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and gluconeogenesis is suppressed 38 in part due to depletion of pyruvate and lactate 39

In high concentrations, homocysteine can increase the risk of heart attacks and strokes since it can damage arterial walls

(With chronic conditions in particular, patients may have the experience of a doctor not believing them, so its critical for doctors to listen and understand that a patients suffering is real, whether or not it shows up on a test.) Providers agree that there are additional things they can do to step up too

Unknown long-term effects

Slow titration from 0.25 mg to 2.4-4.5 mg weekly

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