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[1] [4] Symptoms typically worsen upon standing and improve when lying down, and may include: Lightheadedness or dizziness Heart palpitations or a racing heartbeat Fatigue and exercise intolerance Brain fog or difficulty concentrating Nausea and abdominal discomfort Blurred vision or visual disturbances Tremulousness or shakiness Fainting or near-fainting (presyncope/syncope) In the post-bariatric context, symptoms may emerge weeks to months after surgery, often coinciding with periods of rapid weight loss or following episodes of poor nutritional intake

Moreover, Mendelian randomization analyses support a causal role for specific gut microbes: Actinobacteria and Bifidobacterium taxa appear protective, while Lactobacillaceae increase anxiety risk (Lai and Xiong, 2025)

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Oral carnitine supplementation influences mental health parameters and biomarkers of oxidative stress in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial