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In the citric acid cycle, increased fumarate and succinate levels enhance malic enzyme activity and increase the conversion of pyruvate to malate [82], which in turn inhibits the conversion of pyruvate to oxaloacetate when there is an accumulation of acetyl CoA, further increasing the accumulation of malic acid [83]

Every intake is reviewed by a board-certified DO before anything is prescribed

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They are not designed for manual dose splitting

Some people may experience mild side effects such as nausea, diarrhea, and constipation, which normally go away on their own as their body gets used to the medication