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However, clinical practitioners often recommend a "start low and go slow" approach, particularly for patients with severe chronic illness who may be highly sensitive to new supplements or prone to detoxification reactions (Herxheimer reactions)

A two-step progression from simple steatosis to steatohepatitis and fibrosis has been proposed 13 , and suggests that after fat accumulation in the liver due to insulin resistance, lipids are peroxidized with cytokines and Fas ligand induced by excessive ROS

The last study published in 2024 by Zmitek et al

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