INS and Dravet syndrome: Secondary bile acids are cytotoxic DNA-damaging metabolites converted from primary bile acids by 7-α-dehydroxylase (45) that interfere with proper metabolism of sugars and lipids, causing lipids to accumulate in muscle tissues, induction of oxidative stress and the inflammatory response, mitochondrial dysfunction, insulin resistance, and damage to skeletal muscle cells, thereby increasing the risk of developing DS (46).