Pathobiological Relationship of Excessive Dietary Intake of Choline L Carnitine: A TMAO Precursor Associated Aggravation in Heart Failure in Sarcopenic Patients Red meat and heart disease link: Not all about the fat? Los Angeles Times TMAO: The Gut Metabolite Linking Red Meat to Cardiovascular Disease Comparison of short term and long term effects of peroral L carnitine intake: clinical implications of elevated TMAO levels in cardiovascular complications Metabolic therapy for cardiovascular diseases with propionyl L carnitine ScienceDirect L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active