The Energy Code: 7 Science-Backed Keto Hacks for Women 40+ (Plus 2 Game-Changing Nutrients)

What if the key to boundless energy after 40 wasn’t another cup of coffee, but a combination of two breakthrough nutrients and seven game-changing hacks missing from most keto diets?

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For many women over 40, keto delivers incredible benefits—weight management, mental clarity, and stable blood sugar. Yet, fatigue often lingers, making it feel like an unavoidable side effect of aging. The truth? This energy drain isn’t just about carbs—it’s about your cells and what they need to thrive.

Groundbreaking research reveals that cellular renewal and antioxidant defense systems play a critical role in sustaining energy, and they tend to decline as we age. The good news? With the right tweaks, you can restore your body’s natural energy production, enhance mitochondrial function, and combat oxidative stress—without relying on stimulants or constant snacking.

In this article, we’ll explore seven science-backed energy hacks explicitly designed for women over 40 on keto. From activating your body’s cellular cleanup crew to fortifying your cells against oxidative stress, these strategies—plus two game-changing nutrients—will help you reclaim the energy you thought was lost.

The Key to Beating Fatigue Lies in Cellular Renewal & Antioxidant Defense

Fatigue after 40 isn’t just about getting older—it’s about how efficiently your cells produce and maintain energy. At the heart of this process are two critical factors: cellular renewal and antioxidant defense.

Cellular Renewal: Our bodies constantly repair and regenerate cells, but this process slows down as we age. This decline impacts mitochondria—our cells' “power plants”—leading to sluggish energy production. The keto diet offers some benefits by reducing glucose dependence, but fatigue can persist if mitochondrial health isn’t optimized.
Antioxidant Defense: Every day, our cells battle oxidative stress from environmental toxins, processed foods, stress, and even the natural byproducts of burning fat for fuel. Free radicals accumulate without a strong antioxidant defense system, damaging mitochondria and accelerating fatigue.

The latest research shows that by enhancing these two key systems, women over 40 can significantly boost their energy levels, improve endurance, and even slow cellular aging. And the best part? You don’t need stimulants, extreme dieting, or endless biohacking—just a few strategic shifts that work with your body’s natural processes.

In the next section, we’ll uncover the hidden energy saboteurs that often derail women over 40 on keto—and how understanding them is the first step toward reclaiming vitality.

II. The Hidden Energy Saboteurs After 40

Fatigue isn’t just a random side effect of aging—it has clear, biological causes that can be addressed once you know what’s happening under the surface. For women over 40, two major culprits drain energy, even when following a well-formulated keto diet:

A. Mitochondrial Decline: Why Your “Cellular Engines” Slow with Age

Your mitochondria—the tiny powerhouses inside your cells—generate adenosine triphosphate (ATP), the body’s main energy currency. When mitochondria work efficiently, you feel energized, clear-headed, and resilient. But as you age, several factors reduce mitochondrial efficiency:

Aging & Hormonal Changes: Estrogen plays a direct role in mitochondrial health. As levels decline during perimenopause and menopause, mitochondria lose efficiency, leading to slower metabolism and increased fatigue (3).
Nutrient Deficiencies: Mitochondria require key nutrients like magnesium, B vitamins, and CoQ10 to function optimally. If these are missing, energy production stalls.
Reduced Autophagy: Your body has a built-in process for clearing out damaged mitochondria and replacing them with new, efficient ones—autophagy. Unfortunately, autophagy slows with age, allowing cellular “junk” to accumulate and further reducing energy levels.

🚨 The Bottom Line: If your mitochondria aren’t firing on all cylinders, no amount of keto-friendly fats or electrolytes will fix the underlying issue. The key is to support mitochondrial renewal through targeted strategies, which we’ll cover shortly.

B. Oxidative Stress Overload: The Hidden Drain on Your Energy

Think of oxidative stress as cellular rust—it slowly depletes your body’s energy. While some oxidative stress is normal, excess levels accelerate mitochondrial damage and inflammation, leading to chronic fatigue.

Why does this matter for women over 40 on keto?

Keto & Fat Metabolism: While keto reduces blood sugar fluctuations, burning fat for fuel produces more reactive oxygen species (ROS)—unstable molecules that can damage mitochondria unless properly neutralized.
Environmental Toxins: Daily exposure to pollutants, processed food additives, and even household chemicals creates a toxic burden on the liver, which can further drain energy.
Hormonal Shifts: Estrogen has antioxidant properties, meaning that when levels drop, the body becomes more susceptible to oxidative damage, further slowing energy production.

