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During periods of fasting, improper utilization of fatty acids impairs gluconeogenesis and characteristically leads to nonketotic or hypoketotic (no or minimal ketone body production respectively) hypoglycemia.[3] When fatty acid oxidation is impaired, glucose is readily consumed without replenishment from gluconeogenesis.[6] In carnitine deficiency states, various intermediary metabolic pathways such as Kreb's cycle, amino acid metabolism, and beta-oxidation of fatty acids are also affected

The causes include heredity, hormonal variations, stress, a poorly balanced diet, or even skin aging

Consequently, the buildup of A, which initiates well in advance of the manifestation of symptoms, is viewed as an indicator of aging and metabolic challenges in the brain rather than the root cause (94)

NAD(P) oxido-reduction balance The figure illustrates the NAD(P) oxidation-reduction balance