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One notable case report detailed how a patient with advanced pancreatic cancer with spread to the liver was treated with ALA plus low-dose naltrexone

This metabolic dysregulation is defined by systemically reduced levels of metabolites such as amino acids and fatty acids, leading to reduced TCA cycle activity and oxidative phosphorylation, which may ultimately be a major contributor to neuropsychiatric symptoms associated with reduced energy, such as fatigue and other cognitive impairments [43, 62]

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Comprehensive clinical assessment and management of ME/CFS requires being symptom oriented and the recognition of individual differences