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Similarly, one case-control study found low serum choline concentration was associated with a higher risk of NTDs (210), while another study found no such association (211)

This decyanation process is demanding: Although the amount of cyanide is considered toxicologically insignificant, humans must remove and detoxify the cyanide molecule, reduce the cobalamin to its usable +1 oxidation state, and then enzymatically convert the cobalamin into one of two metabolically active coenzyme forms

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