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doi: 10.1023/A:1007638025856

Only the L-isomer of carnitine is biologically active

In addition, TMAO induces several inflammatory pathways, which cause the activation of pro-inflammatory cytokines such as IL-6 and TNF- which causes chronic inflammation thereby causing plaque formation and plaque rupture leading to cardiovascular disease [71]

However, some studies suggest that while LC supplementation raises TMAO levels, it does not necessarily correlate with adverse cardiovascular outcomes in all populations