In cases of unexplained macrocytic anemia associated with high homocysteine levels and normal B 12 testing results, folate testing may be arranged if supported by laboratory specialist consultation
Tight hamstrings are a frequent contributing factor because they increase tension on the tendons near the bursa
The underlying driver is chronic inflammationspecifically, dysregulated immune signaling involving TNF-, interleukins (IL-17, IL-23), and NF-B pathways
Beyond the absolute contraindications, several situations call for heightened caution in the class framing and are firmly a clinicians domain: a history of pancreatitis or symptomatic gallstones, significant gastrointestinal motility disorders (such as gastroparesis, which slowed gastric emptying can worsen), diabetic retinopathy that is not stabilized, severe renal impairment where dehydration from GI side effects raises risk, and any concurrent use of insulin or a sulfonylurea, where the additive glucose-lowering can produce hypoglycemia