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This article will also bring awareness to some common and overlooked causes of leaky gut syndrome

S.GreeneW

Disruptions in the Methionine Cycle A lack of folate compromises the conversion of homocysteine back to methionine, leading to several metabolic disturbances: Homocysteine Accumulation and Hyperhomocysteinemia Without sufficient folate, homocysteine levels rise, resulting in hyperhomocysteinemia, a condition linked to oxidative stress, inflammation, and metabolic stress

7 Therefore adjustments in dosing regimens because of hypoproteinemia or concurrent administration of highly bound drugs are not necessary except in the rare case of a drug with a high hepatic extraction ratio and narrow therapeutic index that is given parenterally (e.g., IV dosing of lidocaine)

I think its malpractice