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Any of these, alone or in combination, may explain a drop in stamina without pointing to a serious issue
Constipation: Also common, sometimes alternating with diarrhea
Hyperglycemia-driven AGE-RAGE signaling, PKC activation, and RAAS dysregulation converge on oxidative stress, endothelial dysfunction, and profibrotic transcription (e.g., TGF-beta/Smad), while mitochondrial and endoplasmic-reticulum stress amplify lipotoxicity and cell death
A review by Palermo et al
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