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Long-term use of some type 2 diabetes medications can reduce B12 absorption

Inhibition of CYP51A1 with ketoconazole has demonstrated diverse biological effects: it rescued EGFR degradation in A431 carcinoma cells by blocking sterol metabolism upstream of MSMO1, and reduced inflammatory signaling and cytokine release in mouse macrophages, ultimately improving survival in a model of endotoxic shock

What appears to be consistent in the above triggers of CFS is that they initiate excessive amounts of inflammation and oxidative stress, which has a direct impact on mitochondrial function

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