Not sure that I can answer authoritatively as I was just at a Dr a week ago. But, it was getting difficult for me to stand upright in the AM due to back pain. Also had pain during the day in sitting down or getting up. I found that astaxanthin 4mg helped with the inflammation instead of using ibuprofen. During the visit, he told me to try a gluten-free, low Sugar diet for a month. Put me on B6 complex & next week will add zinc. My back has less pain than before in such a short time, hope itís not a placebo effect. Lost 3#. At the end of the visit he suggested research on pyroluria. Yep, sounds like me.