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The biosynthesis of L-Carnitine occurs primarily in the liver and kidneys from the amino acids lysine and methionine, requiring several cofactors including vitamin C, vitamin B6, niacin, and iron

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studies have shown that patients respond differently to probiotics, prebiotics, and even FMT, so personalized intervention plans based on the patients microbiota profile should be tested prospectively in pragmatic RCTs rather than assumed to be effective