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while vitamin B12 is required for methylation reactions involved in homocysteine and folate metabolism, vitamin B12 deficiency does not affect the methylation of myelin basic protein [8]

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Although studies suggested that tryptophan and its derivatives could influence the gut microbiome and interact with the gut mucosal immune system, recent clinical investigations proposed that changes in immunity and kynurenine metabolism may trigger fatigue in ME/CFS but do not sustain it over time [61, 67, 68]