>>12687424I'd guess it's two things:. One a metabolic dysfunction caused by abdominal fat acting as an endocrine signaller and disrupter of organ function, almost all these people are obese with fatty liver. Two it's a problem of metabolic function caused by genetic inefficiencies of enzymes in metabolic processes, we only really know about the pathologies of inborn errors of metabolism when they are total and infants die of them, we know little about sub-optimal inborn errors of metabolism that may only present as these vague symptoms in adults because some metabolic step in only functioning at 10% of what it would in a healthy person.
The fix I would attempt is body recomposition to lose all abdominal fat by a protein sparing very low carbohydrate diet. Don't worry about exercise until diet has stripped off all the fat. The second would be to megadose b vitamins like riboflavin and other conditionally essential nutrients (like choline, betaine, creatine etc.) and hope to find one or more where megadosing or supplementing can blast past a sub-optimal inborn error of metabolism.
The other factor could be gut dysbiosis. Harder there and a lot may be fixed by body recomposition and not eating to excess. Option would be nuking the gut biome with antibiotics and replacing with fecal transfer from a healthy person.
