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Increased d-lactic acid theory Another theory regarding the reduced intestinal pH and increased gut permeability in ME/CFS patients is the increased production of D-lactic acid due to the overgrowth of Gram-positive bacteria such as Enterococci and Streptococci, which leads to systemic inflammation, immune activation, and oxidative stress [22, 44]
However, it should be noted that combined with insulin may lead to hypoglycemia (94)
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