Hi Tareq, The folks who suffered with gastroparesis/constipation usually got immediate results (within 60-90 minutes) for a bowel movement UNLESS they were impacted (the stool was too hard to pass even with vagus nerve stimulation) or if they were on anticholinergic medications or opiates (which diminish the cholinergic effects to some degree). Fatigue, if low acetylcholine was to blame, responded in about the same amount of time. It’s very rewarding to watch patients take it, then often within 30 minutes or so, the sparkle comes back in their eyes, they sit up straight again, and they’re awake! That’s what it was like for me, but I was so incredibly sick that I wasn’t awake for more than 3 hours a day, and I wanted to be asleep those hours! I think my response was so dramatic because I was so extremely affected. When I had poor gall bladder function and pancreatitis, it took about a month before everything was working well, and I could COUNT on having a bowel movement every day, had normal stomach acid production, gall bladder function, etc. One of the doctors in our study wrote me a SONG after 2 days (to the tune of the Monkeys “I’m a Believer”. That was awesome.) I hope you get similar results. I know we are all different, and I don’t know what medications you are on, or even if you show symptoms of low acetylcholine, but this can be a key piece for many of us. I wish the very best for you and yours.