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Two main types of carnitine deficiency syndromes have been delineated: a predominantly myopathic form, with normal serum and low muscle carnitine levels, and a systemic form, with encephalopathy, hepatic dysfunction, muscle weakness and low muscle, liver and serum carnitine levels

Critically, in vitro binding or degradation does not guarantee efficacy in vivo due to the complex gastrointestinal environment, including variable pH, proteolytic enzymes, bile salts, and competition from resident microbiota (30, 94)

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