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But for a large number of people, diet alone isnt enough

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A separate set of enzymes and transporters also plays a buffering role by eliminating acetyl-CoA from inside mitochondria created by the pyruvate dehydrogenase complex that is in excess of its utilization by the Krebs cycle

doi: 10.1016/j.mayocp.2017.12.003 50 MagnussonIRothmanDLKatzLDShulmanRGShulmanGI