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Defects in the L-carnitine shuttle (L-carnitine is released from fatty acid and creates acetyl-CoA) in the mitochondria mainly disturb the oxidation of long-chain fatty acids, as a medium- and short-chain fatty acids may directly penetrate mitochondrial membranes without L-carnitine mediation

7) Liver Dysfunction In a study on over 1,600 adults, high TMAO levels were associated with more severe liver damage and non-alcoholic fatty liver disease [33]

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Patients normally respond to pharmacological doses of oral L-carnitine, particularly if supplementation is implemented prior to organ damage [64]