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They can be easily recognized by primary care physicians by their multiple complaints, negative physical examination results, and a history of multiple medical examinations . Now, lets consider the level of rigor by which people with unexplained symptoms have been examined in the past

In addition to impairing insulin signaling, adipocyte derived FAs can also impact gluconeogenesis in the liver, where a hallmark of T2D is the loss of the inverse relationship between gluconeogenesis and lipogenesis

Inflammatory adipokines like TNF-alpha and IL-6 decline as dysfunctional adipose tissue is metabolized

Furthermore, the threshold effect is consistent with the concept that methionine synthase activity may become saturated beyond a certain B12 concentration [17], explaining the diminishing returns observed at higher levels

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