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It is a chemical leavening agent (typically based on sodium bicarbonate) that makes preparations rise through a chemical reaction, not fermentation

This work was further supported by the UKs Experimental Arthritis Treatment Centre for Children (supported by Versus Arthritis, Alder Hey Childrens NHS Foundation Trust, the Alder Hey Charity, and the University of Liverpool) and partially carried out at the NIHR Alder Hey Clinical Research Facility

A conservative escalation for autoimmune patients might look like this: 2.5 mg weekly for six to eight weeks (instead of four), followed by 5 mg weekly for eight to twelve weeks with careful monitoring of both metabolic and autoimmune markers, then cautious escalation to 7.5 mg only if tolerated and if additional metabolic benefit is desired

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