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TMA is synthesized from choline by choline TMA-lyase (CutC)/activator CutD, and from dietary L-carnitine by two processes: 1) One-step conversation of L-carnitine to TMA by carnitine oxygenase/reductase (CntA/B) and 2) by two-step pathway that involves -butyrobetaine (BB)

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The recommended approach involves checking 25-hydroxyvitamin D levels and supplementing accordingly, typically with 1,000-2,000 IU daily for maintenance or higher doses to correct deficiency under medical supervision

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