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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]

If you have a vitamin B12 deficiencyperhaps due to conditions like pernicious anemia, certain digestive disorders, or a strict vegan dietyou may experience symptoms such as fatigue, weakness, and low energy