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If you substitute pure sterile water in a protocol that requires repeated withdrawals over several days, you run an incredibly high risk of microbial contamination

Not every patient achieves the weight loss targets they are hoping for, and a meaningful proportion of patients even on maximum doses do not reach the 1520% body weight reduction that clinical guidelines increasingly use as a benchmark for meaningful metabolic benefit

No, but it does mean you are operating outside validated protocols

Methionine can also be converted to cytosine, the precursor of gluthione, which is essential in detoxification of the liver