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In posterior segments of the gut (e.g., the cecum and proximal large intestine), gut microbes directly cleave the CN bond of carnitine to release TMA, which subsequently enters the liver through the portal circulation, is converted to TMAO by hepatic flavin monooxygenases (FMOs) [242, 243], and eventually enters the blood circulation [244]

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Comparison between long-term and short-term impact of increased TMAO levels MI: myocardial infarction

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Most patients report noticeable improvements in energy and endurance within 2-3 weeks of consistent use