L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active Role of L carnitine in exercise training: Anti inflammatory, antioxidant, and metabolic interactions ScienceDirect Potential Adverse Effects of L Carnitine Marnys The Basics of Metabolic DysfunctionAssociated Steatotic Liver Disease for Cardiologists: Pathophysiology, Diagnosis, and Treatment JACC