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Increased TMAO levels are caused by lower clearance and increased synthesis as a result of gut dysbiosis, a weakened intestinal barrier, and increased hepatic enzyme activity

All but BMI were within normal range ( Table 2 ), which excludes frequent conditions that may independently cause fatigue (insufficient levothyroxine dose, anemia, diabetes with poor glycemic control, infection)

doi:10.1196/annals.1320.003

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