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Giesen, M., Wel, T., Zur Wiesche, E

"Alpha-Ketoglutarate dietary supplementation to improve health in humans." Nutrition

doi: 10.1172/JCI115574

Nutrient Deficiencies Long-term metformin use can reduce vitamin B12 levels, leading to fatigue

Some doctors might diagnose you with hyperthyroidism and not really distinguish between whether its Graves or Hashimotos, but it can make a difference