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Safety Although the studies included in this review identified no important safety issues, orally administered l-carnitine supplementation has been linked to a increase in trimethylamine (TMA) and trimethylamine- N -oxide (TMAO), as unabsorbed carnitine is metabolised by the gut microbiota to TMA and later oxidised to TMAO in the liver
Without supplementation, 30% of patients with Roux-en-Y gastric bypass develop vitamin B12 deficiency (160)
A score of 0 was defined as no response
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