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This step is the primary rate-limiting bottleneck of fatty acid oxidation

The positron emission tomography (PET) was used to examine brain oxygen consumption and cerebral blood flow and revealed that patients with overt hepatic encephalopathy and those with liver cirrhosis without overt hepatic encephalopathy had a lower cerebral metabolic rate of oxygen and cerebral blood flow than healthy subjects 4

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A few investigations found that the fat-loss benefits of exercise were more prominent in subjects with greater levels of L-carnitine in the body

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Reading, MA: Addison-Wesley (1977)