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New onset metabolic disorders also include type 2 diabetes mellitus (T2DM), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and dysautonomia, especially the postural orthostatic tachycardia syndrome (POTS) 8,9,10,11

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The procedure is done through a pinhole with local numbing and light sedation, so discomfort is minimal most patients report far less pain than surgery

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For patients without neurological involvement , hydroxocobalamin 1 mg is administered intramuscularly three times a week for 2 weeks, followed by maintenance injections every three months for life (if due to pernicious anaemia or other non-dietary cause)

Carnitine and acetylcarnitine, which are potent antioxidants [18], can scavenge ROS and increase the levels of antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) [19]