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Secondary carnitine deficiency can be caused by increased losses, pharmacological therapy, a number of inherited metabolic disorders [38], poor diet or malabsorption of carnitine, from increased renal tubular loss of free carnitine (Fanconi syndrome), haemodialysis, peritoneal dialysis, or the increased excretion of acylcarnitines[39] with certain drugs

Journal of the Science of Food and Agriculture

You'll see better results from NAD+ when you get multiple treatments, and many people notice improvements after finishing a series of sessions

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132, Oct