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As recently as March 2018, it was reported in the International Journal of Sports Nutrition and Exercise Metabolism that, it is likely that the lack of efficacy in many studies is due to its low bioavailability and failure to increase muscle L-carnitine stores. In conclusion, the researchers in The Journal of Clinical Investigation say that, These studies also indicate that daily consumption of L-carnitine, even while maintaining a vegan/vegetarian diet, can induce the gut microbiota-dependent BBTMA transformation, resulting in heightened formation of the atherogenic and prothrombotic metabolite TMAO