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Secondary carnitine deficiency can be caused by increased losses, pharmacological therapy, a number of inherited metabolic disorders [38], poor diet or malabsorption of carnitine, from increased renal tubular loss of free carnitine (Fanconi syndrome), haemodialysis, peritoneal dialysis, or the increased excretion of acylcarnitines[39] with certain drugs

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This variability affects metabolic outputs, including the production of metabolites like trimethylamine (TMA)

doi: 10.1002/elps.200900692

Dietary carnitine, primarily derived from red meat, is considered safe at typical consumption levels, whereas high doses from supplements may lead to oxidative stress, mitochondrial dysfunction, or systemic inflammation, especially in susceptible populations

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