Most patients with type III GSD have enzyme deficiency in liver, skeletal muscle, and heart (type IIIa). However, some patients (<15%) have debranching enzyme deficiency limited only to liver (type IIIb). During infancy and childhood, the disease may be indistinguishable from GSD I. The liver symptoms improve with age and usually disappear after puberty. Overt liver cirrhosis rarely occurs. Hepatic adenomas have been reported, but malignant transformation has not been observed.[17,18]
Definite diagnosis and subtyping requires both liver and muscle biopsies or DNA-based mutation analysis (IIIb).
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.