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Sustained receptor engagement allows continuous activation of satiety pathways without repeated peaks and troughs

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A weakened intestinal barrier or a leaky gut allows for the melody to go off-key, that allows harmful gut microbes and their toxins to enter the portal circulation and reach the liver to elicit an inflammatory response by the Kupffer cells (70, 71)

A recent animal study reported that administration of L-carnitine significantly decreases HMG-CoA reductase, but has no significant effect on expression of LDL receptors (Yousefinejad et al., 2015)