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Together with dihydrobiopterin (BH2), BH4 forms a redox cycle that scavenges endogenous oxidative free radicals, thereby suppressing ferroptosis ( + /NAD(P)H as a cofactor ( De novo synthesis of BH4 depends on three enzymes: GCH1, 6-pyruvoyltetrahydropterin synthase (PTS), and sepiapterin reductase (SPR)

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A holistic approach integrates medication, behavioral therapies, adequate sleep, and social support networks

However, medication should be paired with nutrition and lifestyle steps that improve insulin sensitivity, such as protein-forward meals, reduced ultra-processed food intake, strength training, walking after meals, sleep improvement, and stress reduction

This analysis addresses each of these questions using independent sources, regulatory filings, and published clinical data