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Genetic Influences and Complex Pathways The gut microbiotas first step in converting unabsorbed carnitine into TMA is generation of the intermediate gamma-butyrobetaine (GBB), which has been shown to be atherogenic in mice, although research in humans is inconclusive

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A growing number of preclinical and clinical studies have shown that TMAO is associated with AF 5356 (Table 2)

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For example, symptoms blamed on low energy may actually relate to anemia, thyroid disease, sleep problems, depression, infection, or cardiovascular disease