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Berghe TV, Linkermann A, Jouan-Lanhouet S, Walczak H, Vandenabeele P

The authors note that L-carnitine also can affect cholesterol synthesis pathway (mevalonate pathway) via inhibition of -hydroxy -methylglutaryl (HMG)-CoA reductase activity

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Meldonium can reduce the gut microbiota-dependent production of TMA/TMAO from L-carnitine, thereby lowering TMAO levels and potentially delaying CKD, thereby lowering TMAO levels and potentially delaying CKD (Kuka et al., 2014)

If L-Carnitine levels are depleted, fatty acids accumulate outside the mitochondria, unable to be burned for fuel