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The resulting catastrophic energy deficit is a primary physiological driver of post-exertional malaise (PEM) or 'crashes,' where even minor, everyday activities trigger a disproportionate and prolonged exacerbation of profound fatigue, muscle weakness, and cognitive impairment

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However, researchers think that many people may be suffering from a slight B3 deficiency that is not serious enough to cause pellagra but is still causing symptoms such as anxiety, depression, fatigue, and GI issues

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