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40 Addittionally, homocysteine has several procoagulant properties including the decrease of antithrombin III binding to endothelial heparan sulfate, increase of affinity between lipoprotein(a) and fibrin, induction of tissue factor activity in endothelial cells, and inhibition of inactivation of factor V by activated protein C

A retrospective study looking at concomitant use of proton pump inhibitors (PPIs) alongside metformin in 614 people with type 2 diabetes in the US found a significant reduction in B12 levels of 34% in patients taking both medications, compared to controls taking either drug alone (Long et al, 2012)

[DOI] [PubMed] [Google Scholar] 40.Sancheti H., Akopian G., Yin F., Brinton R.D., Walsh J.P., Cadenas E

News outlets and health authorities have raised concerns about self-administration outside medical supervision