1.00_0.01%2Cenc_auto\/c5cce2_839bf6afc4a342acace236dbc9b7dbaa~mv2.png?ssl=1\" alt=\"\" data-pin-url=\"https:\/\/www.druglesspharmacist.com\/post\/metformin-in-all-its-glory\" data-pin-media=\"https:\/\/static.wixstatic.com\/media\/c5cce2_839bf6afc4a342acace236dbc9b7dbaa~mv2.png\/v1\/fill\/w_967,h_217,al_c,lg_1,q_85\/c5cce2_839bf6afc4a342acace236dbc9b7dbaa~mv2.png\" data-load-done=\"\" \/><\/div>\n<div class=\"\"><\/div>\n<div class=\"\"><span style=\"font-size: 16px;\">Dr Elaine Thomas, PharmD, CCN<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p id=\"viewer-e622p\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">The Drugless Pharmacist<\/span><\/p>\n<p id=\"viewer-bkvd9\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">CEO, Nutritional Pathways Functional Wellness<\/span><\/p>\n<p id=\"viewer-ada31\" class=\"xVISr Y9Dpf bCMSCT OZy-3 lnyWN yMZv8w bCMSCT public-DraftStyleDefault-block-depth0 fixed-tab-size public-DraftStyleDefault-text-ltr\"><span class=\"B2EFF public-DraftStyleDefault-ltr\">DrET@druglesspharmacist.com<\/span><\/p>\n<div id=\"viewer-cef13\" class=\"QHjDE rzoRKE\">\n<div class=\"-jC8z WT9QiX WT9QiX UAgbc OXFdk4 OXFdk4\">\n<div class=\"cceIa\" role=\"none\" data-hook=\"galleryViewer\">\n<div id=\"pro-gallery-cef13\" class=\"pro-gallery\">\n<div class=\"\" tabindex=\"-1\" data-key=\"pro-gallery-inner-container\">\n<div class=\"pro-gallery-parent-container\" role=\"region\">\n<div id=\"pro-gallery-container-cef13\" class=\"pro-gallery inline-styles  ltr \">\n<div id=\"pro-gallery-margin-container-cef13\" class=\"pro-gallery-margin-container\">\n<div class=\"item-link-wrapper\" tabindex=\"-1\" data-id=\"ce8e2fad-3b5d-4b8d-b5c3-4aa925c43fcc_0\" data-idx=\"0\" data-hook=\"item-link-wrapper\">\n<div id=\"pgice8e2fad3b5d4b8db5c34aa925c43fcc_0_0\" class=\"gallery-item-container item-container-hover has-custom-focus visible simulate-hover\" tabindex=\"0\" role=\"link\" aria-label=\"Untitled image\" data-hash=\"ce8e2fad-3b5d-4b8d-b5c3-4aa925c43fcc_0\" data-id=\"ce8e2fad-3b5d-4b8d-b5c3-4aa925c43fcc_0\" data-idx=\"0\" data-hook=\"item-container\">\n<div>\n<div id=\"item-wrapper-ce8e2fad-3b5d-4b8d-b5c3-4aa925c43fcc_0\" class=\"gallery-item-wrapper visible cube-type-fill\" data-hook=\"item-wrapper\">\n<div class=\"gallery-item-content item-content-hover image-item gallery-item-visible gallery-item gallery-item-preloaded   \" data-hook=\"image-item\"><img data-recalc-dims=\"1\" decoding=\"async\" class=\"gallery-item-visible gallery-item gallery-item-preloaded\" src=\"https:\/\/i0.wp.com\/static.wixstatic.com\/media\/c5cce2_5bcc6063020a4bd8a1e594a7a7eb9ff4~mv2.jpg\/v1\/fill\/w_117%2Ch_116%2Cfp_0.50_0.50%2Cq_90\/c5cce2_5bcc6063020a4bd8a1e594a7a7eb9ff4~mv2.jpg?ssl=1\" alt=\"\" data-hook=\"gallery-item-image-img\" data-idx=\"0\" data-pin-url=\"https:\/\/www.druglesspharmacist.com\/post\/metformin-in-all-its-glory\" \/><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Updated:\u00a0Oct 7, 2022 Introduction Metformin was approved in the United States in 1994 as a prescription drug to be used along with diet and exercise to lower blood sugar in patients with type 2 diabetes (T2DM). Several off-label uses have been added over the years. Part 1 will explore the side effect profile of metformin, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":135,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-134","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-content\/uploads\/2023\/08\/e21b7bec30ff45e28e5cbd7b4260993c.jpg?fit=202%2C135&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/posts\/134","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/comments?post=134"}],"version-history":[{"count":1,"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/posts\/134\/revisions"}],"predecessor-version":[{"id":136,"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/posts\/134\/revisions\/136"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/media\/135"}],"wp:attachment":[{"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/media?parent=134"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/categories?post=134"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/demowebsitedevelopment.com\/Drugless-Pharmacist\/wp-json\/wp\/v2\/tags?post=134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}