melanotic macule palate a Multifocal brown macules on the hard showing variation in Intra oral photograph of the

Trimethylamine-N-oxide: a link between the gut microbiome, bile acid metabolism, and atherosclerosis

The mechanism involves inhibition of nitric oxide synthase (NOS) activity: glutathione binds nitric oxide (NO), a critical neurotransmitter in gut motility, effectively sequestering it before it can signal smooth muscle relaxation and coordinated peristaltic waves

The vitamin C component might reduce the efficacy of these medicines

Another study on cardiometabolic risk factors in a diabetes case-control study (NCT02588898) and a vitamin-supplementation trial (NCT02586181) found high plasma concentrations of metabolites, including TMAO and choline, correlated with lower cholesterol and plasma phospholipid levels, suggesting TMAO may aid in cholesterol solubilization and macrophage cholesterol (158)