🚨 The Bottom Line: If your body isn’t properly defending itself against oxidative stress, your energy levels will crash, no matter how clean your diet is. The next section focuses on proven ways to activate cellular renewal and strengthen your antioxidant defense system.

III. Hack #1: Activate Your Body’s ‘Cellular Cleanup Crew’

One of the biggest energy-draining culprits after 40 is cellular waste buildup—damaged proteins, old mitochondria, and toxins accumulating over time. But your body has a built-in solution: autophagy.

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The Science: Why Cellular Renewal Slows with Age

Autophagy, meaning “self-eating,” is your body’s natural recycling process that cleanses damaged cells, repairs mitochondria, and optimizes energy production. When autophagy is active, it:

✅ Removes dysfunctional mitochondria and replaces them with fresh, efficient ones

✅ Reduces inflammation by clearing out cellular debris

✅ Boosts energy by improving mitochondrial function and reducing oxidative stress

The problem is that autophagy slows with age, accumulating energy-draining waste and leaving people feeling sluggish and burned out.

💡 The Fix: Intermittent Fasting + Spermidine-Rich Foods

The most effective way to jumpstart autophagy is through strategic fasting and key nutrients that trigger the cleanup process.

✔ Intermittent Fasting (IF): Going at least 14-16 hours without food signals your body to activate autophagy, allowing cells to repair and renew themselves. Women over 40 often see the best results with a circadian fasting approach—fast for 12-14 hours overnight and extending it gradually. ✔ Spermidine-Rich Foods: Certain foods naturally stimulate autophagy, making fasting even more effective. Top sources include:

Aged cheese (Parmesan, blue cheese, Brie)
Mushrooms (shiitake, maitake, white button)
Fermented foods (natto, miso, sauerkraut)
Wheat germ (for those who tolerate it)

🚀 Breakthrough Ingredient Spotlight: Puremidine® (Spermidine)

Spermidine is one of the most promising nutrients in anti-aging science for enhancing autophagy.

🔬 Research from Nature Aging shows that spermidine enhances autophagy, improving mitochondrial function by up to 30% in animal studies—a potential game-changer for energy levels (1).

🧬 Why it works: Spermidine activates key genes in cellular cleanup, helping your body remove energy-draining waste and optimize mitochondrial performance.

💊 How to Get It: While foods contain spermidine, concentrated sources like Puremidine® provide clinically studied doses that may offer additional benefits.

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IV. Hack #2: Arm Your Cells with a ‘Master Defender’ Against Energy-Killing Oxidative Stress

Even if your mitochondria are working efficiently, they’re constantly under attack. Every day, your cells are bombarded by oxidative stress—an invisible force that silently drains your energy.

The Science: How Oxidative Stress Steals Your Energy

Oxidative stress happens when free radicals (unstable molecules) outnumber antioxidants in your body. These rogue molecules:

❌ Damage mitochondrial DNA, slowing energy production ❌ Trigger chronic inflammation, which can worsen fatigue and brain fog ❌ Accelerate aging by breaking down proteins and essential cellular structures

For women over 40 on keto, oxidative stress is a double threat. While keto has incredible benefits, burning fat for fuel naturally produces more reactive oxygen species (ROS). If you don’t have enough antioxidant protection, this process can backfire—causing mitochondrial burnout instead of sustained energy.

💡 The Fix: Antioxidant-Rich Foods + A Powerful Longevity Nutrient

To neutralize oxidative stress and protect your mitochondria, your body needs a strong antioxidant defense system. This means focusing on:

✔ Antioxidant-Rich Foods: Load up on foods that naturally fight oxidative damage:

Walnuts – Rich in polyphenols that protect brain and mitochondrial health
Berries (blueberries, raspberries, blackberries) – Packed with flavonoids that combat free radicals
Dark leafy greens (spinach, kale, Swiss chard) – Loaded with vitamins C & E, crucial for mitochondrial function

✔ A Unique, Science-Backed Antioxidant: Some antioxidants are more powerful than others. One, in particular, has been making waves in the longevity world:

🚀 Breakthrough Ingredient Spotlight: L-Ergothioneine—The ‘Longevity Vitamin’

🔬 What It Is: L-ergothioneine is a rare, potent antioxidant in certain mushrooms. Researchers hail it as a missing longevity nutrient.

