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Patients on 7 days per month metronidazole therapy had normalized TMAO levels (PAT12-14), whereas two patients on 5 days per month metronidazole therapy had extreme TMAO elevations (PAT 17-18) suggesting that the duration of antibiotic therapy may impact microbial l-carnitine degradation (Table 1)

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Can You Take L-Carnitine on an Empty Stomach

Aside from hormonal support, I see the biggest issue is a lack of understanding of how and what to eat