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This is why testing and early management are very important

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Gutirrez S, Svahn SL, Johansson ME

Also, one must acknowledge that evidence from meta-analysis is currently lacking that an LCD (favoring the carbohydrate-insulin-model) is more effective than a low-fat diet if calorie restriction is achieved (favoring the energy-balance-model) [37]

When carnitine levels drop, the body loses its ability to efficiently utilize fat stores for energy, forcing it to rely on less efficient metabolic pathways that generate toxic byproducts and contribute to systemic fatigue