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Key limitations of the existing evidence include: Small sample sizes in many studies Heterogeneous patient populations Variable dosing regimens (typically 35 grams daily) Short follow-up periods (often 4-12 weeks) Inconsistent outcome measures Potential publication bias favouring positive results Some studies have investigated combination approaches

doi: 10.1007/s10741-006-9195-3

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Antibiotics including rifaximin and metronidazole have been investigated for their capacity to inhibit TMAO formation by targeting gut bacteria that create TMA