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When these two pathways are activated simultaneously, the effect is multiplicative: GHRH increases the amount of GH released per cell, and GHRP increases the number of responding cells
It's favored due to proven synergistic effects (animal studies/anecdotes), safety profile (minimal side-effects), convenience of pen form, and alternative to opioids/NSAIDs
The major causes fall into three broad categories: Increased bilirubin production (hemolysis or ineffective erythropoiesis): Hemolytic anemias (intravascular or extravascular) Autoimmune hemolytic anemia (AIHA) Hereditary spherocytosis, elliptocytosis G6PD deficiency Sickle cell disease Thalassemia Ineffective erythropoiesis Vitamin B12 or folate deficiency (megaloblastic anemia) Myelodysplastic syndromes Thalassemia major Impaired hepatic uptake : Gilbert syndrome decreased activity of UDP-glucuronosyltransferase (UGT1A1)
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