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Both oxidative stress and inflammatory reactions lead to medical problems associated with inflammation, and these chemicals are needed to reduce both (Figure 4)

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Formulation alternatives may provide relief: Different tablet formulations with alternative inactive ingredients may be better tolerated Liquid preparations can be easier to tolerate and allow flexible dosing Intramuscular injections completely avoid the gastrointestinal tract and are particularly useful for those with absorption issues (such as pernicious anaemia or malabsorption) or persistent oral intolerance Review inactive ingredients: Examine the supplement label for potential irritants or allergens

Specifically, the malate/aspartate shuttle proteins MDH2, -KG/malate carrier, and GOT2 were found to be hyperacetylated leading to suppression of the transport and oxidation of cytosolic NADH in mitochondria, which correlated with decreases in oxygen consumption and cardiac energetics (manifested by a reduction in phosphocreatine/ATP) (42, 47)

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