🧬 How It Works: Unlike most antioxidants, L-ergothioneine can cross the blood-brain barrier, directly protecting cells from oxidative stress.

📊 The Research: A study in the Journal of Dietary Supplements found that higher levels of L-ergothioneine were linked to 20% lower markers of inflammation—a key driver of fatigue. Scientists call it a "longevity vitamin" because it supports mitochondrial resilience, helping cells resist oxidative damage and maintain energy production (2).

💊 How to Get It:

Found naturally in mushrooms like shiitake, oyster, and king trumpet
Supplementing with a clinically studied form of L-ergothioneine can provide higher, consistent levels that may offer additional benefits.

V. Hack #3: Why Balancing Electrolytes Is Crucial for Sustained Energy

If you’ve ever felt sluggish, lightheaded, or had brain fog while following keto, you’ve likely experienced electrolyte imbalance. Unlike traditional diets, keto causes a rapid shift in fluid and mineral balance, making proper electrolyte replenishment essential for energy and performance.

The Science: How Electrolyte Imbalance Zaps Your Energy

Electrolytes—such as magnesium, sodium, and potassium—help regulate fluid balance, nerve function, and muscle contractions. When they are out of balance, energy levels plummet.

Here’s why keto women over 40 are particularly vulnerable:

1️⃣ Increased Mineral Loss: Since keto naturally lowers insulin levels, the body excretes more sodium and fluids through urine. Without replenishment, dehydration and electrolyte depletion can lead to fatigue, dizziness, and sluggish metabolism. 2️⃣ Magnesium Deficiency Is Common: Magnesium is crucial for ATP (cellular energy) production, yet studies show up to 50% of adults don’t get enough. Low magnesium levels contribute to muscle cramps, poor sleep, and chronic fatigue (4).

3️⃣ Cortisol & Hormonal Changes Increase Needs: Women over 40 often experience fluctuations in stress hormones (like cortisol), which further impact electrolyte balance and energy regulation.

💡 The Fix: Prioritize Magnesium & Potassium-Rich Keto Foods

To restore energy and maintain optimal hydration, focus on:

✔ Magnesium-Rich Greens:

Spinach
Swiss chard
Avocado
Pumpkin seeds

✔ Potassium-Packed Foods:

Avocado (again—it’s a keto superfood!)
Salmon
Mushrooms
Leafy greens

✔ Sodium & Hydration:

Don’t fear salt—add quality sea salt or Himalayan salt to your meals
Drink mineral-rich water or add trace minerals to your water.

VI. Hack #4: Why Prioritizing Sleep Is the Missing Link to Energy & Recovery

You can follow the perfect keto diet, take all the right supplements, and even exercise regularly—but if you’re not getting high-quality sleep, your energy will still suffer.

For women over 40, sleep disruption is one of the biggest, yet overlooked, causes of fatigue. Changes in hormones, stress levels, and even keto-related shifts in metabolism can interfere with deep, restorative sleep, leaving you wired but tired the next day.

Sleep restores energy, boosts recovery, and fuels wellness."

The Science: How Sleep Impacts Energy & Mitochondria

Sleep isn’t just about feeling rested—it’s when your body performs critical cellular repair and detoxification that directly affects energy levels (5).

🛌 Deep Sleep = Mitochondrial Repair

While you sleep, your body removes damaged mitochondria and restores energy production pathways.
Studies show poor sleep increases oxidative stress, accelerating cellular aging and mitochondrial dysfunction.

🌙 Sleep Triggers Natural Autophagy (Cellular Cleanup)

Melatonin, the sleep hormone, plays a dual role—it regulates sleep cycles and acts as a powerful antioxidant, helping reduce oxidative stress and support mitochondrial health.
Research suggests that melatonin enhances autophagy, aiding cellular renewal and energy production (5).

😴 Lack of Sleep Increases Cortisol (The Energy Killer)

Women over 40 often experience higher nighttime cortisol levels, which block melatonin production and make it harder to get deep sleep.
Chronically high cortisol leads to blood sugar instability, cravings, and increased fatigue.

