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Additionally, exposure to heavy metals, such as cadmium, may also contribute to the development of ME/CFS (154)

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Notably, however, the unstable product flavan-3,3,4-triol ( 4 ) is converted mainly into the by-products epidihydroquercetin ( 9 ), dihydroquercetin ( 10 ) and quercetin ( 11) 13 , while the transformation into the coloured anthocyanidin has only been observed as a minor side reaction in vitro 11,12,13 or in vivo by engineered microorganisms 6,16