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Moreover, case reports in patients with small intestinal bacterial overgrowth further support a microbial contribution to elevated MMA: in such individuals, broad-spectrum antibiotics normalized MMA levels, suggesting that gut bacteria capable of producing propionateand potentially MMA itselfcan significantly elevate systemic concentrations (Tejero et al

Lenton in the context of environmental systems defines tipping points as conditions or situations, where a small perturbation triggers a large response