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But the study also finds that, at least in the short run, they do not reduce overall health care spending

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The nuance is that the body synthesizes carnitine and most people have adequate baseline carnitine levels from dietary intake (primarily from red meat) the supplemental benefit is most pronounced in vegetarians and vegans (who have significantly lower dietary carnitine intake), older adults (whose carnitine synthesis declines with age), athletes in high-volume training (who deplete carnitine more rapidly), and anyone in a caloric deficit where fatty acid oxidation demand is elevated relative to carnitine availability.