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In people with good health, the liver and kidneys produce and store enough of the compound to prevent deficiency

Carnitine levels may be deficient in the blood, in muscle (where it is primarily stored), or in both

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Critics contend that TMAO's broad associations with inflammation, thrombosis, atherogenesis, and renal function are overstated, proposing instead that elevated levels may simply reflect impaired renal clearance or other underlying disease statesessentially acting as an expensive replacement for creatinine or eGFR testing