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When thyroid levels are in range, the benefits of appetite suppression and metabolic improvement may be easier to see

One-year longitudinal association between changes in dietary choline or betaine intake and cardiometabolic variables in the PREvencion con DIeta MEDiterranea-Plus (PREDIMED-Plus) trial

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Homocysteine levels may also look normal on testing, cloaking genuine issues with methylation (a 'false negative')

The strength of evidence varies significantly by application, with most published work describing in-vitro mechanisms or small observational studies rather than Phase II/III controlled trials