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Thiamine deficiency adversely affects the activity levels of these enzymes, with TK, through thiamine-dependent erythrocyte transketolase (ETK) activity, common biomarkers of thiamine status, since it is particularly sensitive to thiamine levels and AKD often exhibiting the earliest detectable changes (, )

The increased levels of aconitate decarboxylase 1 result in diversion of cis -aconitate away from the TCA cycle via its metabolism to itaconate

In this study, we showed intense elastin staining compared to intact tendons

How to begin to optimize blood sugar: Limit or remove refined carbs and sugar Eat protein and fat with meals Strength train regularly Go for daily walks Start the day with 25-30 grams of protein Incorporate fiber rich foods into your meals Avoid caffeine until after breakfast Practice stress reduction techniques Stress plays a role in HPA-D and its critical to address and reduce daily stressors