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Chronic hyperinsulinemia might stimulate a series of interconnected metabolic processes (60), including for example an increased production of very-low-density lipoproteins via the upregulation of cholesteryl ester transport protein (61, 62), altered HDL-C composition (63), or reduced cholesterol efflux (64) thereby reducing reverse cholesterol transport (65, 66)

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These conditions have been reported in ME/CFS patients generating the main symptoms

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L-carnitine also aids in the removal of harmful chemicals from the body, such as excess acyl-CoA molecules produced during fatty acid metabolism