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however, changes in dietary carnitine intake level or in renal reabsorption do not appear to affect the rate of endogenous L-carnitine synthesis (6)

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That leads to a cycle of symptoms going up and down rather than gradually improving over time. Thats why doctors recommend increasing the dosage gradually, which allows your body to get used to the medication while keeping weight loss on track

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Circ Res (2012) 110(10):132235