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A consultation is especially important if you: Have a known allergy to B vitamins or any of the MIC components Are pregnant, breastfeeding, or trying to conceive Have kidney disease, liver disease, or a history of kidney stones (methionine metabolism can affect uric acid and homocysteine levels) Take blood thinners, immunosuppressants, or medications that interact with B12 absorption (such as metformin) Have a sulfa allergy (methionine is a sulfur-containing amino acid) Have a trimethylaminuria (fish-odor syndrome) diagnosis, which affects choline metabolism Have a history of cardiovascular events or uncontrolled hypertension This list is not exhaustive, and it is not a substitute for an individualized assessment

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N Engl J Med 2020;383:1735-45