💡 The Fix: Optimize Sleep for Maximum Energy Replenishment

To support deep, restorative sleep, focus on these key strategies:

✔ Set a Consistent Sleep Schedule

Go to bed at the same time each night to regulate melatonin production.
Aim for 7-9 hours of quality sleep, even if you can “get by” on less.

✔ Boost Melatonin Naturally

Get morning sunlight to regulate your circadian rhythm.
Eat melatonin-boosting foods like tart cherries, walnuts, and fatty fish.
Consider a low-dose melatonin supplement if needed, especially if experiencing perimenopausal or menopausal sleep disturbances.

✔ Reduce Blue Light & Evening Stress

Avoid screens (phones, tablets, TVs) 1-2 hours before bed—blue light blocks melatonin.
Try magnesium glycinate before bed to relax muscles and promote deeper sleep.
Incorporate wind-down rituals like herbal tea, stretching, or journaling to lower cortisol.

VII. Hack #5: How Reducing Liver Burden Can Improve Detox & Daily Energy

Your liver is your body’s main detox powerhouse, filtering out toxins, processing hormones, and metabolizing fats for energy. But when it’s overburdened—whether from environmental toxins, stress, or even keto-related metabolic shifts—your energy takes a serious hit (7).

For women over 40, liver function becomes even more critical due to slower detox pathways and hormonal changes that can impact energy production.

The Science: How Liver Health Affects Energy Levels

Your liver isn’t just about detox—it plays a key role in energy metabolism and fat adaptation, which is especially important on keto.

🧽 Liver Overload = Energy Drain

The liver processes everything you eat, drink, and absorb, but it can't function optimally when clogged with toxins and metabolic waste.
A sluggish liver means poor fat metabolism, which can stall ketosis and energy production.

🔥 Liver Detox = Mitochondrial Support

Your liver breaks down oxidative stress byproducts, protecting mitochondria from inflammatory damage.
Bile production, essential for digesting fats on keto, relies on a healthy liver. Low bile levels cause fatigue, sluggish digestion, and poor nutrient absorption.

💡 The Fix: Support Liver Detox Pathways Naturally

You don’t need extreme detoxes or juice cleanses—your liver detoxes daily when given the right support.

✔ Eat Cruciferous Vegetables Daily

Broccoli, cauliflower, Brussels sprouts, kale, and arugula contain sulforaphane, a powerful compound supporting liver detox and estrogen balance.
Cruciferous veggies increase glutathione production, a master antioxidant that shields mitochondria from damage.

✔ Boost Bile Flow for Fat Digestion

To enhance bile production and improve fat metabolism, incorporate lemon water, apple cider vinegar, and bitter greens (dandelion, arugula, endive).
Tudca or ox bile supplements may help if you struggle with fat digestion.

✔ Support Liver Enzymes with Herbs

Milk thistle: Helps regenerate liver cells and protect against oxidative stress.
Dandelion root: A natural liver tonic that stimulates bile production.
Turmeric (curcumin): Reduces liver inflammation and enhances detox pathways.

✔ Hydrate with Trace Minerals

Proper hydration flushes toxins through the liver and kidneys.
Add trace minerals to your water to replenish electrolytes and support detoxification.

VIII. Hack #6: Why Smarter Hydration = Better Energy & Faster Recovery

You already know drinking water is essential for overall health, but hydration isn’t just about drinking more water but effectively absorbing it. Many women over 40 on keto experience dehydration even when they’re drinking enough, leading to low energy, muscle fatigue, and brain fog.

Smart hydration, elevated—refresh with citrus, cucumber, and mint for energy and faster recovery.

Why? Keto changes how your body retains water and minerals, making strategic hydration crucial for sustained energy.

The Science: How Hydration Impacts Energy Levels

💧 Dehydration Drains Mitochondrial Energy

Every cell in your body relies on water to generate ATP (cellular energy).
Even mild dehydration (1-2% fluid loss) can cause noticeable fatigue, reduced focus, and slower metabolism.

⚡ Electrolyte Imbalances Can Mimic Fatigue

Because ketosis lowers insulin levels, the body flushes more sodium, potassium, and magnesium, minerals essential for energy.
Low electrolytes can lead to dizziness, muscle cramps, poor recovery, and chronic tiredness.

🚰 Drinking Too Much Plain Water Can Make It Worse

If you’re drinking excess water without replenishing electrolytes, you dilute essential minerals, causing further energy depletion.
Signs of over-hydration include frequent urination, dizziness, and muscle weakness.

