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Smith AD, Refsum H (2021) Homocysteine - from disease biomarker to disease prevention

It is important to note that claims about increased energy expenditure in humans remain insufficiently evidenced at this stage, and the net glycaemic effects reflect observed trial outcomes rather than a straightforward mechanistic reduction in hepatic glucose output the concurrent glucagon receptor agonism may, in fact, influence hepatic glucose production in a complex and not fully characterised manner

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However, inflammatory responses can cause excessive activation of microglia, impairing their ability to effectively uptake and degrade A [59]