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10.1126/science.1176333 Science 63 VeigaN.TorresJ.MansellD.FreemanS.DominguezS.BarkerC

Both groups showed at least a 10-fold increase in plasma levels of trimethylamine N-oxide (TMAO) a metabolite generated by gut microbes after choline supplementation, as well as an increase in platelet responsiveness, a risk factor for thrombotic events (blood clotting) like heart attack and stroke

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NAC provides600 mgof N-acetyl-L-cysteine to support glutathione production, antioxidant defense, and detoxificationpathways.*This well-absorbed precursor supports immune, respiratory, and liver health while helping the body manage oxidative and environmentalstress.*

High-risk groups who should be considered for monitoring include: Patients taking metformin for more than three years Those on high-dose metformin (2g daily) Older adults (aged 65 years and above), who have reduced gastric acid production and lower B12 stores Patients with pre-existing risk factors for B12 deficiency, including previous gastric surgery, pernicious anaemia, or inflammatory bowel disease Individuals following vegan or vegetarian diets with limited dietary B12 intake Those taking acid-suppressing medications (proton pump inhibitors or H2-receptor antagonists) Patients with symptoms suggestive of B12 deficiency Patients with unexplained anaemia or neuropathy The frequency of monitoring should be guided by clinical judgement and local pathways, with consideration of individual risk factors

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