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Check Concentration: Efficacy correlates with concentration
The truth is more nuanced
Stomach acid decreases with age and the use of common prescription and over-the-counter drugs, like proton pump inhibitors and acid blockers, further deplete this critical digestive substance

Drug interactions Pivalic acid combines with L-carnitine and is excreted in the urine as pivaloylcarnitine, thereby increasing L-carnitine losses (see also Secondary carnitine deficiency)