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Additionally, the results of our study suggest that the conversion of TML by the enzyme -N-trimethyllysine hydroxylase and the synthesis of TML itself (5) are not affected by higher plasma carnitine levels
All of these can play a role
More serious risks include pancreatitis, gallbladder disease, acute kidney injury (particularly with dehydration), hypoglycemia (when combined with insulin or sulfonylureas), and thyroid C-cell tumors in animal studies
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