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Patients who report the most dramatic energy improvements from SS-31 are typically those with pre-existing mitochondrial dysfunction whether from aging, chronic illness, or metabolic stress

It has been suggested that both innate and adaptive immune responses play a role in NCWS [37], and may share some triggers with FM [35]

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Based on these studies, the relationship between insulin resistance and the carnitine pool remains elusive, and more studies are needed in the future for detailed elucidation