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Interestingly, the mothers were on a vegan or vegetarian diet, which likely contributed significantly to the newborns having riboflavin deficiency.[ref] A case study of a 17-year-old with rhabdomyolysis from exercise, as well as muscle pain and fatigue, was found to have one copy of a known ACADVL mutation along with other ACADVL variants that werent known to cause VLCADD.[ref] Beyond mitochondrial energy: Immune system impacts: When monocytes and macrophages (white blood cells) are activated, the cells undergo metabolic changes, including an increase in long-chain fatty acid oxidation