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NOTE: The FDA banned the sale of ephedra herbal supplements containing measurable levels of ephedrine in 2004 due to an increased risk of stroke, myocardial infarction and sudden death (see ma-huang_ephedra)

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9 You can have a serum B12 of 500, 600, even 800 pg/mL and still have elevated MMA

Also, metabolites of VPA -oxidation (including propionic derivatives and 4-en-VPA) inhibit the mitochondrial CPS I, which is the first enzyme necessary for ammonia elimination via the urea cycle in the liver [19, 24]

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