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The lipotropic agents (methionine, inositol, choline) are pH-sensitive and oxidise rapidly once exposed to air and moisture, which is why the 72-hour window exists rather than the 28-day stability window you'd see with straight methylcobalamin

However, the data also shows that results vary widely from person to person

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Another study using the CIA mouse model also suggested that Clostridium cluster XIVa can activate transforming growth factor- (TGF-), thereby enhancing the immunosuppressive function of Tregs (125)

One without the other creates risk