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In previous studies, TMAO, often used as a key metabolite in the study of microbial metabolome alterations in cardiovascular disease, has been shown to directly stimulate platelets by enhancing intracellular calcium release, among other pathways, causing platelet hyperreactivity, thereby increasing the risk of thrombus formation (50)

But Kristin Zimmerman, associate professor in the department of pharmacotherapy and outcomes science at Virginia Commonwealth Universitys School of Pharmacy in Richmond, grew suspicious several years ago when her mom, who was in her late 60s and living on Floridas Gold Coast, quietly signed up for vitamin B12 injections from a new wellness clinic that had opened at the local mall