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Six RCTs [13, 18, 3235] involving 406 patients provided low certainty evidence (Table 2) that L-carnitine supplementation significantly changes (reduced) in the AST levels (MD: 15.89, 95%CI: 29.87 to 1.91) and low certainty evidence (Table 2) that L-carnitine supplementation significantly changes (reduced) in the ALT levels (MD: 26.38, 95%CI: 45.46 to 7.30)

While insulin resistance per se which allows glucose levels in the blood to rise to dangerous levels hasnt been found in chronic fatigue syndrome (ME/CFS), an exercise-related insulin resistance which was ameliorated by metformin did show up in cultured muscle cells from ME/CFS patients

Variation in the plasma membrane monoamine transporter (PMAT) (encoded by SLC29A4) and organic cation transporter 1 (OCT1) (encoded by SLC22A1) and gastrointestinal intolerance to metformin in type 2 diabetes: an IMI DIRECT study