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Mechanistically, these changes appear to coincide with elevated NAD+ and activation of metabolic gene programs consistent with increased energy expenditure

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Patients with secondary carnitine deficiency accumulate organic acids which causes enhanced urinary excretion of carnitine in the form of acyl-carnitines [36, 37]

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Ultimately, 14 RCTs 10,11,1526 and one open-label clinical trial 12 met the inclusion criteria

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