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informed consent: as procedures were carried out on animals, patient approval was not obtained)

Inborn errors Congenital defects involve enzyme deficiencies in the carnitine transport or metabolic pathways, such as CPT II deficiency, which affects the function of the carnitine transporter CPT II and leads to impaired fatty acid -oxidation, and CACT deficiency, which affects the function of the carnitine transporter CACT and results in carnitine shuttle dysfunction

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Talk to your provider if you are interested in trying one or both of these treatments

GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count to identify macrocytic anaemia Serum B12 and folate levels to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine when B12 results are borderline Intrinsic factor antibodies if pernicious anaemia is suspected Additional tests depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord