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L-Carnitine also helps minimize the buildup of metabolic waste products like lactic acid, which can contribute to muscle soreness and fatigue

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The underlying pathologic mechanisms of primary MS fatigue are poorly understood, with proposed theories including structural damage of white and gray matter, inflammatory processes including elevated cytokines, endocrine dysfunction, and maladaptive network recruitment attributable to distributed lesions or inflammation

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There may also be loss of strength, loss of length, narrowing or wasting of the penis and difficulty with intercourse