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A meta-analysis of blood GSH responses found no significant pooled increase in erythrocyte or plasma GSH after supplementation, with high heterogeneity and reporting concerns, underscoring bioavailability and measurement challenges

Ravandi F, Jeffrey JL, Thomas DA, OBrien S, Jabbour E, Borthakur G , Garris R, Huang X, Garcia-Manero G, Burger JA, Ferrajoli A, Kadia T, Jain N, Wang SA, Kebriaei P, Champlin RE, Estrov Z, Cortes JE, Kantarjian HM

In patients with hyperprolinemia, proline accumulation can cause a decrease in ATPase activity, which further leads to mitochondrial stress and elevated lactate levels, and can also decrease glutamate uptake [17]

Notable distinctions include mechanistic divergence, where metformin activates AMPK peripherally, while TCM formulas, such as Modified Banxia Xiexin Decoction, correct dysbiosis by reducing Clostridium_sensu_stricto_1 and boosting SCFA producers, thereby dampening inflammation and endotoxemia