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Nov 2015;70(11):765-9

Accordingly, it has issued new advice to check vitamin B12 serum levels in patients being treated with metformin who have symptoms suggestive of vitamin B12 deficiency.[] The proposed mechanisms to explain metformin-induced vitamin B12 deficiency among patients with T2DM include alterations in small bowel motility, which stimulates bacterial overgrowth and consequential vitamin B12 deficiency, competitive inhibition or inactivation of vitamin B12 absorption, alterations in IF levels, and interaction with the cubulin endocytic receptor

Your review * First three weeks I did not lose or gain but in week 4 I dropped 4lbs in less then a week

For inflammation, an ice pack or cold compress can help keep the swelling down while reducing pain