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Low methionine intake (from animal products, nuts, and some legumes) or excess folate, B6, betaine, or N-acetylcysteine supplements can lower Hcy

Echocardiography demonstrated decreased left ventricular EF% and FS% in choline-fed mice compared to the control group

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Alterations in both the abundance and functionality of intestinal microbes lead to dramatic fluctuations in the levels and spectra of gut-derived metabolites (172)

Rarely, low blood sugar, kidney problems, allergies, increased heart rate and depression or thoughts of suicide may occur