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If fasting guidelines are instead meant to minimize aspiration events without respect to residual gastric contents, then I think we need to start questioning what amount of residual gastric contents (and what type) are clinically significant.2 Oprea and colleagues published a correspondence this month addressing some of the criticisms of their article

According to some publications, the extent and the intensity of physiological oral mucosal melanin hyperpigmentation increase with age probably owing to the cumulative effects of endogenous and extrinsic melanogenic stimuli, such as inflammatory processes, drugs, tobacco smoke, and recurrent minor functional injuries [4, 6, 11, 13]

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Its also not clear that mega-doses of B vitamins are safe over the long haul, especially in certain populations

These market dynamics suggest a multi-year window where access broadens but requires active navigation by clinicians and patients