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[1] [4] When to seek medical attention : Patients should contact their healthcare provider if they experience severe abdominal pain, persistent vomiting, signs of gallbladder disease, vision changes (prompt ophthalmology evaluation recommended), or symptoms of thyroid tumors (neck mass, difficulty swallowing, persistent hoarseness)

Nadolsky has mixed feelings about them: I used to be much more against the compounded versions

For many people, this constant trickle of bile is less efficient at processing large amounts of fat at once

parasympathetic outflow to the gut and pancreas is increased, whereas vagal modulation of heart rate is diminished

Metab 106, 22912303 (2021)

I recommend just a half scoop serving before workouts