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While insulin resistance per se which allows glucose levels in the blood to rise to dangerous levels hasnt been found in chronic fatigue syndrome (ME/CFS), an exercise-related insulin resistance which was ameliorated by metformin did show up in cultured muscle cells from ME/CFS patients

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Similarly, using multiple compounds that all increase serotonin (Pinealon plus high-dose 5-HTP plus an SSRI, for example) could theoretically create excessive serotonergic activity