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Energy and recovery patterns Marked fatigue after ordinary activity Exercise intolerance or low physical endurance Delayed recovery after infection Variable energy across the day Worsening after fasting or missed meals Neurologic and stress patterns Variable cognitive stamina Brain fog or reduced focus during fatigue Sensory worsening during illness or stress Temperature sensitivity Regression or functional loss during metabolic stress Testing Undermethylation and Mitochondrial Dysfunction in Autism Testing should distinguish possible methylation impairment from mitochondrial stress, oxidative damage, nutrient deficiency and other biochemical patterns that may produce overlapping symptoms

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Notably, central nervous system (CNS) concentrations often surpass peripheral levels, reflecting impaired efflux of brain-derived MMA across the BBB (Sauer et al

FIGURE 1 The prevalence of DED, which surged to as high as 61.0% during the COVID-19 pandemic (Ji et al., 2023), underscores the influence of increased exposure to visual display terminals and widespread mask usage during the pandemic, which likely exacerbated the condition by decreasing blink frequency and increasing thermal air currents over the ocular area, thus enhancing tear evaporation rates (Uwimana et al., 2022