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But only the R-isomer (R-ALA) is naturally produced in the body and actively participates in mitochondrial energy metabolism.12 Some studies suggest that R-ALA may be more bioavailable than standard racemic ALA though the clinical significance of this difference is still under investigation.17 In addition, anecdotal reports and small studies indicate that R-ALA may be easier on digestion, with fewer gastrointestinal side effects than standard racemic ALA, especially at higher doses.18 However, R-ALA is chemically unstable on its own

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Therefore, cancer cells not only use FAO to oxidize fatty acids and to derive energy by mitochondria but they also use acetyl-CoA to endogenously synthesize fatty acids in the cytosol using NADPH as key cofactor for anabolic enzymes (Currie et al., 2013)