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The Standard American Diet high in refined starches and ultra-processed foods is known to promote inflammation and worsen rheumatoid arthritis symptoms

10.1038/nrendo.2013.67 Nat

Sterile water is often used in medical applications, such as wound cleaning, IV hydration, laboratory testing, and as a diluent for medications

Several others were treated with steroids or anti inflammatories

Consider periodic monitoring of B12 in patients on metformin with risk factors for B12 deficiency Risk factors are quite wide-ranging and include the following (MHRA, 2022): Baseline vitamin B12 levels at the lower end of the normal range

Thus, if you also happen to have low stomach acid (as many people with Hashimotos do), taking the protein digestive enzyme Betaine with Pepsin from Rootcology is another great way to get extra trimethylglycine