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Multiple problems of a lower severity may, in the aggregate, create a higher risk due to interactions

While direct drug interactions are unlikely based on known mechanisms, the lack of safety studies and standardized formulations means healthcare providers cannot definitively assess safety or benefit

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Other compounds such as berberine (BBR) [134] and trigonelline [135] are also natural products known to inhibit the formation of TMAO from TMA by lowering the expression of the FMO3 enzyme

Nat Commun 16:8324 Star RA, Rajora N, Huang J, Stock RC, Catania A, Lipton JM (1995) Evidence of autocrine modulation of macrophage nitric oxide synthase by alpha-melanocyte-stimulating hormone

Pituitary 7 , 243248 (2004)