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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. References: Gnoni A, Longo S, Gnoni GV, Giudetti AM

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Lastly, 3 (16.6%) patients developed hypocarnitinemia at the last timepoint follow-up (2+ years)

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