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The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for the two primary biochemical outcomesserum vitamin B12 concentration increase and homocysteine reductionacross all included studies, and separately for randomised controlled trials (RCTs) and observational studies
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However, combining them also increases the total peptide burden on the hypothalamic-pituitary axis and gastrointestinal tract, which warrants caution
[1] [2] This weight loss, particularly the reduction in visceral adipose tissue, can improve insulin sensitivity as excess fat tissue contributes significantly to insulin resistance
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