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doi: 10.3390/ijms21030950 33

These synthetic forms are not biologically active in the same way as the natural L-isomer and can actually competitively inhibit the absorption and utilization of naturally occurring L-carnitine, potentially inducing a state of carnitine deficiency and worsening fatigue symptoms

157 Observational studies indicate higher fibrinogen levels are correlated with increased risks of coronary artery and peripheral artery disease

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