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Ambrecht, L

Reduced urea production, which results in excessive ammonia levels in the body, may increase the likelihood that patients develop altered brain function, a condition called hepatic encephalopathy

Elevate homocysteine levels, impairing normal blood vessel function, promoting oxidative stress, and increasing risk of atherosclerosis, cardiovascular disease, insulin resistance, and Type 2 diabetes

meta-analyses report no significant difference in overall incidence of adverse events between berberine and placebo, and no serious toxic reactions occurred (Ju et al., 2018