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The long answer: Refrigeration is critical because it dramatically slows down two separate but equally problematic processes

F., Su, H., Zhang, C

Increased TMAO levels in addition to endothelial dysfunction, vascular aging, and oxidative stresses have been shown to cause thrombotic events and platelet excitability in humans, which in turn induce atherosclerosis [69, 72]

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The paper, at the same time, outlines the missing details that one would expect for a natural substance