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Often, multiple factors are responsible
High index of suspicion should be present among physicians when a vegetarian patient presents with hyperpigmentation over the body
10.1007/s12031-021-01922-7 5 CameronN
However, it should be noted that supplementation of betaine in individuals with CBS deficiency, without sufficient dietary methionine restriction, leads to methionine excess with severe clinical consequences (Schwahn et al, 2019)
