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For all analyses a P value less than 0.05 was considered significant

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Here is what to watch for: Exercise intolerance, tiring sooner than usual or refusing to continue walks they previously completed without difficulty Generalised weakness, particularly in the hindquarters Lethargy and reduced engagement with normal activities and play Reduced appetite and progressive weight loss Episodes of fainting or collapse, particularly during or after exertion Breathlessness or laboured breathing, which may become more noticeable with mild activity Abdominal distension in cases where dilated cardiomyopathy has led to fluid accumulation A persistent, soft cough that is more noticeable at rest or at night, which can reflect early fluid in the lungs from cardiac involvement The cardiac signs are among the most significant

In the l-carnitine group, 74.2% (23/31) of patients with impaired brain function and with normal ammonia levels had improved NIRS data at 8 weeks of treatment (Fig

Potential benefits of a ketogenic diet to improve response and recovery from physical exertion in people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a feasibility study