💡 The Fix: Hydrate Smarter, Not Just More

To maximize energy and improve cellular hydration, focus on:

✔ Add Electrolytes to Your Water

Use an electrolyte mix with sodium, potassium, and magnesium—but avoid sugar-laden sports drinks.
A pinch of sea salt + lemon juice in water can help replenish lost minerals naturally.

✔ Prioritize Potassium & Magnesium-Rich Fluids

Coconut water (low-carb, unsweetened) provides natural potassium for hydration.
Herbal teas like dandelion or nettle support kidney function and mineral balance.
Bone broth is rich in sodium, potassium, and collagen—great for hydration and gut health.

✔ Drink Water Strategically

Start your morning with 12-16 oz. of mineral-rich water to rehydrate after sleep.
Sip throughout the day instead of chugging large amounts at once.

Drink water 30 minutes before meals rather than during meals to support digestion.

IX. Hack #7: How Managing Cortisol Can Prevent Energy Crashes & Improve Resilience

Ever feel wired but exhausted—like you’re constantly running on fumes despite getting enough rest? That’s likely cortisol dysregulation at play. Cortisol naturally follows a daily rhythm, but hormonal changes in midlife can cause irregularities that lead to fatigue and poor sleep quality (6).

Cortisol, often called the stress hormone, plays a vital role in energy production, metabolism, and blood sugar stability. However, for women over 40—especially those following keto—chronic stress, poor sleep, and hormonal shifts can cause cortisol imbalances that drain energy and sabotage resilience.

The Science: Why Cortisol Balance = Consistent Energy

🔄 Cortisol Follows a Natural Rhythm

In a healthy cycle, cortisol is highest in the morning (to wake you up) and tapers off at night to allow restful sleep.
When this rhythm is disrupted—due to stress, poor sleep, or under-eating—cortisol stays high at night, leading to restless sleep, morning fatigue, and midday crashes.

⚖️ Keto Can Affect Cortisol Levels

While keto stabilizes blood sugar, dropping carbs too low for too long can stress the adrenals, triggering excess cortisol.
Women are more sensitive to carb restriction than men, meaning a proper balance of keto-friendly carbs can prevent excessive cortisol spikes.

⚠️ Signs of Cortisol Imbalance: ✅ Waking up exhausted, even after a full night’s sleep ✅ Energy crashes in the afternoon (2–4 PM slump) ✅ Feeling “tired but wired” at night ✅ Increased belly fat, even with healthy eating

💡 The Fix: Support Cortisol Balance for Steady Energy

✔ Start Your Morning with Sunlight & Protein

Get 10–15 minutes of morning sunlight within an hour of waking to regulate your circadian rhythm.
Eat at least 30g of protein at breakfast to stabilize blood sugar and cortisol.

✔ Use Adaptogens to Support Stress Resilience

Ashwagandha – Helps regulate cortisol and improve sleep.
Rhodiola – Supports mental focus and energy under stress.
Holy Basil (Tulsi) – Reduces stress-related fatigue and inflammation.

✔ Avoid Overtraining & Excessive Fasting

High-intensity workouts (HIIT, fasted cardio) can spike cortisol. Try strength training and walking instead.
If feeling drained, consider adding 20–30g of keto-friendly carbs (berries, squash, or dark chocolate) in the evening to prevent cortisol spikes at night.

✔ Evening Wind-Down Rituals to Lower Nighttime Cortisol

Turn off screens 1–2 hours before bed to reduce blue light exposure.
Try deep breathing, stretching, or a magnesium drink (like Natural Calm) before sleep.
Limit caffeine to mornings only—even small amounts in the afternoon can disrupt cortisol balance.

The Smart Solution: Advanced Greens Plus—A Science-Backed Energy & Mitochondria Booster

Pure, refreshing, and nutrient-packed—green juice for effortless energy and daily wellness.

For busy keto women, getting enough spermidine, L-ergothioneine, magnesium, and stress-balancing adaptogens every day can be challenging. That’s where Advanced Greens Plus comes in.

🔬 What Makes Advanced Greens Plus Stand Out?

✅ Packed with Superfoods – Loaded with organic greens, fruits, and vegetables for maximum nutritional value.

