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However, numerous studies indicate that individuals with ME/CFS experience increased intestinal permeability, supporting the theory that Gram-negative bacterial endotoxins, also known as LPS, may enter the mesenteric lymph nodes and the blood stream through the loosening of tight-junction proteins (e.g., Zonulin), triggering an immune response and resulting in systemic inflammation [10, 21, 24, 39,40,41,42]

However, high-dose oral therapy (1,0002,000 g daily) may be effective in some cases through passive diffusion, with appropriate monitoring