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During low-intensity aerobic exercise, the body prefers to use fatty acids as the main energy source, and an adequate supply of carnitine can promote FAO and support prolonged exercise [275]

These changes were associated to an increase in L-carnitine levels in plasma, but with no significant increase in muscle

The criteria highlight the need to avoid an incorrect diagnosis due to stress hyperglycaemia, which can be of any magnitude

(PubMed) 1Pastori D, Carnevale R, Cangemi R, et al

In addition to prolonged fatigue, patients must have four or more of the following symptoms to be diagnosed with chronic fatigue syndrome: Impairment in short term memory or concentration Sore throat and swollen, tender lymph nodes, recurrent viral like illness Muscle and joint pain Non-restorative sleep Post exercise fatigue anxiety, depression, panic attacks Night sweats, chest pain Dry eyes, dry mouth Irregular heart beat Many patients I see have have symptoms of severe fatigue but do not meet the diagnostic criteria for CFS set by The Centers for Disease Control (CDC)

These findings confirm that abnormal muscle development contributes to the observed swimming and muscle endurance issues in these fish