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Metabolic Concerns TMAO (Trimethylamine N-Oxide) Production: Recent concern (2025): Approximately 90% of oral ALC metabolized to TMAO by gut microbiota[21] Plasma TMAO levels: Can reach 50 M after supplementation (1.5 g dose)[21] Cardiovascular risk: Elevated TMAO previously associated with adverse cardiovascular outcomes in observational studies Clinical significance: Uncertain

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A 2017 meta-analysis of data from over 40,000 women treated for breast cancer found that the risks of radiation therapy may outweigh the benefits for long-term smokers (Taylor 2017)