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These markers included increased plasma alanine and lactate levels and the presence of organic acids, such as 3-methyl-glutaconic and dicarboxylic acids, and Krebs cycle intermediates, in the urine of these patients [69]

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Finally, most published studies focus predominantly on young men attending gyms, which limits the generalisability of findings to other populations, including women, adolescents, and individuals with differing health profiles or patterns of substance use

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