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A classic story is that the patient remembers their GI bug and their gut has never been the same since. Diabetes, medications, anatomical abnormalities, hypothyroidism, autoimmune and other conditions interfering with intestinal neuromuscular function are also associated with MMC deficiency

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Patterson RE, Sears DD (2017) Metabolic effects of intermittent fasting

10.1096/fj.202000860RR 47 SongX.JiaH.JiangY.WangL.ZhangY.MuY.et al (2015)

And a lot of them are selling the stuff or getting paid and free peptides from the guys that are

Also seek urgent evaluation for back pain with right upper quadrant abdominal pain, which may suggest gallbladder disease