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Nausea was the most common side effect reported, she said

Hyperpigmentation of the skin, caused by an increase in melanin, is usually seen as aesthetically unfavorable

10.1128/cmr.00060-22 Summary Keywords atrial cardiomyopathy, gut microbiota, gut-heart axis, dysbiosis, inflammation, remodeling, short-chain fatty acids, trimethylamine n-oxide Citation Sun T, Song B and Li B (2025) Gut microbiota and atrial cardiomyopathy

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This substantial deacetylation is the reason that high plasma levels of acetyl-l-carnitine are not observed after its oral intake, unlike after parenteral administration, during which the substance bypasses the gut and enters the bloodstream directly

This is considered more realistic than pure in vitro testing because the natural architecture and cell-to-cell communication is maintained