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ALA acts as a cofactor for mitochondrial enzymes involved in energy metabolism

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31 Phenformin has been reported to exhibit anti-thiamine activity in animals, 32–34 and as a result, it has been suggested that a possible anti-thiamine effect of metformin might contribute to some cases of metformin-associated lactic acidosis, a rare condition, but one that has been shown to have a mortality rate of 18–25%