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Under this reaction is a pathway showing choline being converted to betaine, which then donates a methyl group to homocysteine via a vitamin B 12 -independent reaction
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[DOI] [PMC free article] [PubMed] [Google Scholar] 100.Mitchell J.E., King W.C., Chen J.Y., Devlin M.J., Flum D., Garcia L., Inabet W., Pender J.R., Kalarchian M.A., Khandelwal S

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Oral and mucosal symptoms often provide early clues

It peaks during the first 1 to 2 weeks after each dose increase, then gradually diminishes as your body adapts
