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Additionally, the study indicated a potential decrease in the expression of urea cycle enzymes in animal models

Carroll says

Circulation 1999

To further investigate the role of lipid catabolism in fasting-induced longevity, we examined two key regulators: Adipose Triglyceride Lipase-1 (ATGL-1), which initiates lipolysis, and Carnitine Palmitoyl Transferase-2 (CPT-2), which catalyzes carnitine removal and Coenzyme A conjugation to the fatty acid within the mitochondrial matrix 43,44

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Also, after weight loss surgery, patients are on a very restricted diet and adjusting to a reduction in stomach capacity making it difficult to ingest all the nutritional supplements required