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Experimental work indicates that statins disturb mitochondrial complexes, although this sits mainly in mechanistic studies rather than patient-level trial In clinic I treat these hypotheses as prompts to focus on whole-mitochondrial support sleep, nutrient-dense diet, physical activity matched to capacity, and careful review of polypharmacy rather than chasing every possible supplement

Several patterns consistently separate positive outcomes from disappointing results

Ask specific screening questions about pregnancy, lactation, and chronic conditions (pernicious anaemia, cardiac disease, hypertension) that may interact with parenteral B-12 therapy