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While patients may also notice cloudy, dark, or foul-smelling urine, or hematuria (blood in the urine), these findings alone are not diagnostic and should be evaluated alongside other symptoms

Moreover, mitochondrial dysfunction can affect the function of the endogenous antioxidant system, reducing the cells ability to resist oxidative stress, thus forming a vicious cycle and accelerating muscle atrophy [34]

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Severe niacin deficiency, known as pellagra, has been historically associated with poverty and consumption of a diet predominantly based on corn, which is low in bioavailable niacin (25, 26)

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Blood work: If your provider recommends it, monthly or quarterly blood panels can track metabolic markers including fasting glucose, HbA1c, insulin levels, lipid profiles, and liver function