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6 Multiple microbes in both the small and large intestines can convert dietary L-carnitine into GBB, but relatively few can transform GBB into TMA.13 The GBB-to-TMA conversion is much higher in omnivores than in vegans and vegetarians, likely because of differences in the gut microbiota, although this aspect of the L-carnitine-to-TMAO pathway is not fully understood

Since there are known APOE -dependent differences in the gut microbiota in both humans and APOE-TR mice (Tran et al., 2019), L-carnitine metabolism could be impacted and, in turn, affect cerebrovascular function by disturbing normal L-carnitine shuttle function, particularly if other vulnerabilities are present

Pairing with carbohydrates can support uptake for some people

Carnitine is more suitable for long-duration exercises and is best when combined with protein supplements