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Metabolic characteristics of keto-adapted ultra-endurance runners

In PCOS cases, the effectiveness of these signals decreases, leading to elevated insulin and androgens and poor ovulation

Lastly, some evidence outlined the involvement of metabolic alterations and carnitine deficiency that may lead to muscular weakness, fatigue and intolerance of physical exercise, contributing to the development and maintenance of FMS [15,30]

Vitamin B12 (cyanocobalamin or methylcobalamin) is often included to address fatigue and support energy metabolism