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However, in the only available human study on trained athletes, this substrate shift appeared maladaptive: the Meldonium group showed a lower VO max and workload alongside an increased RER, suggesting impairedor at least not improvedmaximal performance (59)

Bitter receptor activation is an acute response that can occur within hours of ingestion

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Most practitioners recommend starting at 250-300 mcg daily to assess tolerance, then potentially increasing to 400-500 mcg if initial response is suboptimal and no side effects occur