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Even meat-eaters can experience deficiency due to poor absorption, which often relies on a stomach-produced protein called intrinsic factor

Magnetic resonance spectroscopy (MRS) studies further substantiate the evidence of metabolic disturbances: in ME/CFS patients, brain lactate concentrations and the choline/creatine ratio are significantly elevated, indicating increased anaerobic glycolysis and altered membrane phospholipid metabolism, both of which are linked to neuroinflammation and mitochondrial oxidative stress (155)

Figure 5 As a type I interferon, Plegridy binds to interferon receptors on immune cells, activating JAKSTAT signaling and inducing interferon-stimulated genes

Most patients have several contributing factors at once

Ashwagandha, phosphatidylserine, magnesium, rhodiola rosea, and L-theanine are all commonly used supplements