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Pregnancy and breastfeeding are also contraindications due to insufficient safety data

Effects of the MTHFR Mutation: Reduced Folate Metabolism: Folate (vitamin B9) is essential for many processes in the body, and MTHFR mutations can hinder the conversion of folate to its active form (5-MTHF)

The use of PPIs is also thought to contribute to vitamin B12 deficiency (Aroda et al, 2016)

In addition, a very fresh fecal smear (ideally sampled directly from the rectum) can be placed onto a slide with a drop of saline and looked at under the microscope to observe for movement (giardia may also be seen with this technique and look similar to tritrichomonas, however, tritrichomonas tend to wiggle forward, whereas giardia move in a swirling or 'falling-leaf' pattern)

Insulin is a key hormone that regulates blood sugar control

Munzberg H, Flier JS, Bjorbaek C