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The downstream effects include activation of hormone-sensitive lipase in adipose tissue (which breaks down stored triglycerides into free fatty acids), increased protein synthesis in skeletal muscle, enhanced cellular repair and turnover, elevated IGF-1 production from the liver, and improved lipid metabolism including reduced triglycerides

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Some of the neurological complications result from defective myelin synthesis and repair, and not all are reversible

doi: 10.1093/ajcn/75.5.789