✅ Boosts Energy Naturally – Helps fight fatigue and improves daily energy levels without caffeine or artificial stimulants.

✅ Supports Detox and Digestion—This supplement contains spirulina, chlorella, and digestive enzymes to aid liver detox and gut health.

✅ Rich in Antioxidants – Protects cells from oxidative stress, promoting better aging and overall vitality.

✅ Convenient and Delicious – Mixes easily into water, smoothies, or juice for a quick, healthy boost anytime.

By combining two of the most powerful longevity-enhancing nutrients—spermidine (Puremidine®) and L-ergothioneine—with a potent blend of greens, antioxidants, and digestive support, Advanced Greens Plus fills in the key nutrient gaps that keep your energy levels optimized.

X. 🔥 The Final Piece: How to Bridge the Gap with a Modern Energy Solution

Now that you have the knowledge of the 7 most effective energy hacks and the two groundbreaking nutrients missing from most keto diets, the next step is making these strategies practical and sustainable in your daily life.

Fatigue, brain fog, and sluggish metabolism don’t have to be inevitable—with the right combination of nutritional strategies, lifestyle shifts, and targeted support, you can reclaim the energy, focus, and vitality you deserve.

Implementing these science-backed hacks—optimizing sleep, balancing electrolytes, supporting liver detox, and reducing oxidative stress—is a powerful foundation for sustained energy and better metabolic health. But we also know that life gets busy, stress happens, and sometimes, even with the best intentions, getting enough of the right nutrients daily can be a challenge.

That’s where strategic supplementation plays a crucial role.

Why Advanced Greens Plus Is the Ultimate Energy Solution for Women Over 40

Incorporating Advanced Greens Plus into your wellness routine is the simplest way to bridge nutrient gaps, support cellular renewal, and sustain energy levels without the guesswork.

This powerhouse greens blend delivers:

✅ The two breakthrough nutrients—Spermidine (Puremidine®) and L-ergothioneine—scientifically proven to enhance autophagy, improve mitochondrial function, and fight oxidative stress.

✅ Essential antioxidants, superfoods, and digestive enzymes to support liver detox and metabolic efficiency—key to sustained energy.

✅ Electrolytes and trace minerals to help optimize hydration, reduce fatigue, and prevent keto crashes.

✅ A stimulant-free, all-natural formula—no caffeine, no artificial fillers, just clean, science-backed nutrition.

Unlike complicated supplement routines or restrictive diets, Advanced Greens Plus makes it effortless to give your body what it needs to thrive, not just survive.

🚀 Your Next Step to Unlocking Endless Energy

Imagine waking up with steady, natural energy—no midday crashes, no reliance on coffee, and no more sluggish mornings.

By implementing these 7 science-backed energy hacks and integrating Advanced Greens Plus into your daily routine, you’re giving your body the nutritional advantage it needs to function optimally—today and for years to come.

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Cheah, Irwin K., et al. "Ergothioneine, a Diet-Derived Antioxidant, in Age-Related Cognitive Decline and Brain Health." The Journal of Dietary Supplements, vol. 17, no. 5, 2020, pp. 586–608, https://doi.org/10.1080/19390211.2020.1765949.
Sun, Nan, et al. "The Mitochondrial Basis of Aging." Molecular Cell, vol. 61, no. 5, 2016, pp. 654–666, https://doi.org/10.1016/j.molcel.2016.01.028.
Barbagallo, Mario, and Ligia J. Dominguez. "Magnesium and Aging." Current Pharmaceutical Design, vol. 16, no. 7, 2010, pp. 832–839, https://doi.org/10.2174/138161210790883615.
Hardeland, Rüdiger. "Melatonin and the Theories of Aging: A Critical Appraisal of Melatonin’s Role in Anti-Aging Mechanisms." Journal of Pineal Research, vol. 55, no. 4, 2013, pp. 325–356, https://doi.org/10.1111/jpi.12090.
Manfredini, R., et al. "Circadian Rhythms, Aging, and Adaptations in the Cardiovascular System." Chronobiology International, vol. 27, no. 8, 2010, pp. 1623–1641, https://doi.org/10.3109/07420528.2010.516860.
González, Daniel E., et al. "Liver Function and Energy Metabolism: An Updated Review." World Journal of Hepatology, vol. 13, no. 4, 2021, pp. 419-437, https://doi.org/10.4254/wjh.v13.i4.419.