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The harms are related both to the dose and duration of exposure to excess folic acid

The metabolic restoration is real

RISK FACTORS TO BE ON THE LOOKOUT FOR: Those who are likely to be at risk of more severe adverse effects after intra-articular corticosteroid injection: older age, white race those with pre-existing avascular necrosis secondary to trauma & injury to blood supply femoral neck # or dislocation non-traumatic insidious onset of pain, with possible history of long-term oral steroid use long-term alcohol abuse radiation treatments or chemotherapy other health conditions - blood disorders, autoimmune disorders, HIV etc those with pre-existing subchondral insufficiency fracture older adult with osteoporosis younger adult who is active acute pain, which gradually worsens for weeks without an identifiable incident ultrasound findings such as a larger-than-expected joint effusion, extensive intraarticular debris, or synovial thickening, indicating an active joint process those with a rapidly progressive form of osteoarthritis

Medium-chain triglycerides (MCTs), which are made up of intermediate-length fatty acids, are absorbed intact in the intestines and readily converted into ketone bodies by the liver

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PMID 15711210