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In humans, dietary l-carnitine is converted into the atherosclerosis- and thrombosis-promoting metabolite TMAO via 2 sequential gut microbiotadependent transformations: (a) initial rapid generation of the atherogenic intermediate BB, followed by (b) transformation into TMA via low-abundance microbiota in omnivores, and to a markedly lower extent, in vegans/vegetarians

The former is a calculated risk that many researchers accept with the understanding that BUDs include a safety margin

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Diab Ther 2019

Metabolism 131, 155194