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Acetaldehyde is even more toxic than ethanol due to its high reactivity, forming covalent adducts with proteins [21, 22], phospholipids [23], and nucleic acids [24], thereby altering their biological functions

No Phase 3 trials have been completed for either form

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From a research standpoint, extensive, strain-specific multicenter trials that include comprehensive product characterization, standardized outcome measures, and sufficient follow-up are essential to establish minimal effective doses, assess the durability of effects, and identify infrequent adverse events

Chu FF, Esworthy RS, Lee L, Wilczynski S