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Increased d-lactic acid theory Another theory regarding the reduced intestinal pH and increased gut permeability in ME/CFS patients is the increased production of D-lactic acid due to the overgrowth of Gram-positive bacteria such as Enterococci and Streptococci, which leads to systemic inflammation, immune activation, and oxidative stress [22, 44]
The chronic pain problem: where the evidence and the biology diverge The most common leap I see is the leap from maybe helpful for an acute tendon injury to maybe helpful for arthritis, chronic knee pain, or long-standing degenerative issues. This is where I think the case is weak
For individuals with absorption disorders or severe deficiency, this distinction in delivery speed can meaningfully affect how quickly levels normalize
No synergy with topical treatments
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