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Therefore, the fatigue and cognitive impairments observed in PEM should not merely be attributed to energy depletion in muscles or neurons but should be understood as a more complex process of interoceptive dysregulation: the brain receives intense danger and low-energy signals from peripheral systems, such as muscles and the immune system, and misinterprets them as an overwhelming burden, necessitating forced rest

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This mechanism is particularly beneficial for individuals with diabetes or metabolic syndrome, as it helps regulate blood sugar levels and may help with insulin resistance

The key is consistent application and realistic expectations about timeframes