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There are theories by clinicians that extremely low homocysteine could negatively impact glutathione and detoxification
Mechanistically, this was associated with increased expression/internalization of VEGFR2 and activation of downstream Akt-eNOS signaling (Hsieh 2017)
This can create a serious challenge for employers considering funding them for weight loss, depending on the number of users within a covered population
In the recently published BARI-OPTIMISE double-blind, placebo-controlled trial, 70 patients post-SG or RYGB who were tested and found to have insufficient GLP-1 response to meal stimulation were randomized to receive liraglutide (3 mg/day) or placebo, in addition to lifestyle interventions [49]
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