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Mechanisms and consequences Whilst researching a related topic for a soon-to-be-published MedNut Mail email, I came across this diagram and asked the question what are the likely mechanisms of action for metformin to alter pyridoxines (vitamin B6) metabolic pathway? Early evidence indicates metformin use is associated with a higher risk of B6 deficiency, with one study estimating a risk increase of about 48%

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Oxidative stress can activate this pathway, promoting cellular antioxidant defense and energy metabolism [504]