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Gamma-butyrobetaine is a proatherogenic intermediate in gut microbial metabolism of l-carnitine to TMAO

While one cannot guarantee this request was followed, at least an attempt was made

For patients with hyperadrenergic POTS or MCAS, an adrenaline spike can trigger severe tachycardia and symptom flares, making it essential to buffer the supplement with a meal

doi:10.1016/j.atherosclerosis.2020.07.010 Germano-Soares AH, Andrade-Lima A, Meneses AL, et al

Martinon and Tschopp, 2007

Some patients may require an even higher dose of 2 mg weekly for optimal effect, particularly for weight management indications, though this should be approached cautiously with careful monitoring for adverse effects