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However, whether the increase in plasma TMAO levels caused by changes in dietary structure or imbalance of the intestinal microbiota is sufficient to regulate the CSNS and induce arrhythmias directly is currently unclear

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Dehghan A, van Hoek M, Sijbrands EJ, Hofman A, Witteman JC

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If you notice a sudden return of hunger or cravings at a dose that previously controlled your appetite, degraded medication could be the cause