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BBB dysfunction in ME/CFS can be triggered by various stressors, including viral infections, chemical exposure, and chronic stress

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However, B12 is not directly involved in fat metabolism the way L-carnitine is

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Pediatrics 67:95100 Novak M, Monkus EF, Buch M, Silverio J, Clouston OM, Cassady JC (1988) l-Carnitine supplementation of a soybean-based formula in early infancy: plasma and urine levels of carnitine and acylcarnitines

When a long-chain fatty acid enters the cell, it is first activated into an acyl-CoA molecule