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In addition, it is thought that the decrease in adipokine and cytokine secretion may regulate energy metabolism by increasing insulin sensitivity (91)

You might have to take a B12 supplement or try a new medication

The enhancement of PDHC acetylation through ACAT1 activation helps recruit PDK to the phosphorylation sites of PDH, thus inducing a decrease in PDHC activity, while the blockade of PDHC acetylation through SIRT3 activation may lead to its dephosphorylation and activation (31)

Cisterna B, Costanzo M, Nodari A, Gali M, Zanzoni S, Bernardi P, Covi V, Tabaracci G, Malatesta M (2020) Ozone activates the Nrf2 pathway and improves preservation of explanted adipose tissue in vitro