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Whether this translates to humans is unresolved, so the label contraindicates it in the highest-risk groups as a precaution

The effects of betaine supplementation on fluid balance and heat tolerance during passive heat stress in men

To more fully characterize the quality of evidence supporting recommendations, the Practice Guideline Committee of the AASLD requires a Class (reflecting benefit versus risk) and Level (assessing strength or certainty) of Evidence to be assigned and reported with each recommendation (Table 1, adapted from the American College of Cardiology and the American Heart Association Practice Guidelines)

doi: 10.1186/s12885-020-07447-3 69 WangQDaiXXiangXXuZSuSWeiDet al

Metformin enhances nitric oxide production and diminishes Rho kinase activity in rats with hyperlipidemia