Q: You’ve written in the past about the importance of a balanced gut microbiome for our general health. Are there studies on how poor gut health might contribute to skin disorders like psoriasis? I keep thinking this might be helpful.

A: Scientists are now investigating the links between the balance of gut microbes and skin diseases, such as psoriasis. One review found that dietary changes, traditional Chinese medicine and probiotics improve gut microbiome diversity and lower inflammation in psoriasis sufferers (Frontiers in Cellular and Infection Microbiology, Aug. 7, 2024).

Q: I am a retired registered nurse, and I find that blood pressures are not taken correctly, whether it is the dentist’s office, when donating blood, in the family practice office, etc. Practitioners at all levels often fail to follow all guidelines; frequently there are several errors in technique.

I often wonder about the point of even measuring blood pressure if it is not done correctly. It is disturbing to think how many people are probably being treated for high blood pressure when it is not even taken correctly in the office of the doctor prescribing the medicine.

A: High blood pressure leads to a lot of misery including heart attacks and strokes. That’s why it is critical to measure blood pressure accurately.

Here are some guidelines:

Patients should be encouraged to empty their bladders before a blood pressure measurement (Hypertension, May 2019).

They should be allowed at least 5 minutes to sit quietly in a comfortable chair with their back supported and the arm resting at heart level.

The blood pressure cuff must be the right size for the arm. If it is too small, the reading could be falsely elevated. A study of home blood pressure devices reveals that most come with an arm cuff that is too small for many people (Hypertension, Sept. 5, 2024).

Taking your blood pressure at home does make sense if you do it properly. One reader points out why you should measure your own blood pressure: “I have 40 years of experience in the medical arena. I am 80 years old, and I take my blood pressure three times a day. I don’t believe my blood pressure has ever been taken correctly given all the parameters. My BP is different depending on the time of day.”

Q: Thank you for writing about the side effects of metformin. I have been on it for at least 15 years, and now I am starting to have trouble with numbness and tingling, usually at night. Horrific leg and foot cramps are depriving me of much-needed sleep. Could metformin be causing these problems?

A: Your doctor should be monitoring your vitamin B12 level. Metformin can deplete the body of this crucial nutrient, especially if taken over a long period of time.

Symptoms of vitamin B12 deficiency include balance problems, weakness, confusion, memory problems, numbness and tingling in hands and feet, burning tongue and depression.

Another problem with long-term metformin use is low magnesium (American Journal of Clinical Nutrition, June 2024). This could contribute to the nighttime cramps troubling you.

In their column, Joe and Teresa Graedon answer letters from readers. Send questions to them via www.peoplespharmacy.com.